GLOBALIZATION

AND PUBLIC
HEALTH
 CONTENTS
1. Globalization, Global Health and Public Health.
2. Changing Concepts of Public Health.
3. Causes, Aspects and Types of Globalization.
4. Social Changes due to Globalization.
5. How Globalization affects Public Health.
6. Globalization of Public Health.
7. Threats to Global Health.
GLOBALIZATION
GLOBAL HEALTH
PUBLIC HEALTH
 GLOBALIZATION
• Derived from the word ”globalize” refers to
“the emergence of an international network of economic
systems”.

• Globalization –
“Process of rapid economic, cultural and institutional integration
among countries”.

“The spread of products, technology, information, and jobs

across national borders and cultures”.
 GLOBAL HEALTH
“An area for study, research, and practice that places a
priority on improving health and achieving health equity for
all people worldwide”

Replaced the older terminology of “International health.”

primarily referred to

“A focus on the control of epidemics across the boundaries

between nations”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852240/
 PUBLIC HEALTH

• The term came into general use around 1840.

• It arose from the need to protect the public from the spread of
communicable diseases.
• Peter Frank conceived public health as good health laws.
• The public health act passed in 1848 in England enunciated the
principle that state is responsible for the health of its people.
 “The science and art of preventing disease, prolonging life,
and promoting health and efficiency through organized
community efforts for the sanitation of the environment, the
control of communicable infections, the education of the
individuals in personal hygiene, the organization of medical
and nursing services for early diagnosis and preventive
treatment of the disease, and the development of social
machinery to ensure for every individual a standard of living
adequate for the maintenance of health, so organizing these
benefits as to enable every citizen to realize his birth right of
health and longevity”
- Winslow (1920)
CHANGING CONCEPTS OF PUBLIC
HEALTH
1. DISEASE CONTROL PHASE (1880-1920) -
• Public health was largely a matter of sanitary legislation.
• Aimed at control of man’s physical environment.
• Water supply and sewage disposal.
• Vastly improved the health of people through disease and death
control.
2. HEALTH PROMOTIONAL PHASE (1920-1960) -
• The process of enabling people to increase control over, and to
improve their health.
• Provision of basic health services through primary health centres
and subcentres.
• Initiated as personal health services.
• Mother and child health service, school health services, industrial
health services, mental health and rehabilitation services.
3. SOCIAL ENGINEERING PHASE (1960-1980)
• Chronic diseases began to emerge e.g. cancer, diabetes,
cardiovascular diseases, alcoholism and drug addiction.
• New concept of “risk factors” as determinants of diseases came into
existence.
• Social and behavioral aspects of disease were given a new priority.
4. HEALTH FOR ALL PHASE (1981-2000)
• World Health Assembly in 1977 set the main social goal.
• Attainment by all the people of the world by the year 2000 of a
level of health that will permit them to lead a socially and
economically productive life.
• The essential principle of “Health For All” is the concept of “equity
of health”.
HOW GLOBALIZATION AFFECTS
PUBLIC HEALTH
 POPULATION HEALTH
• Population health has been defined as "the health outcomes of a
group of individuals, including the distribution of such outcomes
within the group“.
• Determinants of population health-
 Institutional determinant.
 Economic determinant.
 Socio-cultural determinant.
 Ecological determinant.
Comparison of major health indicators
• Mortality Measures (Neonatal mortality, Infant mortality,
childhood mortality and maternal mortality and life
expectancies)
• Disability
• Disease burden
• Top 10 diseases
• Non communicable disease
• and other Global Disease burden and risk factor

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 Cross border disease like HIV AIDS, Malaria, polio, TB, Swine flu, Bird flu etc and
their impact in health system
• Global risks for health
• Public health crisis in developing countries
• Emerging infections
• Cross-Border Health Risks
• Cross border delivery of services
• Positive impacts of Cross border disease in health system
• Negative impacts of Cross border disease in health system

Global Health Issues; Bioterrorism, World Bank, IMF, Trade Related Intellectual
Property Rights and Health
• Definition of Global Health Issues
• History of Global Health Issues
• Trends of Global Health Issues
• Recent global health issues
• Advantages of Global Health

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First, Second & Third Worlds

Industrialized countries where businesses operate independently of

governments North America, Western Europe, Japan and Australia

Communist countries, where governments plan the economies.

