Chapter 12 – The Global Context of Health

Lecturer PowerPoint
Lecturer Lesson Plan
Additional Case Study
3 Papers
3 Websites
3 Media Articles
Learning Tasks Discussion
Issues you may have considered in relation to the Learning Tasks in the book…

Learning Task 1: Global health challenges

Which resources did you use to help you with this task? Did you refer to the Grand Challenges list? This website contains details of 14 scientific challenges that have been identified by the Bill and Melinda Gates Foundation, which awards grants related to these areas:

Grand Challenge #1: Create Effective Single-Dose Vaccines
Grand Challenge #2: Prepare Vaccines that Do Not Require Refrigeration
Grand Challenge #3: Develop Needle-Free Vaccine Delivery Systems
Grand Challenge #4: Devise Testing Systems for New Vaccines
Grand Challenge #5: Design Antigens for Protective Immunity
Grand Challenge #6: Learn about Immunological Responses
Grand Challenge #7: Develop a Genetic Strategy to Control Insects
Grand Challenge #8: Develop a Chemical Strategy to Control Insects
Grand Challenge #9: Create a Nutrient-Rich Staple Plant Species
Grand Challenge #10: Find Drugs and Delivery Systems that Limit Drug Resistance
Grand Challenge #11: Create Therapies that Can Cure Latent Infection
Grand Challenge #12: Create Immunological Methods to Cure Latent Infection
Grand Challenge #13: Develop Technologies to Assess Population Health
Grand Challenge #14: Develop Versatile Diagnostic Tools

Many of the areas discussed within these challenges are linked to the social determinants of health. For example, several projects are related to food and nutrition, with access to food being socially determined. The 2019 grant priorities are linked to emerging technological approaches as a solution to identified issues and increasing demand for vaccination services. Do you agree with the focus of the priorities as determined by this foundation? Given that a United Nations Commission set up in 1999 found that the disproportionate disease burden experienced by lower-income countries was a massive threat to global wealth and security (Brundtland, 2003), and that millions of poor people die from preventable and treatable conditions simply because of their societal position (Sachs, 2001), should priorities be more focused upon poverty reduction in general?

Learning Task 2: Investigating the impact of health professional migration

In accessing the website link, you can search the WHO site and see the numbers of medical doctors and/or nurses and midwives per country. Across the world, 57 countries were identified as having ‘critical shortages’ of staff; 36 of these are in Africa (WHO 2006).
Pay differences in salaries are significant between low- and high-income countries and it should therefore be no surprise to find that countries with the lowest salaries are often those with the greatest nursing shortages, as qualified nurses who can emigrate for better wages often do so.
Nurses often leave their home countries for better pay and conditions elsewhere, and heathcare systems in the UK and the USA have significant numbers of migrant nurses employed within them. In the UK, NHS recruitment specifically targets overseas nurses and openly acknowledges that staff from outside the UK are essential to its services, which are not achieving staffing-related targets. So international recruitment is seen as an essential source of staffing for the UK.
Clearly, this leaves many countries facing their own staff shortages, many of which are experiencing significant challenges. Countries losing personnel are unable to staff their own systems or make progress in terms of tackling health and economic challenges. Obviously, patients in these countries also suffer in terms of the availability of medical staff to treat them, as there are shortages affecting access.

Learning Task 3: Globalization, the environment and health

Positive impacts
Globalization itself can be tapped to build a more sustainable, economically feasible and environment-friendly approach. For example, globalization is about competition, so if privately owned companies take the lead in being environmentally friendly, then others are likely to do the same.

Globalization has led to increased awareness of environmental challenges, and policymakers in many places are now keen to find solutions to the complex challenge of climate change.

Globalization can be used as an opportunity to trigger environmentally friendly technological innovations – these can then be transferred to countries experiencing the worst pollution.

Negative impacts
Globalization tends to increase global demand and production, leading to the exploitation of the environment and the depletion of natural resources.

The increased movement of people across the planet not only affects the spread of disease but it also has an impact upon the environment, notably contributing to climate change.

