The relationship between globalization, health and development is complex. There are many positive and negative ways in which globalization affects health. The inverse is also true; a society that suffers from a high burden of disease is not in a position to participate effectively in the processes of globalization and will not, therefore, be able to share its benefits. As in the case of SARS, a global disease outbreak can lead to significant human and financial losses around the world. The interface between globalization, health and development has all the ingredients of a virtuous circle but also the potential to turn into a vicious spiral.
The processes of globalization are creating new threats to health and its determinants. Health issues that transcend national boundaries include environmental degradation and climate change, inequality and lifestyle changes, access to medicines and health knowledge as well as new and re-emerging diseases.
Global trade and travel leads to a more rapid spread of disease, while global marketing leads to the spread of consumption habits through advertising and other influences (smoking, changing patterns of food consumption). Global disease spread can have a range of negative impacts on both rich and poor countries as the SARS epidemic and spread of obesity demonstrate.
Financial flows resulting from the global movement of investment and the remittances of expatriate workers have both far outweighed aid to the developing world in recent years. But poor regulation of the financial system and a lack of transparency can support corruption and tax evasion and produce sudden shocks to the system, as the recent crisis has shown.
The illegal trade in drugs, alcohol, cigarettes, counterfeit medicines and the trafficking of people is also a product of globalization, with severe negative consequences for health.
Global communications technology has helped to increase scientific and technological knowledge-sharing for the development of medicines, vaccines and medical appliances, enabling the development of new forms of treatment and prevention. It has also improved communication and transport possibilities and, thereby, reduced the technical barriers to access to medical education, information and treatment. Internet communication has also dramatically improved the possibility of tracking and monitoring outbreaks of infectious diseases.
Globalization has lead to increased inequality in access to medical progress. As the health sector has continued to grow in developed countries, economic restrictions for the health sector in many poor countries have increased. Reasons include pressures on public expenditure, sometimes caused by conditions imposed on structural adjustment loans, increasing prices for newly developed medical inputs due to more stringent international property rights rules, low research and development expenditure on many tropical diseases, donor focus on disease-specific programmes and a lack of priority assigned by some of the countries themselves. Many poor countries find it increasingly difficult to retain medical staff attracted by higher pay in rich countries.
The influence of private actors has increased as health becomes a major global market and popular concern. Powerful companies and other private for-profit actors try to defend their strategic position in a liberalized global trade system; this includes food, pharmaceuticals, agricultural products and insurance companies. Global civil society, in turn, has considerably strengthened its advocacy role and is increasing the pressure on private business to accept corporate social responsibility for global health. Global philanthropists have made extraordinary new resources available, their influence having grown to the extent that private individuals now sit at the table with nation states and intergovernmental organizations to discuss international cooperation.
The G-20 summit in London in 2009 noted that unconstrained free market globalization can lead to many negative consequences. Europe is deeply committed to the development of responsible globalization. This requires the inclusion of global trade, finance, communications and cultural exchange within a framework of global governance, and international law that ensures that globalization works for health and development and provides protection against possible harm and misdeeds.