Globalisation: seizing the opportunities for health

Abstract

Health Systems, UK Global influences on human health are not new. Before the dawn of recorded history, our very existence was shaped by natural events with global consequences. The opening of the African Rift Valley changed the climate of Africa, forcing our ancestors down from the trees, leading ultimately to our emergence as homo sapiens. More recently, a shift in the earth’s orbit gave rise to the last ice-age and a sequence of events that, quite literally, shaped our continent. More recently still, there is credible evidence to link a volcanic explosion in Indonesia in the fifth century with climatic changes and outbreaks of disease in Europe that accelerated the collapse of the Roman Empire and the emergence of the linguistic groupings that make up modern Europe. But the situation today is different, for two reasons. First, many of the global forces that are now shaping our destiny are of our own making, whether they are climate change, trade in tobacco, or the transmission of infectious disease. Second, we can do something about them. If we are to address these challenges we must develop effective global responses. These involve the provision of a range of things that, collectively, are termed global public goods. Public goods are defined as non-excludable (so that once the good is provided it is available to all) and non-rival in consumption (so that consumption by one person does not reduce what is available for others). The problem is that, in traditional markets, they are under-produced, as the inability to extract a price for them reduces the incentive to produce them. The most important global public good is knowledge. An example is the report on the Global Burden of Disease, using innovative methods to reveal the distribution of disease and premature death throughout the world. Although at times controversial, it has the benefit of reminding us of the large burden borne by the many millions of people who, in most cases, remain invisible to us as neither their births or deaths are ever recorded. But it also includes research using innovative methods to understand the increasingly complex determinants of disease. Traditional epidemiology, based on a single, well defined exposure, and a discrete outcome, has little to offer those seeking to disentangle the chain of events linking the global demand for mobile phones with a war that has led to the death of millions in the Congo. In fact, the link is the growing demand for tantalum, mined in the Congo, and a key component in phone chips. As with diamonds in Sierra Leone or oil in Iraq, the war is essentially a struggle for control of natural resources where the cost is borne by the poor and the benefits gained by the rich. Similarly, imaginative methods are needed to show the important health effects of climate change, such as the research linking El Nino with the changing distribution of malaria transmission, or with changes in rates of ‘natural’ disasters. More immediately, it includes knowledge of outbreaks that have the potential to wreak global havoc, illustrated well by the example of SARS. This knowledge depends in turn, on the provision of other global public goods, such as surveillance systems and public health infrastructures. But knowledge will only be effective if it leads to action. This action can take many forms, from global law making, illustrated by the Framework Convention on Tobacco Control, through the co-ordination of many individual actions, as in the response to SARS, or to discrete local action facilitated by global movements such as the environmental and human rights movements. The increasing ability for human activity to impact at a global level brings threats and opportunities. Our task is to seize the opportunities to minimize the threats and this paper will as how we, as a global public health community, can best do it.