Globalization and Health Care

Table of Contents

Author Supplied Abstract...............................................................................................................2

Author Supplied Keywords............................................................................................................2
Overview......................................................................................................................................2
The New Collaborations......................................................................................................4
The Effects of Migration .....................................................................................................5
Applications.................................................................................................................................7
The Need for Social Action............................................................................................................7
Conclusion......................................................................................................................................8
Terms & Concepts........................................................................................................................8
Bibliography................................................................................................................................9
Suggested Reading.....................................................................................................................10
Barnett, T. & Whiteside, A. (2006). AIDS in the Twenty-First Century : Disease and
Globalization. Palgrave MacMillan, New York.........................................................................10
Navarro, V. (2007). Neoliberalism, Globalization, and Inequalities: Consequences for Health
and Quality of Life. Baywood Publishing Company, Inc., New York. .....................................11

Author Supplied Abstract

Globalization is the term which refers to the large-scale trends which have created the global
state. This term which became popular approximately twenty years ago recognizes the trends
which encompass a diffusion of economical, political, technological and social evolvements in
todays interchangeable and interdependently-structured global society. Globalization also refers
to the spread of capitalism and the control of an increasing number of countries by a specific
number of international corporations. One of the major ramifications of globalization is the fact
of looser boarders, especially in eastern Europe where a lot of people are migrating throughout
the European Union in search of employment and stability. Globalization brings the people of the
world together politically, economically, technologically and socially in unprecedented ways.
The effect has been the movement of people from one place to another on a scale that has never
been seen before.

Author Supplied Keywords

Anti-Trust Laws
Biometrics
Deregulation
Globalization
Nutriceuticals
Managed Care
Migration
Microcosm
Privatization
SARS
Verifiable
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Globalization and Health Care

Health Medicine & Society > Globalization and Health Care

Overview
Globalization is the process whereby the worlds cultures, economies and people are interacting
together on an unprecedented scale. One of the significant changes brought about by this process
is the globalization of privatized medical care. An increasing number of countries are being

pressured to reform their health care systems and privatization of health care is a growing
international phenomenon. The other side of globalization is the movement of people,
particularly those who are trained/educated in the health care professions. They are moving away
from their home countries (often these are developing countries) and seeking employment in
western countries. The need for health care professionals is always present and western countries
can afford to pay these practitioners the kind of salary they could only dream about in their home
country. So, while western countries benefit from the movement of people away from the
developing world, the people in those countries suffer as a result of the brain drain which takes
health care professionals away from them.
Another significant result of the globalization of health care is the need to train a wide range of
healthcare professionals in western medicine, and the need for western practitioners to travel to
developing countries. In many ways, its as if countries are trading their practitioners. The other
issue is that of the spread of disease as a result of globalization. That too is becoming a serious
issue. Some would suggest that the term global health care might be an appropriate one to
describe the series of issues related to globalization and health care.
Globalization of Medical Care
Globalization is changing the ways in which we perceive medical care and the ways in which it
is provided. Medical systems and philosophies of health care are crossing boundaries as never
before. It is likely that we will have to begin thinking of the world health care rather than just
our countrys health care. One of the primary reasons for the change in health care and the ways
in can be provided is the Internet. Through this unique and still relatively new form of
communication, people have unlimited access to resources, people and international
communications. People can offer their services, including medical services on a global scale.
As the world shrinks and our lives become inexorably intertwined with each other, there is a
growing concern as to who can maintain health care standards in the new global economy. Just
like the global economy, there is no one person or group of persons in charge of global health
care (Miller, 2003, p.114). Indeed, the existence of the global economy now provides
pharmaceutical companies with unlimited markets. Many use the Internet to sell medications
without prescriptions and thus medications such as anti-depressants and anti-inflammatories
which should only be taken under a doctors supervision are only an email away. The availability
of these medications through the Internet and on a global scale gives rise to concerns over
regulations of and standards for international health care.
Another effect of globalization is the increased exposure people have to each other. The outbreak
and spread of SARS in 2002-2003 was an example of a respiratory disorder that spread from
China all the way to Toronto, Canada. Once the spread of a serious condition, illness, or virus
occurs, the question becomes who is responsible to try and contain it. SARS is one of those
viruses that still has no cure and it can spread very quickly. A person can have general symptoms
for over ten days and in that time travel internationally. By the time theyve arrived, they could
be very ill and have spread the virus to hundreds or even thousands of people. The development
of a global economy necessitates an increased amount of international business travel which
could easily result in a serious outbreak in not just one but several countries.

