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See all Premium member Presentation Transcript A PRESENTATION ONGLOBALIZATION AND ITS IMPLICATIONS ON HEALTH CARE : A PRESENTATION ONGLOBALIZATION AND ITS IMPLICATIONS ON HEALTH CARE Ms. Rohini Sharma, MN FINAL STUDENT. Slide 2: What do you understand by GATT? Have you got any idea about Recession ? What do you understand by Global warming? What is Paradigm Shift? What does the global promotion of international brands tells us? What is the International year of Nurse? Slide 3: WHAT DO U UNDERSTAND BY THESE DEVELOPMENTS? WHERE IS THE WORLD AND THE PEOPLE OF THE WORLD HEADING FOR? SHOULD THE NURSES KNOW THE IMPLICATIONS THAT THESE CHANGES ARE CAUSING? WHAT IS THIS PHENOMENA THAT HAS ITS ROOTS DEEP IN THE SYSTEM THAT WE CANNOT UNDERESTIMATE? Slide 4: “The fragility of our frontiers has arisen in the face of the world’s new challenges.” -Britain’s Prime Minister Tony Blair. The shift of human affairs from the restricted frame of the nation-state to the vast theater of planet Earth not only is affecting trade, finance, science, the environment, crime, and terrorism; it is also changing the nature of health challenges faced by people all over the world. Slide 5: “ The earth today has become flat.” Our world today is characterized by rapid changes, which are reflected in all areas of human relationships and the exchange of ideas and goods of any kind, in scientific discoveries, technological innovations, in the various life styles, in values and in cultural expressions of any kind, as well as in art and religion. Every day we hear about and experience the consequences of a multi-dimensional phenomenon, the so-called globalization. What is Globalization?? : What is Globalization?? Increasing and improving our way of living. Comfortable and convenient way of living Easy for to reach other people anywhere in this world. Easy to manipulate and access in exchanging and transmitting of information, knowledge, goods and funds to the allied countries. Slide 7: Interconnectedness and interdependence of people and countries and includes the opening of borders to increasingly fast flows of goods, services, finance, people and ideas across international borders. (WHO) International Forum on Globalization (IFG) states that globalization is the present worldwide drive toward a globalized economic system dominated by supranational corporate trade and banking institutions. History of globalization: : History of globalization: Started from the World War II, Britain and the US helped to form the World Bank and International Monetary Fund in 1944 to promote a liberal, capitalist world against Socialism and Marxism. The loans are granted by IMF and WB on the condition that the borrowing country will reduce the state's role in the economy, lower barriers to imports, remove restrictions on foreign investment, eliminate subsidies for local industries, reduce spending for social welfare, cut wages, devalue the currency, and emphasize production for export rather than for local consumption. Slide 9: Such conditions gave birth to the World Trade Organization. Many governments have Adopted free-market Economic systems, vastly increasing their own productive potential and creating New opportunities for international trade and investment. A defining feature of globalization, is an international industrial and financial business structure. Types / Forms Of Globalization: : Types / Forms Of Globalization: Slide 13: Do you think that the policies of the countries of the world shall be affected by globalization? Will opening economies help to boost trade? Will it affect the economic status of the countries? What are the reasons for such wide spread globalized strategies ? Slide 14: There are five multilateral agreements on trade under the World Trade Organization that are relevant for health. Trade-Related Aspects of Intellectual Property Rights (TRIPS), which form a central element of economic globalization. The General Agreement on Tariffs and Trade (GATT) allows countries under certain conditions to ban the import of products if necessary to protect public health. Agreement on the Application of Sanitary and Phytosanitary Measures (SPS) affects national policies for food safety, and runs the risk health and safety regulations being used as an excuse for protecting domestic producers. DO YOU KNOW?? Slide 15: In 1964 Helsinki declaration on ethical principles for medical research involving human subjects was done. The Agreement on Technical Barriers to Trade (TBT) may have implications for the adoption of health and safety regulations, if they add to production costs. The General Agreement on Trade in Services (GATS) extends the concept of cross-border trade to include, for example investments in the hospital sector, thus potentially opening up health systems to privatization Slide 16: The 2002 Canadian Commission on future health care stated that access to health care is not only a domestic policy priority but also a key objective for foreign policy as well, and the promotion of human rights, including the right to health, is a fundamental principle of Canadian foreign policy. In contrast, US foreign policy is shaped by the domestic political agenda with schemes heavily influenced by the present administration's value judgments, and less likely to be part of a coordinated approach with other countries. This bring global health inequality??? DO YOU KNOW?? PROCESS OF GLOBALIZATION : Global movement of four fundamental forms of capital: Human Capital (Immigration, Migration), Financial Capital (Aid, Equity, Debt, Credit) , Resource Capital (Energy, Metals, Minerals) and Power Capital (Security Forces, Alliances, Armed Forces). PROCESS OF GLOBALIZATION : Global promotion of brands such as Coca-Cola and McDonald's is a cultural phenomenon but also an economic one (driven by the opportunity to expand profits and markets). “First World treatment at Third World prices is how industry sources define medical tourism in India.” According to a study by McKinsey and the Confederation of Indian Industry - CII, medical tourism in India could become a US$ 2 billion industry by 2012 (from US$ 350 million in 2006). The medical technology market was billed to be worth about $2.7 billion in 2006 and is likely to cross $10 billion by 2012 with a growth rate of over 20 per cent. It is estimated that over 85 per cent of medical devices and equipment are imported and the market is primarily dominated by MNCs. Slide 19: NOTIONS ABOUT GLOBALIZATION Slide 24: In 1997 an influential report by the U.S. Institute of Medicine stated: “Distinctions between domestic and international health problems are losing their usefulness and are often misleading.” According to the latest projections, Africa will be severely affected as early as 2020 by food shortage. By that date, increased water stress is expected to affect from 75 million to 250 million Africans. A dozen years from now, crop yields in some African countries are expected to drop by 50%. Imagine the impact on food security and malnutrition. The shift in the tobacco pandemic to the developing world has been clearly driven by the tobacco industry. It is estimated that, by 2030, 70% of all tobacco-related deaths (7 million annually) will occur in developing countries. Globalization in relation to health care: : Globalization in relation to health care: Healthcare worldwide is undergoing a dramatic change consistent with the changes due to globalization. While medical care has a long tradition