Globalization contributes to climate change in several ways, for example as a result of increased travel and pollution, the increased demand and use of energy sources, and the consumption of products and associated waste.

The WHO has published a wealth of literature about health and climate change/environmental damage, so visit their website to expand upon your ideas in addressing this challenge.

There are a range of potential problems that may emerge for health services in relation to climate change. Some suggestions are made below but this not an exhaustive list so you may think of other examples:
• Changing diseases as a result of climate change, such as increased cases of malaria, heat stroke, cold-related diseases, and heat-related diseases. As well as the potential costs of treating such diseases, healthcare staff will potentially require more training to be able to adequately deal with these.
• Increased number of admissions associated with changing weather patterns, such as increased flooding, cyclones, storms, etc., which cause injuries and other diseases such as cholera.
• Increased admissions associated with illnesses caused by the displacement of people, e.g. infectious diseases associated with overcrowded conditions in refugee camps.
• Healthcare services may also require more staff numbers, thus increasing costs, as well as adequately trained staff.

Learning Task 4: Were the Millennium Development Goals a success?

The Millennium Development Goals Report 2015 provides a summary of progress against each goal, and therefore offers a clear picture of the progress made by the 2015 deadline. The UN report is positive in terms of the data it shows and how it frames success related to the goals. For example, in terms of MDG 1 – Eradicating Extreme Poverty and Hunger, the following statistics are used:
• In 1990, nearly half of the population in the developing world lived on less than $1.25 a day; that proportion dropped to 14 per cent in 2015.
• Globally, the number of people living in extreme poverty has declined by more than half, falling from 1.9 billion in 1990 to 836 million in 2015. Most progress has occurred since 2000.
• The number of people in the working middle class—living on more than $4 a day—has almost tripled between 1991 and 2015. This group now makes up half the workforce in the developing regions, up from just 18 per cent in 1991.
• The proportion of undernourished people in the developing regions has fallen by almost half since 1990, from 23.3 per cent in 1990–1992 to 12.9 per cent in 2014–2016.

Do you, too, consider the goals a success? Would we need the Sustainable Development Goals if the MDGs had been as successful as this report states? Is the UN report likely to biased in any way?

Do you see the goals as being part of a ‘positive’ approach to global governance? If we did not have such global targets, would there be alternatives in your view?

Multiple Choice Quiz

1. Defining global health is not easy, and there have been several definitions offered in the literature. Which of these definitions is outlined in chapter 12?
a. Kickbusch (2006) has argued that global health can be defined as encompassing health issues which go beyond the boundaries of the national and therefore need global action.
b. Kickbusch (2006) has argued that global health can be defined as an idea, referring to the state of global health.
c. Kickbusch (2006) states that global health is “an area for study, research and practice that places a priority on improving health and achieving equity for all people worldwide”.
d. Koplan et al (2009:1995) argue that global health can be defined as encompassing health issues which go beyond the boundaries of the national and therefore need global action.


The correct answer is c. Answers b and c is part of a broader definition used by Koplan et al (2009:1995). Answer d is a statement made by Kickbush (2006).

2. Globalization is best understood as a process that means which of the following?
a. Transnational companies operating in all countries across the globe
b. Everyone living in the same society
c. The world population is growing and spreading globally
d. Individuals, groups and countries are increasingly interdependent


The correct answer is d. Whilst transnational companies are part of the process of economic globalization, they are just one aspect of a complex multi-dimensional process. Some writers talk about the existence of a global society as part of globalization, but this is not agreed upon by all and is just one aspect of a much more complex concept. Whilst the world population is growing, and the movement of peoples across the globe (migration) is part of globalization, the growth of the world population is not discussed as part of the concept of globalization.

3. Globalization impacts upon health in all but which of the following ways?
a. It increases the spread of infectious diseases
b. It has resulted in increased localism in healthcare provision
c. It has resulted in trends in the global financing of healthcare
d. It has resulted in the development of new forms of global governance


The correct answer is b: whilst national policies remain important in relation to healthcare provision, globalization has increased global policymaking in relation to healthcare, according to many commentators

4. The increased global migration of healthcare professionals for better pay and improved working conditions is called:
a. brain drain
b. doctor drain
c. nurse drain
d. healthcare drain


The correct answer is a.