Russia, Eastern Europe (e.g., Poland), China

Poor, less developed countries, where businesses operate

independently of governments. capitalist (e.g., Venezuela) and
communist (e.g., North Korea, Saudi Arabia, Mali)
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Developed and Developing
• Countries like Canada, the USA, Britain and Japan are regarded as
developed because of their industrialized and diverse economies.

• Countries like Indonesia and Egypt are regarded as developing or

less developed (LDC’s).

• The world’s least developed countries, which often lack resources

– like Chad or Laos – are often described as least less developed
(LLDC’s).

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 Health Gap (2010)
Indicator Least dev. Developing Developed
countries countries countries
Life expectancy at birth 59 68 80
IMR 71 44 5
U5MR 110 63 6
MMR 410 53 14
Dr. pop ratio(10,000) 4 24 28
Nurse pop ratio (10,000) 10 40 81
Access to safe water % 65 93 100
population
Access to adequate sanitation % 37 73 100
population

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 World Ranking of health system

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Human Development Index
• recognizes a country’s development level as a function of
• economics (GDP per capita),
• social (literacy rate & level of education), and
• demographic factors (life expectancy)
• Highest possible rank is 1.0

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Very high human development
Rank Country HDI

1
Norway 0.955
2
Australia 0.938
3 United States 0.937
4 Netherlands 0.921
5
Germany 0.920

157 Nepal 0.463

UN, Human Development Report14 March 2013

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Low human development
Rank Country HDI

183 Burkina Faso 0.343

184 Chad 0.340

185 Mozambique 0.327

186 Democratic Republic of the Congo 0.304

187 Niger 0.304

11/06/2014 UN, Human Development Ashok

Report14
Pandey March 2013 24
 The WHO South East Asia Region has 11 Member States

Rank Country HDI

12 South Korea 0.909
92 Sri Lanka 0.715
103 Thailand 0.690
104 Maldives 0.688
121 Indonesia 0.629
134 Timor Leste 0.576
136 India 0.554
140 Bhutan 0.538
146 Bangladesh 0.515
149 Burma 0.498
157 Nepal 0.463

11/06/2014 UN, Human Development Report14 March 2013

Ashok Pandey 25
Human Development Index

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Literacy Rate

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 Life Expectancy

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1. HEALTH RELATED POLICIES –
• World Health Organization
• World Bank
• International Monetary Fund.
• World Trade Organization.
2. ECONOMIC DEVELOPMENT AND TRADE –
• Global Market facilitates economic growth.
• Goods and services are increasingly being traded.
• Illegal drugs and human trafficking is also globalizing.
3. SOCIAL INTERACTION AND KNOWLEDGE –
• Population migration.
• Conflicts.
• Globalization of education.

4. HEALTH SERVICES –
• Universal access.
• Inequitable access.
• Illegal trading of drugs.
• Movement of healthcare professionals.
5. SOCIAL ENVIRONMENT AND LIFE STYLE –
• Social networks and social integration.
• Social protection.
• Social exclusion and inequality.

6. PHYSICAL ENVIRONMENT –
• Outbreaks of infectious diseases.
• Improved surveillance and monitoring.
• Increased speed of response.
GLOBALIZATION OF PUBLIC HEALTH
Global public health 33

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Global health is the health of populations in a global context; it has been
defined as "the area of study, research and practice that places a priority on
improving health and achieving equity in health for all people worldwide".
Problems that transcend national borders or have a global political and
economic impact are often emphasized. Thus, global health is about
worldwide health improvement, reduction of disparities, and protection
against global threats that disregard national borders.
Global health is not to be confused with international health, which is
defined as the branch of public health focusing on developing nations and
foreign aid efforts by industrialized countries.
Global Health 34