of international cooperation and sharing of expertise, this current phenomenon is very different. Consequently, the mobilization of health services globally is with the expectation that healthcare services will provide quality and safety. Slide 26: Globalization has a great impact in health care sector where it is improving the relationship between personnel and the community, where the individual and the community is working hand in hand in every matter pertaining to health. A prosperous and stable population is an asset in every country. This world will not become a fair place for health all by itself. The globalization has to be converted to provide better facilities and answer to health problems for the people of the world. Slide 27: “Healthcare is a recession-proof industry and hence the impact is limited in this segment. Having said that, one cannot overlook the fact that the nature of this slowdown is due to a financial crisis which can impact all sectors, including healthcare, at the corporate level,” avers Dimple Sanghi, Executive Director, Indi Vision India Partners— a private equity fund of Future Capital Holdings, which invested in Hyderabad-based Global Hospitals through convertibles. Countries such as India, Indonesia, Nepal, Sri Lanka, and Thailand have become increasingly open to foreign direct investment. For example, approval has been given to a German company to have 90% foreign equity ownership for setting up a 200-bed hospital in Delhi. Several specialty corporate hospitals are being built in collaboration between Indian and foreign companies, including a US$ 40 million cardiac centre, set up under a consortium between Australia, Canada, and India. Corporate hospitals in developing countries are also establishing commercial presence overseas. For example, the Apollo group of hospitals in India has established a hospital outside the country and plans to invest roughly US$ 4 billion to build 15 new hospitals in Malaysia, Nepal, and Sri Lanka. Slide 28: It is driven by wage differentials between countries and a search for better working conditions and living standards; a search for better training possibilities; and demand–supply imbalances in the health sector between host and source countries. A 1998 United Nations Conference on Trade and Development/ WHO study estimated that 56% of all migrating physicians flow from developing countries to industrialized countries, while only 11% migrate in the opposite direction; the imbalance was even greater for nurses. The most prominent source countries for health personnel are India, the Philippines, and South Africa. Globalization in relation to nursing: : Globalization in relation to nursing: Nursing's fundamental responsibilities to promote health, prevent disease, and alleviate suffering call for the expression of caring for humanity and environment that runs across cultures, countries and traditions to care of the sick and needy anywhere and anyhow. Nurses should be aware of the concepts of globalization and its influences on health because the increased interconnectedness of the world means that health problems have become globalized. Therefore in contemporary society what happens in one country matters for the rest of the world. The nursing profession cannot ignore these developments. Slide 30: How does the movement of the capital influence the prosperity of a country? In view of new changes , what are the impacts of the globalization on health care? What do the nurses need to know? TREND /SCENARIO OF GLOBALIZATION IN HEALTH CARE: : TREND /SCENARIO OF GLOBALIZATION IN HEALTH CARE: Attracted world attention in various ways Emerged as most dominant force in the global system of economics with significant effect on all spheres. Countries look beyond their borders to promote effective health care strategies. Population health status and its distribution are determined by population-level influences, individual- level health risks, and the health care system. The last two are strongly influenced by the household economy. Slide 32: Rapid advances in communications and travel and an increasingly integrated global economy are defining new challenges and reviving earlier ones. The educated and Internet-savvy consumers, expectations of patients, highly trained physicians/ nurse / technicians, the rapid growing of technologies and new discoveries helps the rapid reduction of infectious, communicable diseases more specifically vaccine-preventable diseases of children are some of the forces behind the demand for globalization in healthcare. Slide 33: Now can you make the connections as to how the money for health facilities is being spent in the developing world. Do you recognize as to how the Multinational companies are setting up their branches in varied sectors in our country ? Can you now formulate an idea as to what are the impacts of globalization ? CONSEQUENCES / IMPACT OF GLOBALIZATION ON HEALTH CARE: : CONSEQUENCES / IMPACT OF GLOBALIZATION ON HEALTH CARE: There are positive as well as negative impacts Slide 35: For Millennium development goals the World Bank is funding. RISE OF TELECOMMUNICATIONS Migration of the health professionals Production and distribution of life saving drugs e.g. HAART Treatments offered by western European countries attract Infertile couples form USA . In India , the sophisticated surgery costs only 10 to 20 % of the cost in the western countries. Slide 36: International. The card from the continent. EU nations are adopting e-health--and the controversial e-health card--at varied rates, with Germany emerging as chief cheerleader. Mainly use in developed countries now is being used for patients in developing countries like Kenya. Derek Morgan argues that “we stand on the threshold of what might be thought to be a new dimension in the relationship of human sciences to biotechnology.” He proposes that the emergent “bio-economy” is set to transform our lives in the same all-encompassing manner brought about by the industrial age and advent of the computer. The internet is truly a global phenomenon; the total internet users worldwide in 2005 reach 1.12 billion users or it’s around 18% from the total human population in the world. This transportation technology brought the world more than US$ 1.2 billion in foreign exchange transaction made everyday Slide 37: TELEDIAGNOSTIC ,TELESURVEILLANCE , TELETREATMENT , TELEPRODUCTS. Slide 38: Recent efforts to assess performance of 191 health systems of world . WHO Pay Commission of India's recommendation on Health care jobs. Turnover problems. Push Pull factors. Gain of Alternative approaches. Slide 39: The noted noble laureate Dr. Amartya Sen (2002) has emphasized that “Global Interaction has been the basis of economic progress in the World but the rewards of globalized trade have come to some but not to others” The richest, one fifth of the World nations today control over 80% of its wealth, while the poorest one fifth have access to only around1% The noted noble laureate Dr. Amartya Sen (2002) has emphasized that “Global Interaction has been the basis of economic progress in the World but the rewards of globalized trade have come to some but not to others” The richest, one fifth of the World nations today control over 80% of its wealth, while the poorest one fifth have access to only around 1% Slide 40: COMMODIFICATION OF HUMAN ORGANS BRAIN DRAIN Online drug sales , cross border health trade leading to blurred frontiers Privatization Poverty Dual Market structure Slide 41: The hypothesis that greater