Globalisation and the challenges to health systems
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7355.95 (Published 13 July 2002) Cite this as: BMJ 2002;325:95
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The internet has evolved as both a cost effective and reliable source
of information dissemination. The people of the developing world primarily
those belonging to Africa are unable to reap the benefits of this
technology. There exists a huge disparity in the availability of
resources. While it is estimated that about 46.1%[1] of Germans between
the age of 14 and 69 use the internet regularly, less than 0.05% of people
in many countries of sub saharan Africa regularly use Internet.Moreover,
internet acting as the spearhead of globalisation is slowly wiping away
indigenious systems of medicine and thereby reversing the health
development to some extend.Instances of developing countries like India
leap frogging into the Information age still remains as isolated
instances.
The researchers of the developing world often feel frustrated when it
comes to publishing their findings .I feel they should exploit the new
avenues opened up by the internet to tide over this .
We at the Center for Cybermedicine and Internet research is in the
process of creating a network of researchers in developing countries
towards achieving this goal.
Competing interests: No competing interests
The pace of globalisation is perhaps in its accelerated phase now.
Internet has emerged as the single largest media which accelerates the
pace of globalisation. Globalisation in terms of health information is to
be discussed seriously.Apart from the huge advantage that information on
practically all ailments are available on the internet, there are rising
concerns on the future of indigenious and alternative systems of medicine,
which derive mainly from the technologically poor developing countries.
Though the fact that there are instances of these knowledge being
available on the internet, these remain isolated instances.These systems
of medicine often evolved in centuries and offer satisfactory, culturally
acceptible and cost effective cure to common ailments. The global
information invasion is gradually wiping away the existence of these
systems of medicine.These systems are often refined based on research and
have already proved useful in many ailments . The immediate need is to
preserve these knowhow for our future generations too.
Vinod Scaria
Competing interests: No competing interests
The real dark side of globalization
Dear Sir
Frenk and Gomez-Dantes1 are to be congratulated in outlining the
challenges ‘globalisation’ poses to public health but in this and three
accompanying articles we find only passing mention of the international
economic context it entails. We would argue that this is both a dominant
feature of the phenomenon and a major determinant of health.
The correlation between Structural Adjustment Programmes and deterioration
in health services and indicators is by now well-documented even by the
World Bank2 and the Poverty Reduction Strategy Papers that have replaced
them continue to prioritise the interests of foreign investors over local
people. So it is ironic that just when the development crisis precipitated
by AIDS has forced global public goods onto the international agenda, the
provisions of the General Agreement on Trade in Services and those
envisaged by the Multilateral Agreement on Investment are facilitating
transnational market penetration and demonstrably threatening provision of
and access to local public goods worldwide, among them safe water, food
security and health.
Developing countries lose at least $1.3 billion every day because of
unfavourable trade rules3, particularly relating to agriculture and
textiles, and $0.5 bn per day in debt servicing4. This continued net flow
of resources from South to North represents a massive opportunity cost for
health that the Fund alone will struggle to redress. If donors met the
OECD target of 0.7% of GDP for official development assistance proposed
more than thirty years ago such funding would reach $200 bn per year by
2005. The $2.05 bn over three years initially committed to the Global Fund
appears in a different light when presented in the company of such
statistics5.
In the current climate of optimism we cannot afford to be cynical and
we agree that health is one global public good that should command
universal assent. We must seize the chance to empirically demonstrate the
effectiveness of the strategy proposed by the Commission on Macroeconomics
and Health. However we must also recognise and challenge the constraints
imposed by the current international economic order in the arena where
it’s inequitable effects are most obvious if our efforts are to have the
scale and impact that the poor and sick in developing countries deserve.
In addition to exchange, evidence and empathy we desperately need
engagement. To many worthy words we would add only those of Mary
Wollstonecraft: “It is justice not charity that is wanting in the world”.
Geraint Davies
Registrar
Department of Microbiology and Infectious Diseases
Nottingham City Hospital
Hucknall Road,
Nottingham NG5 1PB
Mickey Chopra
Senior Lecturer
School of Public Health,
University of the Western Cape,
South Africa
ShunMay Yeung
Research Fellow
Wellcome-Mahidol-Oxford Programme,
Faculty of Tropical Medicine,
Mahidol University,
Bangkok,
Thailand
Corresponding author: gerrydavies@doctors.org.uk
1. Frenk J, Gomez-Dantes O.Globalisation and the challenges to health
systems BMJ 2002; 325:95-97
2. Structural Adjustment Participatory Review International Network. The
policy roots of economic crisis and poverty :a multi-country participatory
assessment SAPRIN April 2002
3. UNCTAD The Least Developed countries report. Geneva: UNCTAD 1999
4. World Bank. Global Finance Report. World Bank 2001
5. Lewis S. Address to the opening ceremony of the G6B People’s summit
June 2002. Available at http://www.g6bpeoplessummit.org
Competing interests: No competing interests