With globalization there is a growing perception among many observers that

the old Westphalian state system needs rethinking, since events in one state,
such as a plague outbreak, can have nearly immediate and potentially
devastating consequences for other states. According to this view, independent
states cannot be left on their own to decide whether or not they will cooperate
with other states in matters of life and death to all (Schwirian, 2002, p.166).
There is another pattern emerging which is that of the health crises in developed countries such
as the U.S. As the developing countries rely increasingly on the western medical model, that
model itself is in crisis. Western medicine is predicated on the brilliant technologies that create a
highly sophisticated medical system. But, these technologies are incredibly expensive and add to
the dilemma inherent in western health care. This highlights the conundrum of Western health
care systems: how to resolve the central contradiction of ever greater reliance on expensive
technologies for individuals at the expense of universal, equitable health care provision
(Keaney, 2002, p.338).
The New Collaborations
As a result of globalization, many of the worlds biggest pharmaceuticals are becoming even
larger and more powerful as they merge together to create mega-pharmaceuticals. Some of the
combinations include: SmithKline Beckmam and Beecham PLC which merged to create
SmithKline Beecham, Zeneca and Astra from Britain and Sweden respectively which merged to
create AstraZeneca. These mergers of pharmaceutical superstars creates another problem which
is that of a monopoly of specific pharmaceuticals and their distribution worldwide. If one of
these mega-pharmaceuticals should, for example, create the HIV/AIDS vaccine, then one can
only imagine the type of control they would have over the worlds health. One of the outcomes
of these big mergers (some of which have been successful, while others have failed) has been the
growing concern of governments over their power. This evolution to fewer global megacompanies will likely generate increased government intervention and trigger anti-trust
concerns (Miller, 2003, p.131).
These mega-mergers are not only interested in pharmaceuticals however. Given the enormous
profit margin in their business, they are setting their sights on cornering the markets in other
areas. One of these is the relatively new industry of nutriceuticals. This is a form of genetic
engineering infusing plants with more vitamins and fewer calories. In essence, some of the
large pharmaceuticals are extending their power and control into the food and vitamin markets
(Miller, 2003).
The positive side of this tendency towards global partnerships is the emergence of research and
development partnerships which likely never would have existed otherwise. Countries such as
the U.S. and Russia for example are working side by side on joint health issues. The fact of
globalization reveals the similar patterns of health concerns the world over. The current age of
globalization poses challenges to promote professional interaction that advances international
scholarly efforts (Meleis as cited in Callister et al., 2006, p.39). Combined approaches,
comparative research and international cooperation lend an enormous hand towards the effort of

trying to solve global health problems. Another benefit is the ability to access researchers and
funding which was previously unattainable. Now that countries are cooperating (whereas they
might not have before), joint efforts are emerging to make funds accessible to researchers in
other countries. Scientists can now find similar research and their colleagues faster through the
Internet, faxing and instant messaging. Opportunities of international collaborative research
include professional growth, idea exchange, establishment of lasting collegial connections,
broadening of perspectives, sharing of resources, enhancing the profession of nursing in
emerging regions, and global dissemination of knowledge(Callister et al., 2006, p.41).
One of the effects of these new collaborations is the need to understand the ways in which other
countries proceed with health research. Protocols in international collaborations must be
carefully set in order to respect each others database of knowledge, sociocultural patterns and
motivations/goals for the research. As well, the outcome of these research projects must be
carefully monitored in order to ensure that all partners have equal access to the benefits of the
research. However, the opportunity for growth and knowledge is unprecedented. Broader
dissemination of knowledge is possible as findings are presented in a variety of settings and
published in international journals and in multiple languages (Callister et al., 2006, p.42).
The Effects of Migration
Globalization has led to an increase in international migration. One of the patterns is that of
people who live in countries that used to collectively comprise the Soviet Union. The breakdown
of the Union has created numerous small countries many of which are unstable politically and
economically. Another pattern is people who are moving more easily in Europe due to the
creation of a multi-country organization known as the European Union. There is also the pattern
of people leaving developing countries for opportunities elsewhere in the world. A primary
reason besides economic and political problems is that of the new global economy. People in
these countries are now aware of the extraordinary opportunities in other countries especially due
to information gained from the Internet. Gushulak and MacPherson (2004) estimate that
approximately 2% of the worlds population now lives in a country other than their native home.
Although this doesnt sound like a significant number at first, it translates into approximately 200
million people.
With this amount of people migrating in and out various countries, its also entire possible that
health problems will follow.
If the health and disease parameters that influence the prevalence of infections
at a migrants point of origin and transition periods are different from those at
the destination, the process of migration and travel can bridge the difference in
disease prevalence and function as a method of transfer between regions
(Gushulak and MacPherson, 2004, p.1742.)
It is an unfortunate reality that migration can be a source of disease. Therefore, increased
migration patterns in the world are also an impetus for policy development, regulation review
and development of immunization protocols. However, the fact is migration patterns are not a
static phenomenon. Migration is constantly taking place and patterns can quickly change due to