trade openness leads to growing household inequality is the hypothesis that growing openness leads to points "below the line" in growth of income of the poor less than proportionate to per capita GDP growth. Slide 44: Strong trade sanctions disallow the drugs to move to needy countries. In 2000 the World Health Organization (WHO) estimated that one third of the world’s population lacked access to essential drugs, with this figure rising to 50 percent in the poorest parts of Africa and Asia (WHO 2000). According to fundamental principles of bioethics and the international right to health, WHO’s Model List of Essential Drugs (those which satisfy the core health care needs of the majority of the population), should be affordable and represent the best balance of quality, safety, efficacy and cost for a given health setting (WHO 2000) Globalization leads to "PIES", which stands for: poverty, instability, ethnicity, and sectarianism. Slide 45: The Millennium development goals include halving world poverty by 2015 and, over the same period, reducing infant mortality by two-thirds; halving the spread of HIV/AIDS and combating malaria and other diseases; achieving universal primary education; halving the number of people without access to safe drinking water; and promoting gender equality and environmental sustainability. Secretary-General Annan urged the adoption of these goals in his report to the Millennium Summit. "The central challenge we face today," he wrote, "is to ensure that globalization becomes a positive force for all the world's people, instead of leaving billions of them behind in squalor." Slide 46: According to your view who is affected more? Developed or developing countries??? Is there a shift in the Indian job scenario seen? What are the advantages of the effects reaped by India? CHALLENGES OF GLOBALIZATION : CHALLENGES OF GLOBALIZATION One is to ensure that the benefits of globalization extend to all countries. That will certainly not happen automatically. The second is to deal with the fear that globalization leads to instability, which is particularly marked in the developing world. The third challenge is to address the very real fear in the industrial world that increased global competition will lead inexorably to a race to the bottom in wages, labor rights, employment practices, and the environment. Slide 48: Resource of allocation for new lifestyle emerging and resurging diseases. Modern private health care in rural areas, where disease burden is mounting, is still negligible. Financial and budgetary constraints under the economic restructuring regime. The investments in the public sector have been decreasing over a period of time while the Public Private Partnership that have initiated are still in infancy stage. Sectoral shifts in healthcare and the moving boundaries between the different sectors (private\public\non- governmental sector). Structural adjustment policy for the shortage of medical / nursing practitioners worldwide. Need for changes in health policy with regard to improved access, budgetary allocation and monitoring. METHODS/STRATEGIES TO MEET THE DEMANDS OF GLOBALIZATION: : METHODS/STRATEGIES TO MEET THE DEMANDS OF GLOBALIZATION: Effective policies: At the national level, policies need to be designed to maximize the well-being of the population, supplemented by "add-ons" such as safety nets and the protection of health and education spending. At the international level, global rules, the activities of intergovernmental organizations, and the external policies of the governments of major developed countries need to be directed towards removing constraints to, and maximizing the incentives for, developing country governments to pursue these policies. e.g. Smoking provides a clear example. Is India’s National Health Policy , according to the demands of Globalization? Slide 50: Exchange: Developed countries are witnessing problems of cost explosion, irrational use of technologies, and consumer satisfaction. Developing nations are dealing with problems of access to care, quality of services, and unregulated growth of the private sector. The communication revolution provides the opportunity to exchange information about the challenges facing national health systems and about the initiatives to deal with them. Evidence. To be informative, such exchange should be based on sound evidence about alternatives, so that a solid knowledge base of what really works is build that may be transferred across countries when it is culturally, politically, and financially reasonable. This obviously implies the need to promote and strengthen international comparative analysis. Slide 51: Regulatory Reforms: Ones that have an impact on global issues of health and health services. This implies the need for a full health impact assessment of international agreements and measures that may have significant effects on health- related sectors, whether directly (e.g. through constraints or influences on sectoral policies) or indirectly (e.g. through the availability of resources and input costs), before they are implemented. Generic policies designed to reduce health inequities are described with reference to the three Rs of redistribution, regulation, and rights. GFATM Slide 52: Changes in international rules and institutional arrangements to fully reflect the needs of developing countries, health wise. It also requires the removal of major obstacles to development in the international economy. E.g. remaining debt problems, the chronic weakness and instability of commodity markets, restrictions on access to developed country markets, and the role of volatile international financial flows in generating financial crises. A greater volume, better allocation, and higher quality of financial and technical assistance is required to create the national conditions necessary for successful integration into the global economy – notably adequate and reliable infrastructure, human development, and effective political and administrative institutions. Slide 53: Economic benefits of globalization need to be translated into health benefits (the links from the national economy to the health care system, health-related sectors, and the household economy). This requires that economic growth be sustainable and directed towards the poor, through better design of pro-poor national economic policies, and more consideration of distributional effects in decisions at the global level. It also requires that the resources generated by a globalization process more favorable to developing countries are used to strengthen health systems, to ensure universal access to cost-effective interventions, and to improve other services essential to health, such as education, water and sanitation, environmental protection and effective nutrition and health safety net progammes. Slide 54: Interests of developing countries and vulnerable populations to be fully represented in international decision-making forums. This requires international institutional reform, including changes in voting structures and negotiation processes, an increased role for civil society organizations, and definition of the appropriate role of private companies. Financial and technical assistance to developing country governments is also required, to enable them to participate effectively in international negotiations on global issues. Slide 56: Moral authority to uphold the principle of equity in health and social justice needs to be catered. This authority has to be translated into norms