Global health

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For example, Bettcher and Lee (2002:8) define the cognitive dimension of globalization as follows: Changes to the creation, exchange and application of knowledge, ideas, norms, beliefs, values, cultural identities and other thought processes as a consequence of globalization.

The driver of these changes centers on the rapid spread of communication and information technologies in recent decades resulting in a more widespread and intense flow of information across national boundaries via the mass media, advertising agencies, think thanks, consultancy firms, public relations bodies, educational institutions, scientists and religious groups. This definition recognizes the influence of globalization on ideas, but does not fully grasp the influence of ideas created by globalization on how we think about the world and, consequently, how we address perceived problems.

In short, the definition frames ideas as passive, rather than active. Some publications deal specifically with cognitive aspects of changes in international health policy. Bunyavanich and Walkup (2001) wrote that deals explicitly with the roots and implications of the discursive transition from international to global health. The results of their interviews with 29 health leaders in government, NGO, professional, international and academic organizations suggest that the term “global health” indicates a normative, universalistic definition in which geopolitics is or should be irrelevant.

However, a closer reading suggests the term implies increasing coordination or communication across national borders (but not their irrelevance). This study deserves credit for noting and researching the shift from international to global health discourse. Refining the relationship between globalization and health policy In recent years, not only has global health received unprecedented attention, but several important international policy measures have been instituted in response. Events such as the creation of new funds have as much to do with the burden of disease posed by certain illnesses as with the perceived threat of those diseases.

For example, the declaration of certain diseases as global security threats during the Clinton administration (1992-2000) gave a dramatic new rationale to U. S. international health involvement. The question of how exactly changes in understandings of disease processes lead to changes in policy deserves further exploration. The dearth of existing literature that specifically addresses how cognitive aspects of globalization relate to international policy can be filled in with information from other areas. Policies rest on implicit or explicit sets of values (see Figure 2).

Disease prevention policies are no exception; they are based on assumptions about disease causality. Following Haas (1990), innovation due to changing understandings about cause and effect relationships related to a phenomenon of major importance in society may cause questioning of previous programs or organizations geared around the phenomenon. As Haas writes, “change in human aspirations and human institutions over long periods is caused mostly by the way knowledge about nature and about society is married to political interests and objectives” (p. 11).

Therefore, the focus on interdependency within the global health/globalization discourse is highly relevant to policy making. National policy makers and their delegates in international organizations base their expectations about international collaboration on world order conceptualizations, which also structure the thinking of professionals working in a given field of study. Conceptualizations of global patterns and processes thus constitute an important dimension in international policy by driving the understanding of what issues are important and what can be done to resolve perceived problems (see Figure 2).

Discussions about globalization and health, particularly those that are critical of it, lean towards regarding it as an all-encompassing new phenomenon. While a certain debate exists about when globalization, or the current phase of it, began, most policy-oriented commentaries on globalization center on a real intensification of globalization around the 1970s. They imply that health determinants were easier to deal with before then. For example,

In today’s world of changing health risks and opportunities, the capacity to influence health determinants, status and outcomes cannot be assured through national actions alone because of the intensification of cross-border and transborder flows of people, goods and services, and ideas. The need for more effective collective action by governments, businesses and civil society to better manage these risks and opportunities is leading us to reassess the rales and institutions that govern health policy and practice at the subnational, national, regional and global levels.

(Dodgson, Lee, and Drager 2002: 5) While globalization creates new problems, the central problem attributed to it—the diminished “capacity to influence health determinants, status and outcomes” never existed through national actions alone. Yet, discussions such as Dogson’s imply that, at some point in history, the governance structure matched the disease challenges they were created to address. Various aspects of globalization do play a role in transnational health concerns.

However, globalization does not erase preexisting geographical patterns, relationships and mechanisms. Rather, it intersects with them. As Lee (1998) illustrates so clearly, “some issues, such as control of infectious-disease transmission, are familiar difficulties given a new twist by globalisation; others, such as regulation of the impact of the global economy on health, have arisen as a direct result of globalisation” (p.

3). Too much on globalization as either a central policy challenge or as a key explanatory variable for other policy challenges ignores the fact that it eclipses other roots of such challenges, for example the dissonance between the spatial organization of states and disease ecology. Most literature on globalization focuses primarily on the economic sphere, with secondary attention to the political sphere (see Figure 1).

This discussion theorizes that, since globalization is a socially-created phenomenon, conceptual aspects mediate all other effects and thus remain central to understanding globalization. However, most existing models highlight the cultural shifts engendered by cognitive aspects of globalization, but not the broader underlying paradigmatic changes. Lee (2000) does point out that globalization changes how we think of ourselves and the world around us, but this central, enormously important point is not developed in Lee’s model.

The discussion shows that if changes introduced by globalization are perceived as problems (or opportunities), policy makers can respond to them within existing institutional structures, which over time can lead to new structures. Because of the fundamental role of the state system in international politics, international cooperation is difficult. However, through internationalization, governments possess the ability to internalize international goals deemed sufficiently important. “Global health” may elicit such changes. The following section explores what these observations mean for the international health system.

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