Globalization and health
Stephen Bach a
Globalization has captured the imagination of politicians and policy-makers alike, and has become the most widely used label to make sense of the profound economic, political and social changes taking place in today’s world. Publication of this book is to be welcomed because it provides a very wide-ranging survey of many of the most important trends that impact on global health.
The book consists of eighteen chapters written by internationally acknowledged specialists, and is divided into three parts. Part I, “The health consequences of globalization”, which comprises more than half of the book, maps out some of the key health challenges involved. The authors of these chapters draw upon an impressive array of statistics, as well as the current literature, to develop authoritative but accessible accounts that will have wide appeal beyond public health specialists. Among the areas covered are surveys of long-standing health challenges such as smoking, the car culture and infectious diseases, as well as topical concerns such as climate change and obesity. The chapters in this part of the book are invariably good at assessing patterns and trends, but are often more equivocal about attributing these developments to globalization. The slimmer Part II, “Monitoring the impact of globalization and health”, examines the tools used to assess the impact of globalization on health, including a somewhat provocative critique of summary measures of population health. Finally, the six chapters of Part III, “The international response to globalization”, focus on the roles of the World Health Organization, the World Trade Organization (WTO) and the World Bank.
The book notes that globalization produces winners and losers, with the increased inequalities within and between countries creating major health challenges. It extensively documents the impact of globalization on women’s health, and some positive consequences are noted in terms of increased opportunities for migrant workers in conjunction with growing awareness of human rights that transcend national boundaries. The book also reflects some of the polarization surrounding the debate about globalization, with contrasting views presented about the degree to which the WTO has incorporated health as a key principle in its deliberations. In a similar vein, some of the contributors remain highly sceptical about the incorporation of poverty-reduction strategies into World Bank and International Monetary Fund thinking.
To attempt to survey all the challenges to health that arise from globalization is an ambitious undertaking, and inevitably some themes receive less prominent coverage. Because of the considerable health challenges that confront sub-Saharan Africa, its burden of disease is discussed at some length in the book. In contrast, little attention is devoted to the role of the European Union and its increasing role in health affairs or to the challenges that confront eastern Europe. The book’s contents also reflect the fact that its contributors are chiefly interested in public health, and only a few broaden their perspective to encompass the role of health systems or engage with concerns about the global health worker crisis.
Overall, this book provides a very useful synthesis of global health challenges and demonstrates the prominence of globalization as it becomes an increasingly important framework of analysis for assessing health challenges. It signals that governments and the wider policy community have implicitly accepted that global health risks require global health responses. However, since the book reflects the current state of the debate, it fails to specify with any precision the relationship between globalization and health. Moving beyond a description of the associations between health and globalization to an analysis of underlying causes may remain elusive for some time to come. ■
- Department of Management, King’s College London, Strand, London WC2R 2LS, England.