and standards, accountability, measures for resolving conflicts and responding to emergencies, and a mandate to implement them. It needs to focus on key aspects of globalization which have implications for health. These include international capital volatility, drug trafficking, migration, protection of the environment, disease surveillance, and the indifference of market forces to marginalization, famine, suffering and oppression. Slide 57: The existing national and international institutions have to be reoriented. They have to re-examine their specific contributions to the overall well-being of the world. They must clearly define the roles of all concerned, and establish true partnerships for equitable cooperation, free from the domination of particular countries and companies. They have to work out new partnerships between civil society, industry, government and other actors. The current health reform efforts should focus on harmonization of living standards, rights, environmental protection, and equity between groups. Slide 58: Creating Supportive Environments: The supportive environments created by hospitals and health care systems of any country under the governmental regulations helps in maintaining the patients health and removal of the problems to certain extent. With emphasis on research and effective health care services they can reduce to a greater extent the ill effects of the globalization. DOES HEALTHCARE NEED GLOBALIZATION?? : DOES HEALTHCARE NEED GLOBALIZATION?? First, economic integration is a powerful force for raising the incomes of poor countries. In the past 20 years several large developing countries have opened up to trade and investment, and they are growing well – faster than the rich countries. Second, there is no tendency for income inequality to increase in countries that open up. The higher growth that accompanies globalization in developing countries generally benefits poor people. Slide 60: Third, economic integration can obviously have adverse health effects as well: the transmission of AIDS through migration and travel is a dramatic recent example. The practical solution lies in health policies, not in policies on economic integration. Global integration requires supporting institutions and policies. Fourth, the international architecture can be improved so that it is more beneficial to poor countries. For example, with regard to intellectual property rights, it may be practical for pharmaceutical innovators to choose to have intellectual property rights in either rich country markets or poor country ones, but not both. In this way incentives could be strong for research on diseases in both rich and poor countries. IMPLICATIONS ON NURSING : : IMPLICATIONS ON NURSING : 1. Nurses in practice should be ready to provide care to ever increasing numbers of patients with communicable and non-communicable diseases and of varied diversities. The nurses have to become advocate of the patients and their rights. 2. Nursing administration: The nurses as administrators need to develop effective policy, actions and infrastructure to address the determinants of health. The policies, rules and norms need to be built with regulation and legislation to ensure a high level of protection from harm and enable equal opportunities for health and well-being of all. Slide 62: 3. Nursing Research: Evidence has to be provided for nursing practice in relation to the treatment of the new diseases that are coming up and prevention of diseases. The research findings have to be disseminated internationally so that best practice is adopted globally. 4. Nursing Education: A workforce for nursing practice has to be made with equipping the students with enough knowledge and practice skills. Many programs in Nursing as in Turkey , China and Latin America are based on USA nursing programs. The global standards for nursing education is being emphasized. Think Now!!! : Think Now!!! Do you think that globalization is useful event? How can you as administrators make effective policies to reap good effects of globalization? Do you think that the negativity of globalization is more than positive effect? Does not it call for you to be more vigilant and informed? Slide 65: As Martin Luther King Jr said: “It really boils down to this: that all life is interrelated. We are all caught in an inescapable network of mutuality, tied into a single garment of destiny. Whatever affects one directly, affects all indirectly. Let us continue to weave together the destiny of better health for all the citizens of our world.” Slide 66: Cutcliffe , J.R. and et al . “Globalization, Commodification and Mass transplant of Nurses”. British Journal of Nursing. July-August , 2007. 16(14) . Page No. 876 to 881. The authors in the above article refer to the world’s current situation wherein the shortage of nurses is present which has been worsened by the mass retirement of the so-called ‘baby-boomers’ generation of nurses. The problem is more pronounced in the Western countries. As the nurses migrate out of the developing world to the developed side of the world there is more of ill-health and shortage of nurses in the developing side of the world and quality of care is suffering the developing countries. The article also debates about the global health where in the countries of the world should come together and sit under one roof to think about how a system of health delivery can be provided to the people of the world that is same for all the countries and irrespective of the borders, caste, creed and the socio-economic backgrounds. This further emphasizes upon the concept of the global citizenship that arises from the concept of similar type of health facilities available to all people of world. Slide 67: Jones –Bradbury C. “Globalization And Its Implication On Health Care and Nursing Practice”. Nursing Standard. February, 2005. 23(25). Page No. 43 to 47. The globalization describes the increasing economic and social interdependence between countries .The article examines globalization in terms of the opportunities and threats it poses to health , particularly increasing rates of the non-communicable diseases including increased longevity , spread of AIDS and HIV , increased tobacco consumption and there is increased problem in the developing countries. The need of the hour is to address such problems with the formulation of the global strategies like developing healthy public policy, create supportive environments, strengthen community action and move into the future. The nurses have a global responsibility to such a situation by effective building of health policy, playing a role in formulating them, building good research, education and practice basis to cater to the changing needs of the people of the society. The nurses should exploit the benefits of globalization and health care changes that are occurring across the world. 