Elsevier

The Lancet

Volume 351, Issue 9100, 7 February 1998, Pages 434-437
The Lancet

Consensus
Globalisation of international health

https://doi.org/10.1016/S0140-6736(97)05546-3Get rights and content

Summary

40 years ago, activities in international health were the domain of WHO, governments (based on bilateral agreements), and non-governmental organisations. This has changed. Today, new players (such as the World Bank and, increasingly, the World Trade Organisation) have an influence on international health. As globalisation of trade and markets takes hold, new coalitions and alliances are forming to examine and deal with the direct and indirect consequences on health. This paper examines the changing context of cooperation in international health, and voices concerns about rising potential inequalities in health, both within and between countries. The question of how such changes will affect the actions of organisations working in international health is also addressed.

Section snippets

Background

WHO, once the main player in “directing and coordinating international health work” is now one of many. Other UN organisations are concerned with health; the World Bank now plays an increased financial and technical role in the sector, and bilateral agencies make significant contributions to health both at global and at national level. The private sector—consisting of a wide range of non-profit organisations, such as nongovernmental bodies (eg, Oxfam) or foundations (eg, Rockefeller), and

Direct challenges to health care in the year 2000

Although many of the direct challenges to health will be met by domestic health policies, some will depend heavily on international collaboration. Health care will be affected directly by predominant disease patterns, such as emerging infections, and by interventions to address them; health care will be affected indirectly by issues such as increased pollution. The understanding, monitoring, and treatment of emerging infections and resistance to existing drug therapy will demand global

Indirect challenges to health

Globalisation is increasingly acknowledged as a force that is changing many aspects of life far beyond financial markets and trade. Although some indirect challenges to health in the next century will not necessarily result from globalisation, changes in trade and markets, the movement of people, goods, and services (including trade in legal and illegal substances and in military arms), and communications over the past half-century will have consequences on health in the next 50 years (panel).

Winners and losers in the global economy—emerging health inequalities

Although the extent to which globalisation is affecting health is unclear, winners and losers in the world economy will undoubtedly emerge—both between and within countries. During the past two decades, for example, the least developed countries—which make up 10% of the world's population—have halved their share of world trade, and today account for only 0·3% of it.21 Whether or not such inequalities result primarily from globalisation, they have potentially severe repercussions for relations

Rethinking the role of international organisations

In view of the challenges that affect health care directly and indirectly, priorities need reordering and hard choices must be made. More attention needs to be paid to which functions international organisations are best able to undertake, and what national governments should be doing. Some functions may be better organised through intergovernmental networks than through multilateral organisations (issues of publichealth regulation, for example).

International organisations may have to increase

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