The World Health Organisation is the main intergovernmental agency responsible for the prevention of disease, disability and injury, and the promotion of health at the global level. Some of its goals in relation to public health, globalisation and trade are:
to improve population health,
to reduce health inequalities, and
to assist with the improvement of the performance of health systems.
More trade - advantages
There are several opportunities for public health in relation to globalisation:
Increasing trade, especially if it is fair, enables greater economic growth for poor countries which in turn should promote the health of the most disadvantaged countries. This positive benefit of globalisation has been particularly pronounced in countries such as China and India which have kept strong control over the terms of their trade. Other countries have not yet seen the benefits of economic globalisation and have experienced increased income inequalities.
Increasing "interconnectedness" encourages countries to respond to what happens outside their borders as well as within when developing health policy and interventions. There are many international opportunities for promoting national health status, for example, the Framework Convention on Tobacco Control.
Greater knowledge dissemination - ideas and information now travel faster across borders.
New rules to control cross border risks (see WHO strategies).
More trade - disadvantages
Global risks also need to be considered:
Trade in hazardous commodities increases, including tobacco, firearms, landmines, drugs, and hazardous wastes.
The opening up of new markets has led to more advertising and marketing of tobacco products and increased the consumption of cigarettes. A World Bank study in four Asian countries showed that liberalisation had increased cigarette consumption per person by an average of 10% in Japan, South Korea, Taiwan and Thailand. These economies had opened their markets in response to US trade pressures during 1980.
Migration of health professionals.
The so-called "brain drain" both from poor to rich countries and within countries from rural to urban areas has been a long standing feature of international affairs. Recently however, it has increased in intensity and presents particular problems in parts of Africa. Several countries have taken advantage of the shortage of health professionals in rich countries and have adopted a deliberate policy of over production for export purposes, for example, nurses from the Philippines.
Cross border transmission of disease.
Every day, two million people cross international borders. The represents a new challenge for public health. Influenza and tuberculosis can easily be spread in crowded airport lounges, or by passengers after their return home. In 1992, poliovirus was imported into Canada by people travelling from western Europe. Infectious disease can also cross borders through contaminated foods and infected animal or insect hosts.
Environmental degradation associated with unsustainable economic development.
This is perhaps the most under-appreciated risk to the future health of all populations. Despite continuing controversy on the nature and extent of global environmental change, action is required now to ensure the sustainability of the global environment.
Response
WHO provides strategic direction and support for national health systems with a focus on diseases of the poor and the major risks to health, for example tobacco consumption. Several recent initiatives have been developed:
Market incentives are being created to spur more investment in research and development of new drugs and vaccines for malaria, HIV/AIDS, and TB, and better diagnostic tests for these diseases.
New resources are being raised to increase access to existing drugs and vaccines and provide more effective treatments to combat polio, measles, diarrhoea and respiratory diseases. International partnerships between the public and private sector have launched campaigns, including Roll Back Malaria, the International AIDS Vaccine Initiative, the Global Alliance for Vaccines Initiative, Stop TB and the Global Fund to Fight AIDS, TB and Malaria.
Knowledge, technology and best practices for affordable and effective prevention and treatments are being shared more widely, and new research is under way to fill gaps in our knowledge.
New global health rules are being developed to control cross-border or global health risks: improved global disease surveillance through strengthened International Health Regulations; a Framework Convention on Tobacco Control to restrain the marketing and illegal smuggling of tobacco; collaboration with the World Trade Organization to ensure public health is protected and promoted in multilateral trade rules.
Remedial measures are being proposed, for example, more international aid to cover the rising costs due to migration of health professionals, and tiered pricing to ensure low cost prices for essential medicines for poor countries.
Capacity building
A policy, research and training programme on "Globalisation, trade and health" was launched in 2001. It aims to:
develop knowledge and skills,
promote policy coherence,
contribute to global public goods for health, global health funds, and international rules for health.
Since September 2001, WHO has run training courses on the public health implications of the WTO multilateral trade (in goods) agreements (MTAs). Participants have been mainly from health ministries in developing countries. The programme aims to improve countries’ ability to:
understand the public health significance of MTAs;
assess national public health impact of MTAs;
participate in and influence relevant policy discussions.
Policy recommendations
WHO recommends the following policy principles:
Equitable and sustainable growth
. Openness - gradual, sequenced and paced
Produce global public goods, control global public "bads"
Increase transfer of financial and technical resources (Global Health Fund, etc.)
Strong national health policies, institutions, regulations and programmes
Engage in managing "interconnectedness" across sectors and borders.
This article is based on a presentation which Dr. Beaglehole updated in December 2002 for inclusion in Update.