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globalization and its implications on healthcare n angel_heart154 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1326 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: May 23, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: Allan_Yngente (13 month(s) ago) i really like your work. can you pls send it to my e-mail. it will definitely help in my studies. thanks alot! my email is deismenes18@hotmail.com Saving..... Post Reply Close Saving..... Edit Comment Close By: elizabeth786 (13 month(s) ago) mam pls do send me ur ppt n standards of nursing audit plz plz plz!!!!! Saving..... Post Reply Close Saving..... Edit Comment Close By: daisemjt (14 month(s) ago) hi dear. you PPt has benn an inspiration in guiding me to understand the present topic. and would like you to send it to my mail smile.228jan@gmail.com. hope u'l do the needful. Saving..... Post Reply Close Saving..... Edit Comment Close By: sgita66 (17 month(s) ago) hai can u send me a copy of this presentation a very good one to my email id Saving..... Post Reply Close By: angel_heart154 (15 month(s) ago) HEY CAN U GIVE ME UR MAIL ID Saving..... Edit Comment Close By: sarahmathew (18 month(s) ago) dear Rohini its really a good presntation congrats ®ards .can you mail me to sarahjacinth@gmail.com Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript A PRESENTATION ONGLOBALIZATION AND ITS IMPLICATIONS ON HEALTH CARE : A PRESENTATION ONGLOBALIZATION AND ITS IMPLICATIONS ON HEALTH CARE Ms. Rohini Sharma, MN FINAL STUDENT. Slide 2: What do you understand by GATT? Have you got any idea about Recession ? What do you understand by Global warming? What is Paradigm Shift? What does the global promotion of international brands tells us? What is the International year of Nurse? Slide 3: WHAT DO U UNDERSTAND BY THESE DEVELOPMENTS? WHERE IS THE WORLD AND THE PEOPLE OF THE WORLD HEADING FOR? SHOULD THE NURSES KNOW THE IMPLICATIONS THAT THESE CHANGES ARE CAUSING? WHAT IS THIS PHENOMENA THAT HAS ITS ROOTS DEEP IN THE SYSTEM THAT WE CANNOT UNDERESTIMATE? Slide 4: “The fragility of our frontiers has arisen in the face of the world’s new challenges.” -Britain’s Prime Minister Tony Blair. The shift of human affairs from the restricted frame of the nation-state to the vast theater of planet Earth not only is affecting trade, finance, science, the environment, crime, and terrorism; it is also changing the nature of health challenges faced by people all over the world. Slide 5: “ The earth today has become flat.” Our world today is characterized by rapid changes, which are reflected in all areas of human relationships and the exchange of ideas and goods of any kind, in scientific discoveries, technological innovations, in the various life styles, in values and in cultural expressions of any kind, as well as in art and religion. Every day we hear about and experience the consequences of a multi-dimensional phenomenon, the so-called globalization. What is Globalization?? : What is Globalization?? Increasing and improving our way of living. Comfortable and convenient way of living Easy for to reach other people anywhere in this world. Easy to manipulate and access in exchanging and transmitting of information, knowledge, goods and funds to the allied countries. Slide 7: Interconnectedness and interdependence of people and countries and includes the opening of borders to increasingly fast flows of goods, services, finance, people and ideas across international borders. (WHO) International Forum on Globalization (IFG) states that globalization is the present worldwide drive toward a globalized economic system dominated by supranational corporate trade and banking institutions. History of globalization: : History of globalization: Started from the World War II, Britain and the US helped to form the World Bank and International Monetary Fund in 1944 to promote a liberal, capitalist world against Socialism and Marxism. The loans are granted by IMF and WB on the condition that the borrowing country will reduce the state's role in the economy, lower barriers to imports, remove restrictions on foreign investment, eliminate subsidies for local industries, reduce spending for social welfare, cut wages, devalue the currency, and emphasize production for export rather than for local consumption. Slide 9: Such conditions gave birth to the World Trade Organization. Many governments have Adopted free-market Economic systems, vastly increasing their own productive potential and creating New opportunities for international trade and investment. A defining feature of globalization, is an international industrial and financial business structure. Types / Forms Of Globalization: : Types / Forms Of Globalization: Slide 13: Do you think that the policies of the countries of the world shall be affected by globalization? Will opening economies help to boost trade? Will it affect the economic status of the countries? What are the reasons for such wide spread globalized strategies ? Slide 14: There are five multilateral agreements on trade under the World Trade Organization that are relevant for health. Trade-Related Aspects of Intellectual Property Rights (TRIPS), which form a central element of economic globalization. The General Agreement on Tariffs and Trade (GATT) allows countries under certain conditions to ban the import of products if necessary to protect public health. Agreement on the Application of Sanitary and Phytosanitary Measures (SPS) affects national policies for food safety, and runs the risk health and safety regulations being used as an excuse for protecting domestic producers. DO YOU KNOW?? Slide 15: In 1964 Helsinki declaration on ethical principles for medical research involving human subjects was done. The Agreement on Technical Barriers to Trade (TBT) may have implications for the adoption of health and safety regulations, if they add to production costs. The General Agreement on Trade in Services (GATS) extends the concept of cross-border trade to include, for example investments in the hospital sector, thus potentially opening up health systems to privatization Slide 16: The 2002 Canadian Commission on future health care stated that access to health care is not only a domestic policy priority but also a key objective for foreign policy as well, and the promotion of human rights, including the right to health, is a fundamental principle of Canadian foreign policy. In contrast, US foreign policy is shaped by the domestic political agenda with schemes heavily influenced by the present administration's value judgments, and less likely to be part of a coordinated approach with other countries. This bring global health inequality??? DO YOU KNOW?? PROCESS OF GLOBALIZATION : Global movement of four fundamental forms of capital: Human Capital (Immigration, Migration), Financial Capital (Aid, Equity, Debt, Credit) , Resource Capital (Energy, Metals, Minerals) and Power Capital (Security Forces, Alliances, Armed Forces). PROCESS OF GLOBALIZATION : Global promotion of brands such as Coca-Cola and McDonald's is a cultural phenomenon but also an economic one (driven by the opportunity to expand profits and markets). “First World treatment at Third World prices is how industry sources define medical tourism in India.” According to a study by McKinsey and the Confederation of Indian Industry - CII, medical tourism in India could become a US$ 2 billion industry by 2012 (from US$ 350 million in 2006). The medical technology market was billed to be worth about $2.7 billion in 2006 and is likely to cross $10 billion by 2012 with a growth rate of over 20 per cent. It is estimated that over 85 per cent of medical devices and equipment are imported and the market is primarily dominated by MNCs. Slide 19: NOTIONS ABOUT GLOBALIZATION Slide 24: In 1997 an influential report by the U.S. Institute of Medicine stated: “Distinctions between domestic and international health problems are losing their usefulness and are often misleading.” According to the latest projections, Africa will be severely affected as early as 2020 by food shortage. By that date, increased water stress is expected to