the outbreak of armed conflicts, environment crises and other natural or human-created
phenomenon. An example of a salient concern is that of HIV/AIDS. The responsibility for
dealing with HIV/AIDS has fallen to the developed world but many people may be migrating
around the world and be unaware they have HIV/AIDS.
With increased migration comes increased responsibility to provide public health and education
on a much larger scale.
The first is an increased need for international public health information.
Effectively managing infectious diseases in situations where many of the
influences originate beyond national borders will require an evolving
reference base of accurate, verifiable baseline and outbreak data linked to
dynamic population health determinants, such as demography, biometrics, and
mobility, which are also influenced by health services availability, access, and
affordability; and socioeconomic, biological and genetic, environmental, and
behavioral factors (Gushulak and MacPherson, 2004, p.1745.)
Another effect of migration is the increased multiculturalism that becomes inherent in practicing
medicine. Doctors and nurses in most developed countries now treat patients from a broad range
of cultural backgrounds. This implies a need to understand the ways in which people from these
cultures understand and cope with concepts such as wellness and illness. This changing
context of health and illness and the ways in which it is conceptualized brings many challenges.
The quest to be responsive to individual need and to be culturally sensitive blurs the boundaries
of health practices and the role of practitioners (Graham, 2005, p.79).
Expansion of Managed Care
The rise of managed care in the U.S. was once a controversial subject. Perhaps, it still is. Yet,
managed care has long since jumped national borders to become an international phenomenon.
The privatization of health care around the world is now available to these companies because of
globalization. They have access to countries and their medical systems as never before. Of
course, one cannot deny that the promise of unprecedented profit is the motivation for these
companies to bring managed care to the world. Increasingly, the global economy is a greater
for profit motive to health care, even in the more historically bureaucratic systems such as
China where health care deregulation is proceeding unabated (Miller, 2003, p.116).
The expansion of managed care is increasingly threatening those countries where universal
health care still exists. Countries such as Canada and those in the European Union still tout the
fact of having universal care, but the rising cost of providing that care is causing even these
countries to rethink their policy on this issue. One area of the world where managed care is
making huge inroads is Latin America. In countries where people have become accustomed to
high levels of social support there has definitely been some opposition to the influx of managed
care. But, even those who would oppose managed care have been unable to stop it (Miller,
2003). Still, the expansion of managed care into Latin America bears a disturbing trademark. The
Latin American market is an attractive one due to the millions of people who live there. It has
previously been an untapped market for HMOs. Unfortunately, Latin America still has millions

of poor people just as in America and the HMOs have no interest in them whatsoever. Their
intent is purely monetary, not social or humanitarian in nature. So, when they take over a
countrys health care, they transform it into a microcosm of the U.S. Health care becomes a
luxury for the rich and the poor are left to fend for themselves when the countrys old system is
dismantled.
Another and perhaps unexpected result of the influx of managed care into Latin American
countries is that its altering the ways in which all people access health care. the real
privatization of Latin American health care is not occurring via private plan enrollment but,
instead, as the poor abandon public health centers to visit private doctors home-based offices,
and fill their prescriptions through private street corner pharmacies (Miller, 2003, p.119).
Just as managed care is growing around the world, the notion of for profit medical systems
expands with it. Along with this growth is the concern that comes with a for profit system. Many
health care policy analysts in the U.S. have been questioning whether or not managed care has
sacrificed quality of health care for the almighty dollar. Certainly there have been enormous
cutbacks and this has caused some consternation around the state of the American health care
system. Now that system is being exported around the world. This raises a major question about
how health care systems around the world will be affected.

