Is globalization dangerous to our health?

Abstract

When asked about globalization, Margaret Thatcher, the former Prime Minister of Great Britain, replied, “There is no alternative.” Her reply was shortened to “TINA,” which some people think is a newly discovered law of nature. Yet, public resistance to this new corporate-centered trade is increasing. What relevance does this have to American physicians? Does globalization affect health? Many think about the health effects of modern global trade as involving increased pollution as corporations strive to limit environmental restraints or global warming caused by the increased reliance on cheap fossil fuels. Others focus on the changes in diet produced by genetically modified foods or the increase in the tobacco market penetration. The expansion of global cigarette exports is a dramatic example, totaling 223 billion (109) cigarettes in 1975 and rising to 1.1 trillion (1012) cigarettes in 1996 (a 5-fold increase). Others might consider the health of child laborers in Pakistan who produce many of the disposable surgical instruments that are increasingly used in US hospitals. Or they might consider deaths from toxic exposures in poor countries as US corporations evade environmental restraints at home. One such example occurred 15 years ago in Bhopal, India, where 5 tons of poisonous methyl isocyanate gas leaked into the air from a Union Carbide pesticide plant, killing more than 3,000 people. These effects are real, but they pale in comparison with globalization's effect on increasing inequality, the most powerful factor affecting population health and responsible for perhaps 14 to 18 million deaths a year (18% of total deaths) worldwide.1