affect from 75 million to 250 million Africans. A dozen years from now, crop yields in some African countries are expected to drop by 50%. Imagine the impact on food security and malnutrition. The shift in the tobacco pandemic to the developing world has been clearly driven by the tobacco industry. It is estimated that, by 2030, 70% of all tobacco-related deaths (7 million annually) will occur in developing countries. Globalization in relation to health care: : Globalization in relation to health care: Healthcare worldwide is undergoing a dramatic change consistent with the changes due to globalization. While medical care has a long tradition of international cooperation and sharing of expertise, this current phenomenon is very different. Consequently, the mobilization of health services globally is with the expectation that healthcare services will provide quality and safety. Slide 26: Globalization has a great impact in health care sector where it is improving the relationship between personnel and the community, where the individual and the community is working hand in hand in every matter pertaining to health. A prosperous and stable population is an asset in every country. This world will not become a fair place for health all by itself. The globalization has to be converted to provide better facilities and answer to health problems for the people of the world. Slide 27: “Healthcare is a recession-proof industry and hence the impact is limited in this segment. Having said that, one cannot overlook the fact that the nature of this slowdown is due to a financial crisis which can impact all sectors, including healthcare, at the corporate level,” avers Dimple Sanghi, Executive Director, Indi Vision India Partners— a private equity fund of Future Capital Holdings, which invested in Hyderabad-based Global Hospitals through convertibles. Countries such as India, Indonesia, Nepal, Sri Lanka, and Thailand have become increasingly open to foreign direct investment. For example, approval has been given to a German company to have 90% foreign equity ownership for setting up a 200-bed hospital in Delhi. Several specialty corporate hospitals are being built in collaboration between Indian and foreign companies, including a US$ 40 million cardiac centre, set up under a consortium between Australia, Canada, and India. Corporate hospitals in developing countries are also establishing commercial presence overseas. For example, the Apollo group of hospitals in India has established a hospital outside the country and plans to invest roughly US$ 4 billion to build 15 new hospitals in Malaysia, Nepal, and Sri Lanka. Slide 28: It is driven by wage differentials between countries and a search for better working conditions and living standards; a search for better training possibilities; and demand–supply imbalances in the health sector between host and source countries. A 1998 United Nations Conference on Trade and Development/ WHO study estimated that 56% of all migrating physicians flow from developing countries to industrialized countries, while only 11% migrate in the opposite direction; the imbalance was even greater for nurses. The most prominent source countries for health personnel are India, the Philippines, and South Africa. Globalization in relation to nursing: : Globalization in relation to nursing: Nursing's fundamental responsibilities to promote health, prevent disease, and alleviate suffering call for the expression of caring for humanity and environment that runs across cultures, countries and traditions to care of the sick and needy anywhere and anyhow. Nurses should be aware of the concepts of globalization and its influences on health because the increased interconnectedness of the world means that health problems have become globalized. Therefore in contemporary society what happens in one country matters for the rest of the world. The nursing profession cannot ignore these developments. Slide 30: How does the movement of the capital influence the prosperity of a country? In view of new changes , what are the impacts of the globalization on health care? What do the nurses need to know? TREND /SCENARIO OF GLOBALIZATION IN HEALTH CARE: : TREND /SCENARIO OF GLOBALIZATION IN HEALTH CARE: Attracted world attention in various ways Emerged as most dominant force in the global system of economics with significant effect on all spheres. Countries look beyond their borders to promote effective health care strategies. Population health status and its distribution are determined by population-level influences, individual- level health risks, and the health care system. The last two are strongly influenced by the household economy. Slide 32: Rapid advances in communications and travel and an increasingly integrated global economy are defining new challenges and reviving earlier ones. The educated and Internet-savvy consumers, expectations of patients, highly trained physicians/ nurse / technicians, the rapid growing of technologies and new discoveries helps the rapid reduction of infectious, communicable diseases more specifically vaccine-preventable diseases of children are some of the forces behind the demand for globalization in healthcare. Slide 33: Now can you make the connections as to how the money for health facilities is being spent in the developing world. Do you recognize as to how the Multinational companies are setting up their branches in varied sectors in our country ? Can you now formulate an idea as to what are the impacts of globalization ? CONSEQUENCES / IMPACT OF GLOBALIZATION ON HEALTH CARE: : CONSEQUENCES / IMPACT OF GLOBALIZATION ON HEALTH CARE: There are positive as well as negative impacts Slide 35: For Millennium development goals the World Bank is funding. RISE OF TELECOMMUNICATIONS Migration of the health professionals Production and distribution of life saving drugs e.g. HAART Treatments offered by western European countries attract Infertile couples form USA . In India , the sophisticated surgery costs only 10 to 20 % of the cost in the western countries. Slide 36: International. The card from the continent. EU nations are adopting e-health--and the controversial e-health card--at varied rates, with Germany emerging as chief cheerleader. Mainly use in developed countries now is being used for patients in developing countries like Kenya. Derek Morgan argues that “we stand on the threshold of what might be thought to be a new dimension in the relationship of human sciences to biotechnology.” He proposes that the emergent “bio-economy” is set to transform our lives in the same all-encompassing manner brought about by the industrial age and advent of the computer. The internet is truly a global phenomenon; the total internet users worldwide in 2005 reach 1.12 billion users or it’s around 18% from the total human population in the world. This transportation technology brought the world more than US$ 1.2 billion in foreign exchange transaction made everyday Slide 37: TELEDIAGNOSTIC ,TELESURVEILLANCE , TELETREATMENT , TELEPRODUCTS. Slide 38: Recent efforts to assess performance of 191 health systems of world . WHO Pay Commission of India's recommendation on Health care jobs. Turnover problems. Push Pull factors. Gain of Alternative approaches. Slide 39: The noted noble laureate Dr. Amartya Sen (2002) has emphasized that “Global Interaction has been the basis of economic progress in the World but the rewards of globalized trade have come to some but not to others” The richest, one fifth of the World nations today control