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Migrant Labour - Mexico and the USA. 3. N Motus / J Weekers. Globalizing Public Health. 4. P Van Krieken. The relationship between health and migration.Globalization: the inter-dependency of population mobility, security and trade: Globalization: the inter-dependency of population mobility, security and trade Douglas W. MacPherson MD, MSc(CTM), FRCPC What is “Globalization” ? : What is “Globalization” ? "It is yet another Civilized Power, with its banner of the Prince of Peace in one hand and its loot-basket and its butcher-knife in the other." -- Mark Twain, in his essay, To the Person Sitting in Darkness, 1901, describing the United States playing the European-style imperialist game in the Philippines.What is “Globalization” ? : What is “Globalization” ? "For globalism to work, ...The hidden hand of the market will never work without a hidden fist -- McDonald's cannot flourish without McDonnell Douglas, the designer of the F-15. And the hidden fist that keeps the world safe ... is called the United States Army, Air Force, Navy and Marine Corps." -- in "What the World Needs Now", by Thomas Friedman, New York Times, March 28,1999." -- from Backing Up Globalization with Military MightWhat is “Globalization” ? : What is “Globalization” ? Is a long-term process of global integration represented by the increasing rate of accessing international venues, driven by: advances in trade, telecommunications, transportation balanced by international security considerations due to population mobility“Globalization” and Mobility? : “Globalization” and Mobility? Implications for Population and Public Policy understanding the process measuring past and current impacts evaluation of policy consequences looking to the future & preparing today.Mobility/Migration – the process: Mobility/Migration – the process Three Considerations*: The People The Phases of Migration Pre-departure Transit Post-arrival The Outcome Determinant Differentials (Prevalence Gaps) *MacPherson, Gushulak. Human mobility and population health. Perspect Biol Med 2001The People: The PeopleMigration Health - Context: Migration Health - Context Globalization and Migration: Globalization and Migration Push pull factors of : population: size, demographics and biometrics processes of movement prevalence gaps: source and host countries Education & training Cultural influences and beliefs Behaviour Language Health International Tourist Movements – Magnitudes - people: International Tourist Movements – Magnitudes - people WTO data. 2002* projectedInternational Tourist Movements – Magnitudes (people sources): International Tourist Movements – Magnitudes (people sources) WTO data. Global Tourist Movements – Magnitudes (economics): Global Tourist Movements – Magnitudes (economics) WTO data. 2001 = US $463 BillionSlide14: Immigration to Canada – 1860-2001 WW I WW II Hungarian RevoltSlide15: Immigration to Canada – 1860-2001 Europeanization Multi-culturalizationImmigration to Canada: Immigration to CanadaThe Phases: The Phases“Pre-departure” Phase: “Pre-departure” Phase Effect may be: negative: e.g., poverty, lower education, poorer health systems neutral: e.g., similarity in environment, education, genetics/biology positive: e.g., healthier behaviours “Transit” Phase: “Transit” Phase Advances in Transportation technology, accessibility and affordability has virtually eliminated the health risks associated with the movement phase EXCEPT: trafficking in humans smuggling in humans “Post-arrival” Phase: “Post-arrival” Phase Effects of “pre” and “transit” phases plus: Balance of “imported” cultural, genetic, behavioural influences with host destination determinants: e.g., health care, environment BUT attainable socio-economic goals now permit reverse migration not possible in previous generations of migrants “VFR” effect: Visiting Friends and Relatives on recent migrant and 1st generation. Prevalence Gaps: Prevalence GapsRefugees & Asylum Seekersby year: Refugees & Asylum Seekers by year Worldwide Persons in need of Protection, UNHCR. * est.Refugees & Asylum Seekers by Host Region, 1999: Refugees & Asylum Seekers by Host Region, 1999Globalization and Migration: Globalization and Migration 140 million people live outside of their country of birth (1/40 persons) migrants represent > 15% of the population in over 50 countries worldwide OECD, Canada, USA –migrants represent ~ 2/3 of population growth 45 million migrants from developing nations will enter the workforce globally to 2015Security, Trade & Health: Security, Trade & Health Is there a relationship between events distant from health in: time and place – Temporally/geographically distant political balance - trade and security vs. healthSecurity - Man-made Disasters: Security - Man-made Disasters Malfeasant September 11, 2002 Anthrax in USA War on Terror CBRN Programs Nuclear Weapon ProgramsSecurity – Man-Made: Security – Man-Made Terrorism: Bombings USS Cole, US Embassies Kenya/Tanzania World Trade Center Bali Israel/Palestine Civil disputes –violent Balkans – Serbia, Kosovo Rwanda/Burundi East Timor Moscow theatreSecurity – Man-Made: Security – Man-Made Accidental Bohpol / Union Carbide Three-Mile Island / Nuclear Uruguay Gold Mines / mercury poisoning The Kursk Nuclear Sub-marine Security – Natural Disasters: Security – Natural Disasters Environmental Severe Weather Floods Drought Storms – hurricanes, tornadoes, FiresSecurity – Man-made/Natural Disasters: Security – Man-made/Natural Disasters Man-made / Environmental MDR – everything Walkerton, Cincinnati VHF – Ebola, Hanta SARS BSE Heat deaths: Chicago, EuropeSecurity: Security Security involves more than intelligence, police or military services:. Environmental security Social security: language, culture, health, employment . . . Trade, Security, and Health: Trade, Security, and Health Post-911 World “Security trumps trade Health trumps security” US Senate Appropriations – USD 40 Billion for security: international, border, homelandUnlinked Costs: Unlinked Costs Cholera in Peru, South America < 1 Billion USD Plague in India 3 – 5 Billion USD BSE in UK/Europe 25 Billion USD SARS 30 Billion USD. War in . . . Balkans, Priceless Great Lakes/Africa, Balkans, Kosovo, on Terror . . . Slide34: Travellers shy away from international travel War, pneumonia outbreak, North Korea blamed for decline in Air NZ bookings on key international routes Air New Zealand 21 March 2003 http://home.nzcity.co.nz/news/default.asp?id=29857&cat=976Migration: Migration Measuring Past and Current Impacts Links: health, security and trade Integrated (horizontal, vertical, longitudinal) decision-making mitigates impacts in the other two sectors . . . = Paradigm shift in local-international public health, economic/trade and security management.Migration: Migration Measuring Past and Current Impacts The West are nations built on migration The West will grow and compete based on migration The West is changing demographically and biometrically, including health determinants, directly related to migrationMigration: Migration Measuring Past and Current Impacts The Developing Nations are source countries for migration The Developing Nations will grow and compete partly due to migration Are the Developing Nations benefiting; (public health, trade, security) related to migration - see WTO, Cancun September 2003?Migration: Migration Evaluation of Policy Consequences foreign policy - trade immigration policy international security policy health policyMigration: Migration Looking to the future & preparing today Challenge to academics & researchers, social scientists, program administrators, and governmental policy makers; and front-line service delivery workers Evidence-based decision-making. 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