Globalization of Global Health

In their article “The World Health Organization and the Transition from “International” to “Global” Public Health” by Theodore Brown, Marcos Cueto, and Elizabeth Fee, the authors discuss the history of the World Health Organization (WHO) and some of the factors that led to the current embodiment of the organization.  One of the major themes that they touch on is the idea of globalization and its effect on the formation of the WHO and global health.  While this article discusses the institutional aspects of global health, it shows that this has a large effect on how global health is practiced in many parts of the world. 

The authors start out by defining “the “new paradigm” of globalization as “the process of increasing economic, political, and social interdependence and integration as capital, goods, persons, concepts, images, ideas and values cross state boundaries.” (Brown et al, 63)  This idea is meant to view globalization in the context of global health through an institution like the WHO.  Some go on to argue that this has negative and positive effects on global health, the positive being the “easier diffusion of useful technologies and of ideas and values such as human rights.” (Brown et al, 63) 

In the context of public health, this flow, or diffusion, of ideas and technology seems to be a mostly one directional flow from the more developed ‘global north’, to the less developed ‘global south’.  Organizations like the WHO and the World Bank picture global health through a framework that is situated in certain ideas of health which can include it as a human right, but also tie health to development and utilize structural adjustment plans and cost effectiveness.  These differing ideas can often seem counterintuitive, but begin to make more sense when we look at the formation of western public health and its connections with social, political and economic factors.   

If we decide that health is a human right, then we have decided that it is something that should be afforded to every person regardless of nationality or economic status.  In fact health is mentioned in the Universal Declaration of Human Rights (UDHR) which states “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”  If health is a human right, then why does cost effectiveness come into play so often?  We don’t generally cite the high cost of free speech or any of our other civil rights as a deterrent to protecting it in this country.  In the UDHR, the right to health is lumped in with other socio-economic rights such as food and housing that most people accept as necessities. When many of us think of health problems in other parts of the world, we tend to lump them in with other problems we might see on this list.  A lack of public health goes along with the lack of other social services and a lack of security.  In the end, our ideas of public health are rooted in our own development and industrialization, and we seem to relate health with development.

The Global Health Watch report that we read seemed to touch on this subject a little bit when they discussed the “global political and economic architecture”.  In this report they discussed the ‘three F’s’ crises- financial, food and fuel.  All three of these crises originated in the developed world and are tied to our political and economic system.  The authors of the report continue on to say that these crises are a failure of the entire system.  They also claim that global economic inequality, of which health inequalities are a result, is more evidence of a failure of this system.    

 

I picked an image that shows one concept of globalization.  The way that many people see this trend is of corporations being able to exert more power and influence over more areas and more people than before.  As mentioned before, there are some benefits from a public health standpoint to more world integration, but the way it is going in many places now is a form of globalization that is driven by interests that do not have public health as their highest priority.  This can have the end effect of global health programs that do not have the desired outcome or that have unintended consequences in other facets of social life.  This also can happen with other organizations that are not corporations.  In the U.S. our public health is run or overseen by public agencies that are ultimately somewhat answerable to the people they serve.  This isn't always the case with global health.  Much of the funding and policy in many comes from international organizations.  What kind of responsibility to the population does an organization have if it is headquartered thousands of miles away in a different country?  These organizations are just trying to fill a gap in local public health, but sometimes they can displace local resources and if they aren't careful to include collaboration as part of their mission, they can cause more harm than good. 

I don't have much experience with global health, either personally or in an academic capacity.  Due to this, I generally relate my conceptions of global health to the other ideas I have about the world.  Many of these connect the ideas of development and globalization as part of an ideology that many in the U.S. benefit from and take for granted while many others are harmed.  I have trouble fitting global health into this framework because of the seemingly universal importance of health to everyone.  Even if ideas of global health are tied to certain social, political and economic factors, an increase in health is never a bad thing.  Some of this has to do with the balance of fixing immediate problems and fixing long term structural problems, and what might be beneficial to one could harm the other.   

In the end, our ideas of health are situated in our own personal and cultural historical context.  The practices of globalization in global health, while sometimes well intentioned, don’t always take into account the myriad local factors inherent in ideas and practices of health.

David Coomes