over 80% of its wealth, while the poorest one fifth have access to only around1% The noted noble laureate Dr. Amartya Sen (2002) has emphasized that “Global Interaction has been the basis of economic progress in the World but the rewards of globalized trade have come to some but not to others” The richest, one fifth of the World nations today control over 80% of its wealth, while the poorest one fifth have access to only around 1% Slide 40: COMMODIFICATION OF HUMAN ORGANS BRAIN DRAIN Online drug sales , cross border health trade leading to blurred frontiers Privatization Poverty Dual Market structure Slide 41: The hypothesis that greater trade openness leads to growing household inequality is the hypothesis that growing openness leads to points "below the line" in growth of income of the poor less than proportionate to per capita GDP growth. Slide 44: Strong trade sanctions disallow the drugs to move to needy countries. In 2000 the World Health Organization (WHO) estimated that one third of the world’s population lacked access to essential drugs, with this figure rising to 50 percent in the poorest parts of Africa and Asia (WHO 2000). According to fundamental principles of bioethics and the international right to health, WHO’s Model List of Essential Drugs (those which satisfy the core health care needs of the majority of the population), should be affordable and represent the best balance of quality, safety, efficacy and cost for a given health setting (WHO 2000) Globalization leads to "PIES", which stands for: poverty, instability, ethnicity, and sectarianism. Slide 45: The Millennium development goals include halving world poverty by 2015 and, over the same period, reducing infant mortality by two-thirds; halving the spread of HIV/AIDS and combating malaria and other diseases; achieving universal primary education; halving the number of people without access to safe drinking water; and promoting gender equality and environmental sustainability. Secretary-General Annan urged the adoption of these goals in his report to the Millennium Summit. "The central challenge we face today," he wrote, "is to ensure that globalization becomes a positive force for all the world's people, instead of leaving billions of them behind in squalor." Slide 46: According to your view who is affected more? Developed or developing countries??? Is there a shift in the Indian job scenario seen? What are the advantages of the effects reaped by India? CHALLENGES OF GLOBALIZATION : CHALLENGES OF GLOBALIZATION One is to ensure that the benefits of globalization extend to all countries. That will certainly not happen automatically. The second is to deal with the fear that globalization leads to instability, which is particularly marked in the developing world. The third challenge is to address the very real fear in the industrial world that increased global competition will lead inexorably to a race to the bottom in wages, labor rights, employment practices, and the environment. Slide 48: Resource of allocation for new lifestyle emerging and resurging diseases. Modern private health care in rural areas, where disease burden is mounting, is still negligible. Financial and budgetary constraints under the economic restructuring regime. The investments in the public sector have been decreasing over a period of time while the Public Private Partnership that have initiated are still in infancy stage. Sectoral shifts in healthcare and the moving boundaries between the different sectors (private\public\non- governmental sector). Structural adjustment policy for the shortage of medical / nursing practitioners worldwide. Need for changes in health policy with regard to improved access, budgetary allocation and monitoring. METHODS/STRATEGIES TO MEET THE DEMANDS OF GLOBALIZATION: : METHODS/STRATEGIES TO MEET THE DEMANDS OF GLOBALIZATION: Effective policies: At the national level, policies need to be designed to maximize the well-being of the population, supplemented by "add-ons" such as safety nets and the protection of health and education spending. At the international level, global rules, the activities of intergovernmental organizations, and the external policies of the governments of major developed countries need to be directed towards removing constraints to, and maximizing the incentives for, developing country governments to pursue these policies. e.g. Smoking provides a clear example. Is India’s National Health Policy , according to the demands of Globalization? Slide 50: Exchange: Developed countries are witnessing problems of cost explosion, irrational use of technologies, and consumer satisfaction. Developing nations are dealing with problems of access to care, quality of services, and unregulated growth of the private sector. The communication revolution provides the opportunity to exchange information about the challenges facing national health systems and about the initiatives to deal with them. Evidence. To be informative, such exchange should be based on sound evidence about alternatives, so that a solid knowledge base of what really works is build that may be transferred across countries when it is culturally, politically, and financially reasonable. This obviously implies the need to promote and strengthen international comparative analysis. Slide 51: Regulatory Reforms: Ones that have an impact on global issues of health and health services. This implies the need for a full health impact assessment of international agreements and measures that may have significant effects on health- related sectors, whether directly (e.g. through constraints or influences on sectoral policies) or indirectly (e.g. through the availability of resources and input costs), before they are implemented. Generic policies designed to reduce health inequities are described with reference to the three Rs of redistribution, regulation, and rights. GFATM Slide 52: Changes in international rules and institutional arrangements to fully reflect the needs of developing countries, health wise. It also requires the removal of major obstacles to development in the international economy. E.g. remaining debt problems, the chronic weakness and instability of commodity markets, restrictions on access to developed country markets, and the role of volatile international financial flows in generating financial crises. A greater volume, better allocation, and higher quality of financial and technical assistance is required to create the national conditions necessary for successful integration into the global economy – notably adequate and reliable infrastructure, human development, and effective political and administrative institutions. Slide 53: Economic benefits of globalization need to be translated into health benefits (the links from the national economy to the health care system, health-related sectors, and the household economy). This requires that economic growth be sustainable and directed towards the poor, through better design of pro-poor national economic policies, and more consideration of distributional effects in decisions at the global level. It also requires that the resources generated by a globalization process more favorable to developing countries are used to strengthen health systems, to ensure universal access to cost-effective interventions, and to improve other services essential to health, such as education, water and sanitation, environmental protection and effective nutrition and health safety net progammes. Slide 54: Interests of developing countries and