5. Health tourism can be described as which of the following?
a. Consumers of healthcare services residing in countries in which they do not reside
b. Consumers investing in public health care for poorer people
c. Consumers accessing healthcare services in their home country
d. Consumers ensuring service improvements in healthcare provision globally


The correct answer is a.

6. Globalization is a multi-dimensional complex process that has resulted in the complex reshaping of health control, governance and policies as well as economic change.
a. True
b. False


The correct answer is a.

7. One of the Sustainable Development Goals is to ensure healthy lives and promote wellbeing across all ages by 2030. Which of the following statements is correct?
a. The Sustainable Development Goals will only make improvements if the economy grows, as poverty reduction requires high levels of economic growth
b. The Sustainable Development Goals are an example of political rhetoric and so will have no effect upon global poverty levels
c. The Sustainable Development Goals are an attempt to promote global collective responsibility for poverty reduction, health threats, and the environment defined in the broadest sense
d. This Sustainable Development Goal needs to be accompanied by increased trade liberalization to achieve its target


The correct answer is c. Debates continue about the impact of economic growth and trade liberalization in relation to health impacts and the target under discussion was not based upon economic growth or increased trade liberalization.

8. The globalization of trade has many consequences for health. Which of the following statements most accurately describes the discussion in chapter 12?
a. Negative health impacts associated with unregulated marketing of products that are harmful to health
b. The development of ethical working in which companies ensure that their workers from lower-income countries are prioritized in terms of health needs
c. The expansion of economic development and therefore poverty reduction as a result of entering into the economies of lower-income countries
d. Improved public health outcomes as a result of trade-associated improvements


The correct answer is a.

9. The way in which pharmaceutical companies operate globally has been criticized especially in relation to TRIPs. TRIPs is an acronym that stands for:
a. Trade regulation of international property
b. Trade-related aspects of intellectual property rights
c. Trade regulation of intellectual property rights
d. Trade-related aspects of international property development


The correct answer is b.

10. There are many global actors involved in the governance of health policy, including the World Health Organization. Its remit is to:
a. regulate global trade
b. provide low-interest loans to lower-income countries
c. act as a specialist health agency to attain the highest level of health for all people
d. shape the global economy, stabilize it and encourage economic growth


The correct answer is c. Answer a is the remit of the World Trade Organization. Answer b is the remit of the World Bank.

Additional Case Study: The global economy and health

Following the ‘global’ financial crisis in 2008, several national governments responded by introducing austerity measures (Wahlbeck & McDaid, 2013: 139). Financial crises tend to significantly impact on a country’s population by leading to unemployment, job insecurity, reduced income for some people, increased poverty and increases in mental distress and suicide (Ifanti et al., 2013). In addition, using an austerity approach typically reduces public spending to save money, which in turn can mean less staff, medications and medical supplies in healthcare contexts (Quaglio et al., 2013) and the broader erosion of the welfare state, which often provides support services to vulnerable populations. Population health and well-being tend to be impacted in a negative way: for example, it is not unusual for suicide rates to increase following economic collapse (McKee et al., 2012). Anxiety and depression in the most vulnerable groups also tend to increase, often widening existing health inequalities (Quaglio et al., 2013). Vulnerable groups include transient populations, the homeless, those in prison, infants and older people (Suhrcke et al., 2011). Stuckler & Basu (2013) state that austerity kills.

Evidence also indicates that rates of infectious or communicable diseases rise during periods of economic recession (Quaglio et al., 2013; Suhrcke et al., 2011). Several factors contribute to this, including decreased access to health and social services. As a country, Greece suffered significant financial hardship following the 2008 collapse and experienced many outbreaks of infectious diseases, including influenza, West Nile virus, and increased outbreaks of HIV infection among people who inject drugs (Bonovas & Nikolopoulos, 2012).

