Global Health Issues and Policies

This article discusses globalization, global stratification, and their relationship to global health issues and policies. Large numbers of people throughout the world face significant health challenges. Health is defined by the World Health Organization as being in “a state of complete physical, mental and social well-being” (WHO, 2009). Following a brief review of the basic sociological perspectives on global stratification, the relationship between a country's level of wealth and its government's ability to provide safe drinking water, good nutrition, and access to medicines and medical treatment is discussed, along with health issues such as unsafe abortion, sexually transmitted diseases, and other infectious diseases such as tuberculosis and malaria as well as HIV /AIDS.

Keywords Biotechnology; Dependency Theory; Globalization; Global Stratification; G8 Nations; HIV /AIDS; Infectious Diseases; International Division of Labor theory; Sexually Transmitted Diseases; Socialized Medicine; Universal Health Care; Unsafe Abortion; World Systems Theory

Global Health Issues & Policies

Overview

For much of the first half of the 20th century, global approaches to health focused on curing infectious diseases. Later in the century, developments in transportation technology exacerbated the transmission of infectious diseases, affecting more people on a global scale. The spread of disease was also accelerated by mass migrations caused by war, civil strife, hunger, and natural disasters. The industrialization of agrarian societies, coupled with the internationalization of trade, has led to some improvements in controlling infectious disease. Today, global health is considered political issue. It is concerned not only with infectious disease, but also chronic diseases, as well as environmental pollution, occupational health, injury prevention, war, and hunger. The entire international community is now a part of the effort to reverse poor health conditions (MacArthur, 2003).

In September 2000, world leaders from 189 countries gathered at the United Nations in New York for the Millennium Summit, which focused on facilitating economic growth and combating health challenges. As the United Nations Children’s Fund reported “as some countries look ahead to prosperity and global cooperation, many barely had a future, being mired in miserable, unending conditions of poverty, conflict and a degraded environment. Some 1.1 billion people still are forced to live on less than $1 a day, and 30 per cent of these are children. Even in the world's richest countries, one in every six children still lives below the national poverty line” (UNICEF, 2008, par. 2).”

Globalization & Health

Globalization, or the global expansion of trade, technology, transportation, communication, and culture, is beneficial to some populations, but harmful to others—namely, the disadvantaged and poor, threatening their health and well-being. Additionally, humanity faces significant challenges related to pollution, global warming, and atmospheric damage (Harris & Seid, 2004). The term global stratification refers to the division of the world’s population between those who are advantaged and those who are disadvantaged. In 2012, 6.6 million children under the age of five died of preventable causes such as pneumonia, diarrhea, and malaria, as well as from malnutrition, poor hygiene and lack of clean water. Millions of people die each year because they lack access to basic services, including vaccines, antibiotics, nutrition supplements, and insecticide-treated bednets.

In many of the world's poorest countries, the malaria parasite has become resistant to chloroquine, which has long been the standard frontline treatment (McKinnell, 2008). Over 8.5 million tuberculosis cases were diagnosed in 2012, mostly in African countries. HIV/AIDS remains a huge problem in sub-Saharan Africa and throughout the world. In 2012, an estimated 33.4 million people worldwide were living with HIV/AIDS. Approximately 97 percent of these cases are in low and middle-income countries, many of which are in Sub-Saharan Africa. An estimated 2 million people are living with HIV in Latin America, in addition to 4.7 million in Asia and 1.5 million in China.

Poor countries face serious challenges related to unequal health care. Private health insurance is essentially non-existent. The majority of health insurance companies will not reimburse for care in developing countries and health professionals often migrate from poor countries to rich countries, impacting the global health economy (Inglehart, 2006). Health care professionals and social scientists are continuing to work to understand the underlying reasons for health inequality. These include the marginalization of large groups of people throughout the world and injustices in trade and the availability of care. Moreover, health care professionals from poor countries rarely return to work in the countries they were born. In addition to the work of international national organizations, university-level programs have been developed to help medical students do more work to address the global problems in inequality and health (Garman & Hughes, 2006).

Global Stratification & Health

Global stratification is a top-down, hierarchical arrangement of inequality among countries, with their position determined by the amount of control these groups have over their own resources as well as the resources outside their borders.

Health is defined by the World Health Organization as a state of complete physical, mental and social well-being. This does not only mean that disease, or frailness is controlled, but goes beyond that narrow definition (Kendall, 2006). But disease is a prime global problem and there are still many uncontrolled infectious diseases such as malaria and tuberculosis, often due to unsanitary or overcrowded living conditions in low-income countries (Kendall, 2006).

The world faces three main health and policy problems. First, for some diseases, there are no good tools or cures. Next, in some cases, cures are available, but too expensive to the reach the poor who need them most. Third, even if solutions to the healthcare crisis are cheap or even free, systems and personnel are not available to get them to the right places (Chan, 2007).

