Globalization- Is it good for your health?

1. Globalization-Is it good for your health? Bernhard H. Liese International Health Department NHS, Georgetown University March 6, 2007

3. Defining Globalization • Globalization is a “catch-all” phrase • Quantitative definitions focus on intensity of interactions: economic measures, physical or cultural connectedness • Qualitative definitions focus on the nature of the interaction: urbanizing, consumerist, human ecology, change of perspective

4. Globalization is not exactly new! • Trade and migration always bound people together • Globalization’s first wave:The Industrial Revolution 1870 to 1917 • Isolation phase 1917 to 1950 • Globalization’s second wave 1950 to 1980 • The third wave:Globalization today 1980 to present

5. Globalization Today The third wave’s pace and intensity have virtually annihilated time and distance

6. Today’s Challenges • Balancing benefits of global integration against new forms of social exclusion • Making globalization work for the poor: The controversy about growing income inequalities • “Openness to trade” as a means to give the poor a bigger stake in global prosperity

7. H5N1 – Avian Flu

12. Grand Princess vs. U.S. Capitol

13. Emerging Diseases

14. Hypothetical Flu Pandemic vs. 1968 Flu Pandemic

15. Conceptual Framework A. International transfer of health risks • Infectious diseases and international travel • Risks associated with transfer of lifestyles • Health and safety standards B. Globalization of health care services • Movement of health providers (incl. “brain drain”) • Health tourism • Cross border establishment of facilities C. International governance • The major players: WTO, WB, IMF, WHO

17. The Nutrition Transition • Rising incomes mean higher fat diets • Shift from local foods towards mass-produced, processed, convenient, inexpensive foods • Increase in saturated fats, trans-fatty acids and salt • Obesity increased 50% over the past seven years, affecting 18% of the global population (WHO)

18. “McWorld” Fast food factoids – McDonalds • Five new restaurants per day • $1 billion spent on advertising per year • Largest purchaser of beef worldwide • Runs more playgrounds then any other private entity

19. Tobacco • Leading cause of preventable deaths in the world today (5 million deaths per year) • Doubling by 2020 • Tobacco consumption falling in industrialized countries • Rapidly rising in the developing world due to aggressive marketing • Reduction of trade barriers allows multinationals access to new markets

20. Occupational Hazards:The Silent Epidemic • 16 people in the U.S. will go to work today and will not come home • 260 in China • 1.1 million deaths worldwide each year from workplace accidents and work-related diseases • Manufacturing shifting to low wage, unregulated environments – “race to the bottom”

21. North-South Trade in Health Services • Medical tourism • Movement of health professionals – “brain drain” • Direct investment in facilities and services in middle income countries

22. Asia’s Exploding Medical Tourism • India: Average 15% growth over the past five years • Malaysia: 175 000 health tourists in 2000; tripled in 2003 • Thailand: Cost of bypass surgery 30% of U.S.

23. Medical Tourism – Malaysia Breakdown of Health services provided by private hospitals to health tourists in 2001, 2002, and 8 months of 2003 Source: Malaysia Ministry of health; Health tourism report October 2003

24. International Migration of Health Professionals • Serious problems for Africa • Kenya retained only 20% of physicians trained • Zambia and Ethiopia lost 50% of physicians • Ghana lost 2,500 nurses to Europe (1999-2003) • 600 Ghanaian medical practitioners are working in New York • “Carousel effect”

25. Governance – WHO • International Treaty for Tobacco Control • Regulates advertising, packaging, exposure to smoke and illicit trade • Treaty came into force Nov. 2004 • Binding for signatories – EU signed Jan. 2005 • First international treaty brokered by WHO • New International Health Regulations • Adopted May 2005

26. Governance – WTO • WTO established in 1995, replaced General Agreement on Tariffs and Trade (GATT) • Regulates multi-lateral trading system • Four relevant agreements that influence public health – TBT, SPS, GATS and … • TRIPS (Trade-Related Intellectual Property Rights) – The most contentious one

27. The TRIPS Agreement • Minimum standards of IPRs protection • “Transitional arrangements” for “developing” and “least developed” members • IPRs protection balanced with public health needs • Aggressive and unjustified interpretation of TRIPs by Pharma industry led “developing members” to demand WTO affirm the right to use the “flexibilities”

28. The Doha Declaration • Confirms the TRIPS Agreement does not limit the grounds on which WTO members may issue compulsory licenses • Each member determines whether a national emergency or circumstance of extreme urgency exists • Members are free to permit “parallel importation” of medicines • Provides maximum flexibility for least developed members to dis-apply patents at least until January 1, 2016

29. Conclusion • Ensuring the “public’s health” has been a key function of the nation state;Today, executing this function effectively requires a global perspective. • “New global health governance challenges” need to be addressed by the international community