As always, there is debate in the literature with some authors noting potentially positive health-related outcomes linked to austerity, suggesting that it can create ‘health opportunities’. For example, some positive effects have been found such as a reduction in the consumption of alcohol and less healthy food due to reductions in disposable income (Karanikolos et al. 2013). If people are working less, then they may well have more leisure opportunities, and a slower pace of life can in some instances be positive by ‘providing more opportunities for civic participation and social networking’ (Walhberg & McDaid, 2013: 143).


Bonovas, S. & Nikolopoulos, G. (2012) High-burden epidemics in Greece in the ear of economic crisis. Early signs of a public health tragedy. Journal of Preventive Medicine and Hygiene, 53, pp. 169-171.

Ifanti, A.A., Argyriou, A.A, Kalofonou, F.H. & Kalofonos, H.P. (2013) Financial crisis and austerity measures in Greece: Their impact on health promotion policies and public health care. Health Policy, 113 (1), pp. 8-12.

Karanikolos, M. et al. (2013) Financial crisis, austerity, and health in Europe. The Lancet, 381 (9874), 1323-1331.

McKee, M., Sim, F. & Powerleau, J. (2011) Inequalities in health. In (Eds.) Sim, F. & McKee, M. Issues in Public Health. 2nd Ed. Maidenhead, Open University Press. Chapter 4, pp. 78-106.

Quaglio, G., Karapiperis, T., Van Woensel, L., Arnold, E. & McDaid, D. (2013) Austerity and health in Europe. Health Policy, 113 (1), pp.13-19.

Stuckler, D., and Basu, S. (2013) The Body Economic: Why Austerity Kills. Allen Lane, London.

Suhrcke, M. et al. (2011) The impact of economic crises on communicable disease transmission and control: A systematic review of the evidence. PLoS ONE, 6 (6), e20724.

Wahlbeck, K. & McDaid, D. (2013) Actions to alleviate the mental health impact of the economic crisis. World Psychiatry, 11 (3), pp. 139-145.

3 Papers

Benatar, S. (2009) Global health: Where to now? Global Health Governance 2. LINK
This article outlines the need for new ways in which to frame global issues, for example with more of a focus upon planetary health. The author argues that current global governance systems are unable to offer solutions, therefore new framing can help reshape action.

Donkin, A., Goldblatt, P., Allen, J., Nathanson, V. & Marmot, M. (2017) Global action on the social determinants of health. BMJ Global Health 3: e000603. LINK
This article provides a summary of global progress in relation to the social determinants of health, detailing summaries of action in a range of countries as well as the need for health in all policies. It was used to develop the case study at the end of chapter 12.

Kickbusch, I. & Reddy, K.S. (2015) Global health governance – the next political revolution. Public Health 129, pp. 838-842. LINK
This article revisits arguments about the role of the WHO and associated global governance. The authors argue that a health crisis can create an opportunity for reform and that, in the instance of the Ebola crisis, this has happened with the WHO undergoing a political revolution.

3 Websites

1. Globalization and Health
This is an open-access, peer-reviewed, online journal which focuses upon the topic of globalization and its effects on health, both positive and negative. The journal is affiliated with the London School of Economics and Political Science.

2. World Health Organization – Globalization
The WHO website discusses globalization and has links to several detailed reports and documents that can be downloaded for more in-depth reading, on topics such as health and development, trade, intellectual property rights and access to medicines, and globalization and infectious disease.

3. Giddens & Sutton Sociology
This website accompanies the book and has chapter summaries and useful resources related to globalization. Specifically see chapter 4 on globalization and social change, chapter 5 on the environment and chapter 6 on global inequalities.

3 Media Articles

1. UN resolution pledges to plastic reduction by 2030
Summary of UN Assembly Resolution (non-binding), linked to a broader acknowledgement that plastic is bad for the environment.

2. Davos: leaders talk about globalization as though it’s inevitable – when it isn’t
Discussion of globalization linked to the World Economic Forum’s meeting in early 2019.

3. Global fight against killer diseases seeks £11bn
Need for investment in the global fund is discussed in this BBC news report, because of progress in the fight against infectious diseases ‘stalling’.