Our current fractured world has seen the tide of globalisation wash over it, with ills and pains it left in its wake. The gains from a globalisation have been unparalleled, with millions being lifted out of extreme poverty in the past few decades of accelerated growth.[1] However, the vast social and economic costs to many communities cannot be ignored. It would be an understatement to say that this global model has failed many, and yet, before we write off the system as a total failure, it is worth acknowledging that what is instead needed is a complete re-evaluation of the system as a whole. It is not nearly perfect enough, with half the world’s population without full coverage of essential health services.[2] It can surely be agreed, however, that under no system has healthcare worked best for everyone.
Given its many determining factors, healthcare should be considered holistically on a global scale, where gains are made to benefit the whole of humanity. Innovations in medical care flourish best when not stifled by patronising polices and hindered trade.[3] Apart from the fiscal benefits of free trade that allow countries to direct more funds to healthcare, globalisation provides much needed market competition that incentivises companies to innovate.[4] For example, companies producing antibiotics or medical equipment are required to keep products up to standard and create new ones that undoubtedly contribute to global wellbeing. Competitive market conditions discipline industries, and those such as the pharmaceutical industry can make much needed drugs more widely available at a lower price because of globalisation.
Issues in healthcare cannot be justly examined without addressing underlying inequities. Contrary to what opponents to free trade often claim, trade barriers tend to transfer wealth within a country, not necessarily making everyone better off. Tariffs increase the surplus of the producer but to compensate for the gain, the consumers take a loss.[5] If the gains are not distributed fairly, the divide between the socioeconomic status of the wealthy and that of the poor is further exacerbated, which is reflected in the health status of individuals.[6] Equally as imperative are the health implications of those individuals who are excluded from the global market due to poverty. While the world is richer, the wealth is not shared equally, and simultaneously these communities are denied prosperity and good wellbeing.[7]
Globalisation has meant that global institutions remain pertinent in imposing and maintaining health policy worldwide.[3] The World Health Organisation helps to strengthen health services and encourage governments to work towards achieving the Sustainable Development Goals, while the World Bank can provide nations with resources to improve their health sector through its loan schemes. And yet the very same global force has economically excluded and rendered many helpless.
Too often this debate revolves around dismissing globalisation, but we would do ourselves a favour by simply asking a different question; how do we make it work better? It is harder to fix something than to simply decide it doesn’t work and is flawed at its core. Our effort should be focused on empowering communities and targeting those left behind in a sustainable manner. Progressive tax reforms in conjunction with ensuring that social safety nets compensate those who lose out should be at the forefront, while also providing proper training for displaced workers for jobs of the future. As such, corporations need to invest in their human capital, for all parties’ sake. In an increasingly dynamic world where the only certainty is uncertainty and where technology is evolving at an accelerating rate, all rules of competition indicate that enterprises cannot afford to have an unadapted vulnerable workforce. Where socio-economic status is inevitably linked to health status, redundant workers will have a harder time facing burgeoning healthcare costs.[8]
Amid the many qualms regarding globalisation it is undeniable that there has been significant progress in global health status worldwide. Health should not be a private good at the mercy of market conditions, but a ‘global public good’.[9] An overhaul of the current system is needed. After all, what is our alternative?
[1] Bagri, N. T. (2016, October 2). Balancing the scales [Web blog post]. Retrieved from https://qz.com/798481/over-a-billion-people-have-been-lifted-out-of-poverty-since-1990-but-the-next-billion-will-be-harder/
[2] Dimitrova, D., & Candeias, V. (2018). Healthcare costs impoverish millions. 4 ways to end the injustice. Retrieved from https://www.weforum.org/agenda/2018/04/healthcare-costs-impoverish-millions-4-ways-to-end-the-injustice
[3] Huynen, M. M., Martens, P., & Hilderink, H. B. (2005). The health impacts of globalisation: a conceptual framework. Globalization and Health, 1, 14. http://doi.org/10.1186/1744-8603-1-14
[4] Gorodnichenko, Y., Svejnar, J., & Terrell, K. (2009). Globalization and innovation in emerging markets. Policy Research Working Paper, 2009, 4808. Retrieved from https://openknowledge.worldbank.org/bitstream/handle/10986/4006/WPS4808.pdf?sequence=1
[5] Gans, J., King, S., Byford, M., & Mankiw, N. G. (2015). Principles of Microeconomics (6th Edition). South Melbourne, Vic: Cengage Learning Australia.
[6] Sommers, B. D., Gawande, A. A. & Baicker, K. (2017). Health insurance coverage and health- What the recent evidence tells us. The New England Journal of Medicine,377, 586-593. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMsb1706645#t=article
[7] Feachem, R. G. A. (2001). Globalisation is good for your health, mostly. BMJ : British Medical Journal, 323(7311), 504–506. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121084/
[8] Chau, D. (2018, January 25). Health insurance premiums to rise by twice as much as wages [Web blog post]. Retrieved from http://www.abc.net.au/news/2018-01-25/health-insurance-premiums-to-rise-4pc/9360936
[9] Smith, R. D. (2003). Global public goods and health. Bulletin of the World Health Organisation, 81(7), 475. Retrieved from http://www.who.int/bulletin/volumes/81/7/en/Smith0703.pdf
Image: Marco Verch