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Globalization- Is it good for your health? Bernhard H. Liese International Health Department NHS, Georgetown University March 6, 2007.

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Presentation on theme: "Globalization- Is it good for your health? Bernhard H. Liese International Health Department NHS, Georgetown University March 6, 2007."— Presentation transcript:

1 Globalization- Is it good for your health? Bernhard H. Liese International Health Department NHS, Georgetown University March 6, 2007

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3 Defining Globalization Globalization is a catch-all phrase Quantitative definitions focus on intensity of interactions: economic measures, physical or cultural connectedness Qualitative definitions focus on the nature of the interaction: urbanizing, consumerist, human ecology, change of perspective

4 Globalization is not exactly new! Trade and migration always bound people together Globalizations first wave: The Industrial Revolution 1870 to 1917 Isolation phase 1917 to 1950 Globalizations second wave1950 to 1980 The third wave: Globalization today 1980 to present

5 Globalization Today The third waves pace and intensity have virtually annihilated time and distance

6 Todays Challenges Balancing benefits of global integration against new forms of social exclusion Making globalization work for the poor: The controversy about growing income inequalities Openness to trade as a means to give the poor a bigger stake in global prosperity

7 H5N1 – Avian Flu

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12 Grand Princess vs. U.S. Capitol

13 Emerging Diseases

14 Hypothetical Flu Pandemic vs. 1968 Flu Pandemic

15 Conceptual Framework A. International transfer of health risks Infectious diseases and international travel Risks associated with transfer of lifestyles Health and safety standards B. Globalization of health care services Movement of health providers (incl. brain drain) Health tourism Cross border establishment of facilities C. International governance The major players: WTO, WB, IMF, WHO

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17 The Nutrition Transition Rising incomes mean higher fat diets Shift from local foods towards mass- produced, processed, convenient, inexpensive foods Increase in saturated fats, trans-fatty acids and salt Obesity increased 50% over the past seven years, affecting 18% of the global population (WHO)

18 McWorld Fast food factoids – McDonalds Five new restaurants per day $1 billion spent on advertising per year Largest purchaser of beef worldwide Runs more playgrounds then any other private entity

19 Tobacco Leading cause of preventable deaths in the world today (5 million deaths per year) Doubling by 2020 Tobacco consumption falling in industrialized countries Rapidly rising in the developing world due to aggressive marketing Reduction of trade barriers allows multinationals access to new markets

20 Occupational Hazards: The Silent Epidemic 16 people in the U.S. will go to work today and will not come home 260 in China 1.1 million deaths worldwide each year from workplace accidents and work-related diseases Manufacturing shifting to low wage, unregulated environments – race to the bottom

21 North-South Trade in Health Services Medical tourism Movement of health professionals – brain drain Direct investment in facilities and services in middle income countries

22 Asias Exploding Medical Tourism India:Average 15% growth over the past five years Malaysia:175 000 health tourists in 2000; tripled in 2003 Thailand:Cost of bypass surgery 30% of U.S.

23 Medical Tourism – Malaysia Source: Malaysia Ministry of health; Health tourism report October 2003 Breakdown of Health services provided by private hospitals to health tourists in 2001, 2002, and 8 months of 2003

24 International Migration of Health Professionals Serious problems for Africa Kenya retained only 20% of physicians trained Zambia and Ethiopia lost 50% of physicians Ghana lost 2,500 nurses to Europe (1999-2003) 600 Ghanaian medical practitioners are working in New York Carousel effect

25 Governance – WHO International Treaty for Tobacco Control Regulates advertising, packaging, exposure to smoke and illicit trade Treaty came into force Nov. 2004 Binding for signatories – EU signed Jan. 2005 First international treaty brokered by WHO New International Health Regulations Adopted May 2005

26 Governance – WTO WTO established in 1995, replaced General Agreement on Tariffs and Trade (GATT) Regulates multi-lateral trading system Four relevant agreements that influence public health – TBT, SPS, GATS and … TRIPS (Trade-Related Intellectual Property Rights) – The most contentious one

27 The TRIPS Agreement Minimum standards of IPRs protection Transitional arrangements for developing and least developed members IPRs protection balanced with public health needs Aggressive and unjustified interpretation of TRIPs by Pharma industry led developing members to demand WTO affirm the right to use the flexibilities

28 The Doha Declaration Confirms the TRIPS Agreement does not limit the grounds on which WTO members may issue compulsory licenses Each member determines whether a national emergency or circumstance of extreme urgency exists Members are free to permit parallel importation of medicines Provides maximum flexibility for least developed members to dis-apply patents at least until January 1, 2016

29 Conclusion Ensuring the publics health has been a key function of the nation state; Today, executing this function effectively requires a global perspective. New global health governance challenges need to be addressed by the international community


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