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March 2002 |
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A SMALL WORLD |  Back to contents | |
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At its most simple, public health is concerned with protection of the public from disease through adequate sanitation and hygiene. At its more complex, public health is about inequality and to what extent one's inequality can prevent access to public health measures. Public health, in terms of fundamental provision of adequate shelter, food and primary healthcare, should be considered a basic human right. But for many, in both the developed and the developing world, it is not. Poor health is spread and exacerbated by poverty and inequality, both domestically and internationally and as global poverty increases, so public health reduces. Therefore, changing, globalising capital systems must also be influencing public health, with consequent effects on livelihood and employment opportunities in both the developed and developing world. It is the world's most vulnerable and disadvantaged whose health is increasingly at risk. They are most likely to live in poorer environments - the primary influence on their health and development - are least likely to be able to access basic public health measures and health promotion services, and have the least power to be able to do anything about it. Globalisation is not a new concept - trade routes have existed for centuries. It can be seen as an increasingly single global economy, resulting from increasing neo-liberal policies, particularly since the 1980s, growing interdependence and interconnectedness, or the growing power base of trans-national companies. Fundamentally, the globalisation process enables those with an already powerful market advantage to escalate their powerful positions by spreading into new locations, largely using their own rules of engagement. PERSPECTIVES ON GLOBALISATION
In a white paper on eliminating world poverty, the DFID states that it is:
Others are more inclined to focus on some of the issues of power and powerlessness inherent in the globalisation process. According to Stephens (2001):
Regardless of one's perspective, there are some serious concerns to be raised about the changing power balance of accountability of transnational companies and nation states. The globalisation process has been legitimated by trading agreements between powerful nations, which are able to expand their markets by creating favourable trading conditions throughout the world, but there are many questions, including:
WHO ARE THE KEY PLAYERS? There are many governmental and non-governmental organisations working to promote globalisation and many seeking to inhibit some of its effects at local level. Perhaps the two most commonly known organisations involved in enabling the "delivery" of globalisation are the International Monetary Fund (IMF) and the International Bank for Reconstruction and Development - more commonly known as the World Bank. The IMF was established in 1946, with the original purpose of providing monetary and currency stability for post-war prosperity through growing world trade and expanding national economies. It now supports 183 member countries in promoting international monetary co-operation, exchange stability and exchange arrangements, fostering economic growth and provides temporary financial assistant to countries. The World Bank is one of the world's largest sources of development assistance and has provided some US$17bn in loans to client countries. It works in more than 100 developing countries to assist the world's poor, particularly in areas of education and food programmes3. International funding organisations can risk making the situation worse in the long term. For example, Ghana was set to be a "model pupil" of World Bank policies, a show-case for the rest of the developing world in introducing a neo-liberal economy and structural adjustment as a response to poverty. However, the result has been increased dependency and poverty, with many Ghanaians worst off than before4,5. Servicing its debt takes such priority that Ghana is not able to direct funds toward domestic priorities, including health and education, adding to the already grave cycle of poverty. Voluntary organisations working at local level, and supported by international resources, can frequently offer a more sustainable way forward in helping to combat poverty and discrimination that could otherwise lead to political instability and cultural clashes - which may have been responsible for the poverty in the first place. There are many organisations working to bring sustainable, local change at grass roots level, for example; Jubilee 2000, Drop the Debt and the Development Group for Alternative Policies. Such organisations have helped to raise public awareness and bring pressure for change that positively focus assistance on combating poverty. THE IMPACT ON THE DEVELOPING WORLD Globalisation brings new wealth, technology and knowledge, but it is not evenly distributed and its sustainability is sometimes questionable - aggravating inequality and dependency both within and between countries. One in five (two-thirds of whom are women) live in extreme poverty internationally, surviving on less than one dollar a day1. Globalisation has brought some benefits and there has been enormous developmental progress in many areas. Since the 1960s, life expectancy in developing countries has increased from 46 to 64 years; infant mortality rates have halved; there has been an 80 per cent increase in children enrolling in primary schools; and a doubling of access to safe drinking water and basic sanitation1. However, Watkins (2000) reported that by end of the 1990s, there were 70 million more people in the developing world (excluding China) living in poverty than at the start of decade6. Arguably, poorer countries are unable to compete in neo-liberal global economies since policies favour richer countries for economic growth, and protectionism by wealthier economies is estimated to cost poor countries in excess of US$700bn per annum. The least developed countries account for 12 per cent of the world's population, but only 0.5 per cent of trade. Perhaps the worst feature of globalisation is the powerlessness of poorer countries in the face of trade rules and subsidies - decided by corporations and legitimated by First World government policies - that can destroy livelihoods in poorer countries. GLOBALISATION AND SETTLEMENT PATTERNS Globalisation means that capital can be, and is, very mobile. The movement of people to areas of employment and higher wages is contributing to deteriorating conditions in human settlements, including7,8:
Such new urbanisation processes are being researched by the United Nations Centre for Human Settlements (Habitat) (UNCHS), whose objectives include poverty reduction and the promotion of sustainable development and adequate shelter for all. UNCHS is collating evidence on habitation patterns, including issues such as access to drinking water, space standards, sanitation etc4. In many cities in the developing world, up to the half of the population now live in shack settlements (also called shanty towns, or informal developments) which lack infrastructure and amenities. Such developments represent an affordable housing solution created by and for the urban poor, often located close to sources of employment. Residents are powerless and suffer the constant threat of eviction because their settlements frequently lack legitimacy and tenure. Consequently, residents have insufficient incentive or financial ability to improve conditions. Such a mobile - and often impoverished - population can suffer detrimental health effects, including an increased vulnerability to disease, due to reduced immunity, and also an increase in sexually transmitted diseases, especially HIV/AIDS. The economic cycle is further diminished through the disproportionate poor health and malnutrition of the world's poor, as good health is seen to improve gross domestic product (GDP). This can be aggravated by a net withdrawal of health personnel relocating to areas where wages are higher and working conditions preferable, encouraging an educational and technological divide. Poverty reduction, rather than increased dependency on international trade, is seen as crucial. Diversification of exports - with fair trade rules - can help promote local, sustainable economies, while local schemes to eliminate poverty and promote livelihoods can help communities to move away from dependency and help promote gender equality. What is needed is the promotion of greater global social justice. The alternative is growing conflict, which effects us all. Jill Stewart, senior lecturer at the School of Health, University of Greenwich, London. References
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An
understanding, appreciation and acceptance of the process and outcomes
of globalisation depends largely on one's perspective (see table
1). The UK's Department for International Development (DFID) sees
globalisation as a positive concept that, if carefully managed,
can drive world change to benefit all, including the world's poor.
Stephens
is concerned with structural changes brought about by the globalisation
process - including who is making and influencing policy decisions
- and how this forges public health shifts, including behavioural
patterns and employee status2.
This is summarised in table 2 . However, there are also those who
adopt a Marxist perspective, whereby globalisation is seen more
fundamentally as an evolving form of capitalism.