by Dr. Chandrima Chatterjee, Dr. Parul Malik and Dr. Arathi P Rao

Globalization has been described by the economist Brian Easton [1] as “problematic”. He also mentions that often writers avoid explaining about globalization analytically but rather, relate it to a series of phenomena such as capital flow, international organizations and policies as the likes of “free trade”. There is an absence of a common definition of globalization and an ample amount of debate is ongoing, regarding the same. One of the ways in which globalization is sometimes referred to as is “a progressive integration of economies and societies”.

An important domain that globalization has had a definite impact on, is health and health care. Health systems encompass stakeholders at various levels- local, national and international. Individuals, households, communities, organizations, policy makers, institutions, industries, health centres and more are directly or indirectly being influenced by this ongoing globalization, when it comes to health and related matters.

Global Heath (GH) is defined by Koplan et al. [2] as ‘an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide’ has come to the forefront as a promising and emerging segments of health, with its own possibities as well as challenges and responsibilities. GH and globalization, both, despite being processes of increased worldwide interconnectedness, can operate only if an understanding of the local systems is thorough. Especially in healthcare, it is very important to understand the local health scenario and risks that communities face or are prone to, in order to ensure an effective and feasible decision making. [3]

An emerging example of globalization in healthcare is the rapid growth of medical tourism.[4] It is an example of dissolving boundaries in terms of healthcare service delivery. On the international map, countries like India, Indonesia, Malaysia, Philippines, Singapore, Thailand etc. have marked themselves as major ‘medical tourism destinations’.[5] Many people travel to get less expensive and more timely medical attention.

Medical tourism has come in vogue for individuals from countries where there is a delay in getting certain medical procedures done, for example, patients requiring hip and knee replacement surgeries in Canada, often choose to travel to India as the services are more rapidly available, in comparison to their own country.[6] An example of rampant utilisation of medical tourism is the ‘uninsured’ (over 47 million) Americans [5] travelling to Mexico and India, to obtain affordable care.[7] Another factor which has contributed to increased medical tourism is the acceptance of some medical practices like Euthanasia, in certain countries. [8] In an alternate scenario, people who can afford expensive healthcare are often seen to make arrangements for obtaining their medical treatments in renowned medical facilities of the USA like Mayo Clinic and Cleveland Clinic. [5]

On the other side, this increase in medical tourism has its own associated risks, for example, the safety of the patients as well as their attendants. Health-related travel, once promoted by individual medical facilities such as Bumrungrad International Hospital, Bangkok, is now being driven by government agencies, public–private partnerships, private hospital associations, airlines, hotel chains, investors and private equity funds, and medical brokerages. This could, in the long run, increase regional economic inequalities and undermine health equity. [5]

To take another example, the World Health Organization has estimated that by the year 2020, Non-Communicable Diseases (NCDs) like obesity, cardiovascular diseases and cancers will constitute almost two-thirds of the disease burden of the world. [4] This expected increase can be attributed to two factors- globalization, and individual choices such as the choice of food and lifestyle. The numbers of overweight and obese individuals are projected to increase by 44 and 45%, respectively, from 2005 to 2030, totalling to nearly 1.35 billion people being overweight and 573 million being obese, globally, with a more rapid increase in the developing regions of the world. [9]

“The worldwide increase in obesity and related chronic diseases has largely been driven by global trade liberalization, economic growth and rapid urbanization. These factors continue to fuel dramatic changes in living environments, diets and lifestyles in ways that promote positive energy balance.” [10]

On one hand, globalization has resulted in remarkable improvements in quality of life and food security as well as a reduction in poverty, but on the other hand, the unintended consequences of globalization due to range of food options available are driving the obesity epidemic throughout the world. The availability of fast food and beverage brands across the borders has become increasingly possible because of the process of globalization causing obesity to increased manifold. As many countries experience rapid economic growth and modifications to food choices and availability, evident shifts in dietary structure or nutritional transitions occur that increase overnutrition and positive energy balance. For example, the global number of outlets of McDonalds grew from 951 in 1987 to 7,135 in 2002. Fast food has been associated with obesity and metabolic disease for numerous reasons, including high calorie content, large portion sizes, highly refined carbohydrates, unhealthy fats and levels of sugar and oils.[10]

Both medical tourism and the burden of obesity are instances where globalization has exerted influence on people’s lifestyle, with immediate and possible long term consequences. These examples show that globalization, therefore, has a multifaceted impact on health care and influences it economically, technologically, politically, socially, scientifically and culturally. [4] The resultant outcomes have been both- positive and negative.

With the advent of the COVID-19 pandemic, there is no option but globalisation, as we take aid and lessons from other countries to contain the pandemic. Exchange of academic expertise across the countries provides a first hand experience about the effects of pandemic compared to literature reviews. The debate whether globalization is a boon or a bane, can never be settled, but an analysis of both the aspects, can give a direction to future policy and planning. For globalization to be a success, it is very important to understand the local scenarios in the communities to comprehend the health needs and address any inequities which are already present or can be expected to arise.

Dr. Chandrima Chatterjee is a dental surgeon and currently a postgraduate student, pursuing Master of Public Health (Global Health) at Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.

Dr. Parul Malik is a medical doctor with a Master of Public Health (Global Health) degree from Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.

Dr. Arathi P Rao is the Coordinator of MPH Programme and the Head of Manipal Health Literacy Unit at the Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.

References

  1. Easton B. Globalisation and the Wealth of Nations. Auckland University Press; 2013 Oct 1.
  2. Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, Wasserheit JN. Towards a common definition of global health. The Lancet. 2009 Jun 6;373(9679):1993-5.
  3. Birn AE, Pillay Y, Holtz TH. Textbook of global health. Oxford University Press; 2017 Jan 24.
  4. Pang T, Guindon GE. Globalization and risks to health: As borders disappear, people and goods are increasingly free to move, creating new challenges to global health. These cannot be met by national governments alone but must be dealt with instead by international organizations and agreements. EMBO reports. 2004 Oct;5(S1):S11-6.
  5. Turner LG. Quality in health care and globalization of health services: accreditation and regulatory oversight of medical tourism companies. International Journal for Quality in Health Care. 2011 Feb 1;23(1):1-7.
  6. Crooks VA, Cameron K, Chouinard V, Johnston R, Snyder J, Casey V. Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients. BMC health services research. 2012 Dec 1;12(1):417.
  7. MacReady N. Developing countries court medical tourists. The Lancet. 2007 Jun 2;369(9576):1849-50.
  8. Gan LL, Frederick JR. Medical tourism facilitators: Patterns of service differentiation. Journal of Vacation Marketing. 2011 Jul;17(3):165-83.
  9. Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. International journal of obesity. 2008 Sep;32(9):1431-7.
  10. Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nature Reviews Endocrinology. 2013 Jan;9(1):13-27.3.

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