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Global Health refers to those  Global health and public
health issues which transcend health are indistinguishable.
national boundaries and (Frenk 2011)
governments and call for
actions on the global forces
and global flows that local

determine the health of

people. (Kickbusch 2006)
national global
World Poverty Today
35

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Ashok Pandey
Among 7+ billion human beings, about
868 million are chronically undernourished (FAO 2012),
2000 million lack access to essential medicines
(www.fic.nih.gov/about/plan/exec_summary.htm),
783 million lack safe drinking water (MDG Report 2012, p. 52),
1600 million lack adequate shelter (UN Special Rapporteur 2005),
1600 million lack electricity (UN Habitat, “Urban Energy”),
2500 million lack adequate sanitation (MDG Report 2012, p. 5),
796 million adults are illiterate (www.uis.unesco.org),
218 million children (aged 5 to 17) do wage work outside their household —
often under slavery-like and hazardous conditions: as soldiers, prostitutes or
domestic servants, or in agriculture, construction, textile or carpet production.
35
 INTERNATIONAL HEALTH
ORGANIZATIONS
WORLD HEALTH ORGANIZATION
• Specialized agency of the United Nations that is concerned with
international public health.
• It was established on 7 April 1948.
• Headquartered in Geneva, Switzerland.
• Played a leading role in the eradication of smallpox.
• Current issues include communicable diseases, non communicable
diseases, occupational health and substance abuse.
 CENTERS FOR DISEASE CONTROL AND PREVENTION
 Leading National public health institute of the United States.
 Headquarter in Atlanta, Georgia.
 Main goal is to protect public health and safety through the control
and prevention of disease, injury, and disability.
 Focuses on infectious disease, food borne pathogens, environmental
health, occupational safety and health, health promotion, injury
prevention.
 WORLD BANK
 Created in 1944, based in Washington DC.
 Leading institution for investments in health and development.
 World Bank strives to alleviate poverty.
 Providing loans, credits, and grants to poor counties.
 To implement various development projects in areas such as
education, healthcare, agriculture, environmental and natural
resource management, infrastructure, and other relevant projects.
 UNITED NATIONS INTERNATIONAL CHILDRENS EMERGENCY FUND
 Created by the United Nations General Assembly on 11 December
1946.
 To provide emergency food and healthcare to children and mothers
in countries that had been devastated by World War II.
 Spends majority of its budget on promoting health initiatives, and
prioritizes the needs of the world's most vulnerable children.
 Strives to address major health concerns such as HIV and AIDS,
maternal and child nutrition, excessive maternal mortality, increasing
vaccination rates and child survival and development.
THREATS TO GLOBAL HEALTH
 AIR POLLUTION AND CLIMATE CHANGE
 Air pollution is considered as the greatest environmental risk to
health.
 Nine out of ten people breathe polluted air every day.
 Killing 7 million people prematurely every year.
NON-COMMUNICABLE DISEASES
 NCDs such as diabetes, cancer and heart disease, are collectively
responsible for over 70% of all deaths worldwide, or 41 million
people.
 Five major risk factors: tobacco use, physical inactivity, harmful use
of alcohol, unhealthy diets and air pollution.