Globalization of Health-Related Technologies

There are also several issues related to the globalization of health-related technologies. Development of new drugs and vaccines is often lacking for diseases that most often occur in poor countries. Drugs are often misused, or are not pathogen resistant. To counteract these negatives, vaccines and medicines must be made available at a lower cost (Inglehart, 2006). But equally as important is the fact that technology, including health-related technologies, have adverse effects on the environment, and that these technologies are often not available to those who need them most among the poor and the disadvantaged.

Further Insights

Several theories have been put forward to answer the question of why so much of the world is getting richer and thus, receiving better health care, while the poor cannot achieve even a basic standard of living. These theories include the Development (and within it, the Modernization Theory), the Dependency Theory, the World Systems Theory and the International Division of Labor Theory. Each of these theories reflects the sociological perspectives of the structural-functionalist and conflict schools of thought in sociology (Macionis, 2007).

Development & Modernization Theories

A structural-functionalist theory, the Development and Modernization theory argues that a higher standard of living occurs when a nation industrializes and social mobility becomes possible. Low income countries can improve their standard of living through economic growth and the falling away of traditional cultural beliefs and values (Rostow, 1971).

Dependency Theory

According to conflict theorists, because poor countries need the money offered by high income countries, they are continually in debt and can never repay what they owe, making them continually dependent on more foreign capital in what amounts to a vicious cycle (Macionis, 2007).

World Systems Theory

The World Systems Theory argues that it is not exploitation of one country by another, but simply economic domination because of high levels of industrialization and urbanization by core, or high income nations over peripheral, or low income countries (Wallerstein, 1979).

International Division of Labor Theory

Finally, the International Division of Labor theory, which states that multinational corporations can locate wherever labor is the easiest and cheapest to obtain. Often, sending jobs into low income countries does not lower the poverty level of the workers involved. Many of them have reported that they cannot afford to buy the products they help to manufacture (Goodman, 1996).

Global Economies

Because data from individual countries can be difficult to moderate, the United Nations uses the gross domestic product of a country, which tracks all the goods and services a country produces each year, and the World Bank use a measure of income inequality known as the Gini coefficient, which ranges from 0 meaning everyone has the same income, to 100, meaning one person receives all the income. Where a country's economy resides along the continuum from 0 to 100 determines its state of wealth, or poverty (Macionis, 2007)

The gap between the richest and poorest countries in the world has grown in the past half century, with the wealthiest countries often having 80 times the income of the poorest countries (U.N. Development Programme, 2003). Social scientists have identified three different global economies: low income, middle income and high-income countries.

Several key factors affect a group of people's quality of life and these indicators of human development are constantly measured by the United Nations and the World Bank. For example, in 2011, the World Health Organization reported that the average life expectancy in high income countries was 80 or higher, while in low income countries the life expectancy was 60 or below. This disparity often has to do with nutrition.

Also, because education is often believed to be the way out of poverty for groups of people, literacy and school enrollment are used to measure a country's development. An estimated 75 percent of the world’s 775 million illiterate adults live in developing countries.

Health Issues

Infectious diseases, unsanitary living conditions, and degenerative diseases such as cancer can affect the physical, mental or social well-being of a people. The health of all populations is negatively affected by lifestyle choices such as cigarette smoking and unhealthy foods.

Despite numerous types of health insurance programs, about one-third of all U.S. citizens do not have health insurance or are unable to pay for medical care and often must do without medical treatment. Other countries such as Canada, Great Britain and China, offer some form of socialized medicine or universal healthcare, where medical services for people are paid for through a system of taxation on all citizens (Kendall, 2006).

New technologies in medicine are very costly and not everyone can afford them. They are saving lives, but they are also changing the way people relate to one another. For example, a person can be kept alive artificially, sometimes indefinitely. It becomes the obligation of family members to decide how long the situation should continue, mounting great financial cost and putting an enormous burden and often a strain on family relationships. The ability to decide when to begin, or to terminate life, has people questioning the ethics of these decisions that in earlier times were believed to be outside the realm of human choice. For example, a couple expecting a baby can find out in utero, if the fetus has any major health problems and if they want to continue, or abort the pregnancy.

Sexually Transmitted Diseases

In many places in the developing world, people have traditionally avoided talking about sexually transmitted diseases (STDs), and moral judgments and attitudes have affected programs and funding because of these cultural prejudices. The only STD that has received major attention and response is HIV/AIDS, but controlling other STDs has actually declined in recent years. Programs to screen for syphilis, for example, can also help during the screening process, to make early detection of HIV possible, thus constraining both types of infectious disease. However, the stigma and moral opposition to STDs must be overcome through educational programs before any demonstrated control is possible (Low et al., 2006).

Sanitation & Water Supplies

Safe and accessible drinking water is a major concern throughout the world because it can result in vast improvements in the overall health of a population. Unsafe water supplies are often contaminated with infectious agents, toxic chemicals, and radiological hazards. In 2012, the United Nations estimated that some 2.5 billion people worldwide do not have basic sanitation facilities.