vulnerable populations to be fully represented in international decision-making forums. This requires international institutional reform, including changes in voting structures and negotiation processes, an increased role for civil society organizations, and definition of the appropriate role of private companies. Financial and technical assistance to developing country governments is also required, to enable them to participate effectively in international negotiations on global issues. Slide 56: Moral authority to uphold the principle of equity in health and social justice needs to be catered. This authority has to be translated into norms and standards, accountability, measures for resolving conflicts and responding to emergencies, and a mandate to implement them. It needs to focus on key aspects of globalization which have implications for health. These include international capital volatility, drug trafficking, migration, protection of the environment, disease surveillance, and the indifference of market forces to marginalization, famine, suffering and oppression. Slide 57: The existing national and international institutions have to be reoriented. They have to re-examine their specific contributions to the overall well-being of the world. They must clearly define the roles of all concerned, and establish true partnerships for equitable cooperation, free from the domination of particular countries and companies. They have to work out new partnerships between civil society, industry, government and other actors. The current health reform efforts should focus on harmonization of living standards, rights, environmental protection, and equity between groups. Slide 58: Creating Supportive Environments: The supportive environments created by hospitals and health care systems of any country under the governmental regulations helps in maintaining the patients health and removal of the problems to certain extent. With emphasis on research and effective health care services they can reduce to a greater extent the ill effects of the globalization. DOES HEALTHCARE NEED GLOBALIZATION?? : DOES HEALTHCARE NEED GLOBALIZATION?? First, economic integration is a powerful force for raising the incomes of poor countries. In the past 20 years several large developing countries have opened up to trade and investment, and they are growing well – faster than the rich countries. Second, there is no tendency for income inequality to increase in countries that open up. The higher growth that accompanies globalization in developing countries generally benefits poor people. Slide 60: Third, economic integration can obviously have adverse health effects as well: the transmission of AIDS through migration and travel is a dramatic recent example. The practical solution lies in health policies, not in policies on economic integration. Global integration requires supporting institutions and policies. Fourth, the international architecture can be improved so that it is more beneficial to poor countries. For example, with regard to intellectual property rights, it may be practical for pharmaceutical innovators to choose to have intellectual property rights in either rich country markets or poor country ones, but not both. In this way incentives could be strong for research on diseases in both rich and poor countries. IMPLICATIONS ON NURSING : : IMPLICATIONS ON NURSING : 1. Nurses in practice should be ready to provide care to ever increasing numbers of patients with communicable and non-communicable diseases and of varied diversities. The nurses have to become advocate of the patients and their rights. 2. Nursing administration: The nurses as administrators need to develop effective policy, actions and infrastructure to address the determinants of health. The policies, rules and norms need to be built with regulation and legislation to ensure a high level of protection from harm and enable equal opportunities for health and well-being of all. Slide 62: 3. Nursing Research: Evidence has to be provided for nursing practice in relation to the treatment of the new diseases that are coming up and prevention of diseases. The research findings have to be disseminated internationally so that best practice is adopted globally. 4. Nursing Education: A workforce for nursing practice has to be made with equipping the students with enough knowledge and practice skills. Many programs in Nursing as in Turkey , China and Latin America are based on USA nursing programs. The global standards for nursing education is being emphasized. Think Now!!! : Think Now!!! Do you think that globalization is useful event? How can you as administrators make effective policies to reap good effects of globalization? Do you think that the negativity of globalization is more than positive effect? Does not it call for you to be more vigilant and informed? Slide 65: As Martin Luther King Jr said: “It really boils down to this: that all life is interrelated. We are all caught in an inescapable network of mutuality, tied into a single garment of destiny. Whatever affects one directly, affects all indirectly. Let us continue to weave together the destiny of better health for all the citizens of our world.” Slide 66: Cutcliffe , J.R. and et al . “Globalization, Commodification and Mass transplant of Nurses”. British Journal of Nursing. July-August , 2007. 16(14) . Page No. 876 to 881. The authors in the above article refer to the world’s current situation wherein the shortage of nurses is present which has been worsened by the mass retirement of the so-called ‘baby-boomers’ generation of nurses. The problem is more pronounced in the Western countries. As the nurses migrate out of the developing world to the developed side of the world there is more of ill-health and shortage of nurses in the developing side of the world and quality of care is suffering the developing countries. The article also debates about the global health where in the countries of the world should come together and sit under one roof to think about how a system of health delivery can be provided to the people of the world that is same for all the countries and irrespective of the borders, caste, creed and the socio-economic backgrounds. This further emphasizes upon the concept of the global citizenship that arises from the concept of similar type of health facilities available to all people of world. Slide 67: Jones –Bradbury C. “Globalization And Its Implication On Health Care and Nursing Practice”. Nursing Standard. February, 2005. 23(25). Page No. 43 to 47. The globalization describes the increasing economic and social interdependence between countries .The article examines globalization in terms of the opportunities and threats it poses to health , particularly increasing rates of the non-communicable diseases including increased longevity , spread of AIDS and HIV , increased tobacco consumption and there is increased problem in the developing countries. The need of the hour is to address such problems with the formulation of the global strategies like developing healthy public policy, create supportive environments, strengthen community action and move into the future. The nurses have a global responsibility to such a situation by effective building of health policy, playing a role in formulating them, building good research, education and practice basis to cater to the changing needs of the people of the society. The nurses should exploit the benefits of globalization and health care changes that are occurring across the world.