https://www.who.int/emergencies/ten-threats-to-global-
health-in-2019
 GLOBAL INFLUENZA PANDEMIC
 WHO is constantly monitoring the circulating influenza viruses.
 Every year, WHO recommends which strains should be included in
the flu vaccine.
 Influenza pandemic is unpredictable and inevitable.
FRAGILE AND VULNERABLE SETTINGS
 More than 1.6 billion people (22%) live in places where protracted
crises and weak health services leave them without access to basic
care.
 Vulnerable settings - Drought, famine, conflict, and population
displacement.
 ANTIMICROBIAL RESISTANCES
 Drug resistance is driven by the overuse of antimicrobials in people,
or in animals as well as in the environment.
 Resistance to Anti-TB drugs is a formidable obstacle to fighting a
disease that affects 10 million people and kills 1.6 million every year.
EBOLA AND OTHER HIGH THREAT POTENTIALS
Ebola, Zika, Nipah, Middle East respiratory syndrome coronavirus,
SARS and disease X.
 Ebola outbreaks in the Democratic Republic of the Congo put more
than 1 million people at risk.
 Democratic republic of Congo is a conflict zone.
 WEAK PRIMARY HEALTH CARE
 Primary health care is the first point of contact people have with
their health care system.
 Many countries do not have adequate primary health care facilities.
 All countries have committed to renew the commitment to primary
health care made in the Alma-Ata declaration in 1978.
DENGUE
 An estimated 40% of the world is at risk of dengue fever.
 Around 390 million infections a year.
 WHO’s Dengue control strategy aims to reduce deaths by 50% by
2020.
 VACCINE HESITANCY
 Vaccination is one of the most cost-effective ways of avoiding
disease
 It currently prevents 2-3 million deaths a year.
 Vaccine hesitancy is the reluctance or refusal to vaccinate despite the
availability of vaccines.
HIV
 The epidemic continues to rage with nearly a million people every
year dying of HIV/AIDS.
 At Least a Third of Human Deaths

— some 18 (out of 57) million per year or 50,000 daily — are due
to poverty-related causes, in thousands:
diarrhea (2163) and malnutrition (487),
perinatal (3180) and maternal conditions (527),
childhood diseases (847 — half measles),
tuberculosis (1464), meningitis (340), hepatitis (159),
malaria (889) and other tropical diseases (152),
respiratory infections (4259 — mainly pneumonia),
HIV/AIDS (2040), sexually transmitted diseases (128).
WHO: World Health Organization, Global Burden of Disease: 2004 Update, Geneva
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2008, Table A1, pp. 54-59. 46
 Global public health contd…

• Activities within the health sector that address normative health

issues, global disease outbreaks and pandemics as well as
international agreements and cooperation regarding non-
communicable diseases;
• Commitment to health in the context of development assistance
and poverty reduction;
• Policy initiatives in other sectors – such as foreign policy and
trade

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Key action areas for a global public health
• Health as a global public good
• Health as a key component of global security
• Strengthen global health governance for interdependence
• Health as a key factor of sound business
• Practice and social responsibility
• Ethical principle of health as global citizenship.

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1st World success of public health
• Changes of developed societies: health societies
• a high life expectancy and ageing populations,
• an expansive health and medical care system,
• a rapidly growing private health market,
• health as a dominant theme in social and political discourse and
• health as a major personal goal in life.
• Post-modern health societies of the developed world stand in stark contrast to
the situation in the poorest countries.

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Situation in the poor countries
• A falling life expectancy in many African countries;
• A lack of access to even the most basic services;
• An excess of personal expenditures for health of the poorest;
• Health as a neglected arena of national and development politics;
• Health as a matter of survival.
• Predominant pattern is still infectious diseases engendered by the natural environment (malaria,
tuberculosis and infant diarrhoea), as well as AIDS and high rates of maternal deaths.
• Non communicable diseases are also beginning to plague these regions

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Some of the most important problems in global health
today
There are three broad cause groups of health problems that,
collectively, constitute the world's total disease burden.
• Group 1: communicable, maternal, perinatal and nutritional
conditions;
• Group 2: non communicable diseases;
• Group 3: injuries.

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15 leading individual GH problems
1.lower respiratory 6.cerebrovascular (11) malaria;
infections disease;
2.diarrhoeal diseases 7.tuberculosis; (12) COPD;

3.conditions during the 8.measles; (13) falls;

perinatal period;
4.unipolar major (9) road traffic (14) iron-
depression; accidents; deficiency

5.ischemic heart disease (10)congenital (15) anaemia

anomalies;
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Other problems
• Non communicable diseases are the most widespread diseases.
• We need to work together to share our knowledge about these conditions for
prevention and cure.
• Although many international programs and initiatives target problems like AIDS,
Malaria, TB, etc, chronic disease becomes a major threat to human health as the
countries move through the epidemiologic transition.

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THANK YOU