Unsafe Abortions

Unsafe abortions throughout the world have reached pandemic proportions, with some 20 million unsafe abortions performed every year, nearly 100% of the time in low income countries. These abortions, performed by unskilled persons in medically unsafe environments, threaten the lives of women in low income countries where abortions are restricted by law, or where safe abortions are too expensive and not readily available. In high income countries, safe abortions have become highly skilled and efficient industries. Researchers point to the resources available to governments, but a lack of political interest in and disdain for the well-being of women in many societies precludes improvement in this area. Access to safe abortions will greatly improve the health of women, their children and their families (Grimes et al., 2006).

Pharmaceuticals

There are problems in the invention, manufacture and distribution of medicines to people the world over who need them. Many people blame the pharmaceutical companies for the problems, arguing that the industry is more interested in the bottom line than in helping sick people get well. However, governments must share in the blame by making cost-containment the centerpiece of their health care policies.

On the other hand, the pharmaceutical industry counters that research and development is very expensive. For example, it costs about $800 million and a period of ten to twelve years to develop a new pill; money that often isn't returned (McKinnell, 2008).

Biotechnology

Researchers point to a "10/90 gap" whereby 10% of the world's population receives about 90% of health research money. Meanwhile, resources for health research in developing countries are limited and the urgency with which new technologies are needed to save lives seems to fall on deaf ears. Scientists seem to feel that biotechnology cannot contribute to health and prevention of disease in poor countries. But their colleagues are developing models that point to the success a simple vaccine would have in preventing infectious diseases. New drug systems and delivery methods must be created that do not require refrigeration, for example, and can thus be distributed in the most remote areas (Daar et al., 2002).

Conclusion

Global healthcare is a complex issue and requires a concerted and coordinated effort between private and public sectors. This effort has begun with the battle against AIDS, but there are many other diseases and health problems that are killing millions. In low income countries, malaria and tuberculosis are highly problematic. But the basics of good nutrition, sanitation, and safe drinking water must also be addressed. In high income countries, problems are similar. Heart disease, cancer and stroke kill people despite, and perhaps even because of, rich diets and sedentary life styles.

Recent scientific discoveries and advances such as the mapping of the human genome have helped raise the level of well-being in the world. The sharing of the accumulating scientific knowledge via new communications technologies like the Internet is helping to stimulate more discoveries. Computers are vitalizing the pharmaceutical sector as well, by allowing research on different compounds to go on simultaneously.

Governments, academic and private groups must join forces to expand the understanding of global health problems and to find common solutions (McKinnell, 2008).

The goals of the Millennium Summit are as follows:

• Eradicate extreme poverty and hunger

• Achieve universal primary education

• Promote gender equality and empower women

• Reduce child mortality and improve maternal health

• Combat HIV/AIDS, malaria, and other diseases

• Ensure environmental sustainability

• Develop a global partnership for development (UNICEF, 2008)

They need to be supported by everyone to improve the health and well-being of all citizens of the world.

Terms & Concepts

Biotechnology: The use of microorganisms or biological substances for industrial or manufacturing processes such as the production of drugs, synthetic hormones, and food.

Dependency Theory: A sociological conflict perspective, which argues that global inequality exists because rich countries exploit poor countries.

Globalization: The expansion of global links, organization of social life on a global scale, and growth of global consciousness, creating a world society.

Global Stratification: A system of social and economic inequality throughout the world.

High-income Countries: Nations with the highest overall standards of living.

G8 Nations: The Group of Eight (G8) is an international forum that includes Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, and the United States

International Division of Labor Theory: Allocating various parts of the production process to different places in the world where low-skilled, poorly paid, and ecologically damaging work is moved to developing countries, where the work is often done by non-unionized, female labor, working in poor conditions.

Sexually Transmitted Diseases (STD): Diseases that are passed on to others through sexual contact.

Socialized Medicine: A publicly-funded health care system.

Universal Health Care: A health care system uses both public and private health care providers.

Unsafe Abortion: An unsafe abortion is a procedure for terminating an unintended pregnancy by persons with no requisite skills, or in a place that has low, medically safe amenities.

World Systems Theory: Economic domination by high-income nations of middle-income and low-income nations.

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Suggested Reading

Greenberg, H., Raymond, S. U., & Leeder, S. R. (2011). The prevention of global chronic disease: Academic public health's new frontier. American Journal of Public Health, 101, 1386–1391. Retrieved December 30, 2014 from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=64138690

Koop, C., Pearson, C., & Schwarz, M. (eds.). (2002). Critical issues in global health. San Francisco, CA: Jossey-Bass.

Nadakavukaren, A. (2005). Our global environment: A health perspective. Prospect Heights, IL: Waveland Press.

Nichter, M. (2008). Global health: Why cultural perceptions, social representations, and global biopolitics matter. Tucson, AZ: University of Arizona.