Applications
The Need for Social Action
One of the issues that emerges from the literature on this topic is the lack of research on the
connections between globalization and health care. There is a strong need to conduct far more indepth research on this topic to understand the complex nature of their relationship to each other
and how both developed and developing countries can respond. First, there seems to be a lack of
direction in international policy with respect to how to cope with the effects of globalization on
the worlds health. Second, to date, the developed world has received all the economic benefits
from globalization and they have not shared this equally with developing countries. The
developed countries must ensure that they provide the technical assistance and economic aid that
the developing world needs in order to have appropriate health care. If this aid and assistance is
not provided then the developing world will be left behind in the rush to solidify the global
economy. A greater volume, better allocation, and higher quality of financial and technical
assistance are also required to create the national conditions necessary for successful integration
into the global economy (Woodward, Drager, Beagelhole & Lipson, 2001, p.877).
Another key area for policy is the health care response to increased world migration. As noted
previously in this paper, this can be the cause of increased disease as people move in and out of
the developing world and into the developed world. Countries must take measures to protect
public health. A genuinely health-centered process of globalization can be achieved only by
ensuring that the interests of developing countries and vulnerable populations are fully
represented in international decision-making forums (Woodward et al., 2001, p.877).

Health Care, Power and Control

One of the most notable effects of the globalization process is the increased control that
developed countries such as the U.S. have more the developing world. In addition to the money
they give, they are exporting their own health care system and their HMOs stand to make
millions of dollars. This gives countries like the U.S. a tremendous amount of power and control
over these countries. The notion of control is endemic to the capitalist system and this is the
political/economic system which drives the U.S. as a country and as a political/economic force.
The western health care system is now inextricably linked to many countries around the world.
This is a process that will be very difficult to stop. The more deeply they become engrained into
other countries, the more power and control countries like the U.S. will have over their
developing counterparts.
The other by-product of this process is the growing disparity between countries. As countries like
the U.S. continue to make profits by exporting their health technology, other countries will start
to fall behind. there are more heart catheterization laboratories in Chicago than in all of
reunited Germany (Miller, 2003, p.127).

Conclusion
The process of globalization is an extremely complicated one. It is also an ongoing and dynamic
process, not a static one. Therefore, the effects of globalization will continue to impact on people
world-wide and these effects may continue to change as the dynamics of the process evolves
over time. One of the key areas that globalization impacts on is that of the worlds health. New
patterns of migration, changing economic agendas, the spread of capitalism and the effects of the
international expansion of managed care are all affecting the worlds health. There is an
increased need for policies, public education and social action to address the multiplicity of these
complicated issues.

Terms & Concepts

Anti-Trust Laws are a series of laws that are enacted in some countries (e.g. the U.S.) which
prohibits behavior that is anti-competition and inhibits any fair business practices.
Biometrics sometimes referred to as biological statistics.
Deregulation is a process by which the government of a country reduces or removes the
restrictions on certain kinds of businesses.
Globalization is the process whereby certain phenomenon such as economics or healthcare of a
country or area become global. Some people would describe it as the process of the world
becoming more interdependent and a global society or world society.
Nutriceuticals is a term that refers to extracts of foods which are believed to have medicinal
effects. They often come in the form of capsules or powders (such as garlic pills).

Managed Care is the system of various strategies used to reduce costs of public health care and
hopefully improve quality of care at the same time. Used prominently in the U.S. The
organizations that use these strategies are referred to as managed care organizations.
Microcosm a way of seeing various patterns in society (or even in the universe) reduced down to
the smallest level.
Migration The process by which people move about in the world. There can be rural-urban
migration, cross-border migration and international migration.
Privatization The process by which previously publicly owned companies or utilities become
privately owned.
SARS Severe Acute Respiratory Syndrome there was an outbreak of this in 2002-2003 which
killed over 700 people. The syndrome has no cure.
Verifiable This refers to something a hypothesis or theory being verified through the
presentation of facts and evidence.

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Suggested Reading
Barnett, T. & Whiteside, A. (2006). AIDS in the Twenty-First Century : Disease and
Globalization. Palgrave MacMillan, New York.
Kawachi, I. & Wamala, S.P. (2006). Globalization and Health. Oxford University Press, New
York.

Kickbusch, I., Hartwig, K.A., & List, J. M. (2005). Globalization, Women, And Health In The
21st Century. Palgrave MacMillan, New York.
Lee, K. (2003). Health Impacts of Globalization. Palgrave MacMillan, New York.
Navarro, V. (2007). Neoliberalism, Globalization, and Inequalities: Consequences for Health
and Quality of Life. Baywood Publishing Company, Inc., New York.
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Essay by Ilanna Mandel, M.A.

Ilanna Mandel is a writer and editor with over seventeen years of experience, specifically in the
health and education sectors. Her work has been utilized by corporations, non-profit
organizations and academic institutions. She is a published author with one book and numerous
articles to her credit. She received her MA in Education from UC Berkeley where she focused on
sociology and education.
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