Globalization has not just enabled the rapid transfer of ideas and culture; the phenomenon is also profoundly impacting global health, according to Gian Luca Burci, Legal Counsel of the World Health Organization (WHO) and adjunct professor of law at the Graduate Institute of International and Development Studies in Geneva.
Burci shared his views on the “intertwined, binary relationship” between globalization and health with the Fletcher community this week as part of the Charles Francis Adams Lecture series. An expert in international health law and governance, Burci has served at the WHO since 1998.
“Many aspects of globalization have a direct or indirect impact on health. Conversely, the need to protect health has a profound influence on how policies of globalization are seen, conceptualized and implemented,” he said.
Globalization has already shifted perceptions of public health over the past 10 to 15 years, Burci noted. Public health, once seen as something domestic, has become increasingly politicized and internationalized.
Furthermore, public health is no longer viewed exclusively in terms of health care and medical treatment, said Burci. The WHO, for instance, focuses on the issue from an “upstream” perspective, exploring the determinants of public health.
“The development of human rights law has been decisive in pushing this notion that there are conditions that enable people to be healthy, such as education, empowerment, access to medicine, the position of women,” he said.
Burci identified several specific elements of globalization – such as growing migration, increased trade and investment and the rise of information technology – that impact public health around the world. He noted that we have been dealing with some of these elements for centuries, but the speed at which they now occur creates unique challenges.
Migration offers a perfect example, he said. Though people have moved across borders for ages, “the order of magnitude has exploded…so the reaction time to prevent the spread of disease is no longer in months but in days or even hours,” Burci said. He noted that the H1N1 flu outbreak in 2009 spread around the world in a mere six weeks.
The rapid movement of peoples can generate challenges not just for controlling diseases but may also have human rights implications, Burci argued, citing the HIV/AIDS epidemic as an example. “Imposing immigration restrictions and proof of health status merely pushed the disease underground,” he said. “A huge achievement of the health community has been in bringing evidence that these human rights violations were not good for public health.”
Increased trade and investment activity has also created new health challenges, since disease often travels with goods. With globalization, Burci said, the speed and intensity of exchanges have increased while barriers have decreased. This has created a tension for governments, who must counterbalance the desire to create a level playing field for trade and the need to protect citizens from the spread of disease.
The information technology revolution, which is part and parcel of globalization, has had many positive impacts on health, said Burci. He and his colleagues at the WHO have found that web technologies can significantly improve transparency and information-sharing. “It’s now difficult for countries even with a high level of social control to hide large-scale health issues,” Burci noted.
Information technology can also be a powerful instrument for protecting against the spread of disease. The WHO uses the web as a vehicle to improve information on outbreaks, said Burci, regularly collaborating with government and non-government organizations. Combing the web, these organizations can discover news articles, blogs or even search histories that reveal patterns of illness – thus providing an early warning to policy makers and health practitioners.
Environmental change is yet another element of globalization that can directly impact public health. Degradation, climate change and loss of biodiversity can all have unique impacts on health outcomes. But the shifting environment may also alter patterns of illness: for example, as temperatures rise, tropical diseases may emerge in areas that haven’t seen them previously. “There is a dire need for policy coherence on this issue,” Burci said. “You can’t address it if you just put environmental concerns on top of the macro model of globalization. These concerns need to be implemented in the policy of globalization.”
Finally, and perhaps most conspicuously, the globalization of Western (specifically North American) lifestyles is starting to take its toll on the world’s population, Burci said. And the blame doesn’t lie entirely with the golden arches. “We’re seeing a remarkable homogenization,” Burci said, “not just in consumption but in pollution, urbanization and sedentary lifestyles.” This homogenization has led to an explosion of non-communicable diseases such as cancer, diabetes, cardiovascular and respiratory diseases – what Burci refers to as “the new plagues.”
“It’s creating a double burden of communicable and non-communicable diseases among poor populations, and many countries are simply not equipped to handle it,” he added.
So what’s the best prescription for managing the complex relationship between globalization and health? “There is a dire need to rethink globalization,” Burci said. “We need more policy coherence to balance the economic, social and health aspects of a phenomenon which is here to stay.”
--Emily Simon, MALD ’13 candidate