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While the term might be the latest buzz word amongst sociologists and other theorists, neither the concept nor the activity is new (e.g. Lenin, 1911) Only the pace has changed due to technological innovation and faster and cheaper international transport The human experience of globalization: The human experience of globalization Globalization brings about closer interaction amongst human activities across a range of spheres: The economic, The social, The political The cultural, These are experienced along three dimensions: the spatial, the temporal and the cognitive (Lee 2000) Consequences of Globalization: Consequences of Globalization Our perceptions of physical space have changed – the ‘death of distance’ has made the world feel smaller – more people travel, and more often (in 1950 there were 2 million international airline passengers a year; today there 1.4 billion) Our perceptions of time have changed – the communications revolution has heightened our expectations of quick turnarounds. Instantaneous communication from anywhere to anywhere The worldwide availability of physical commodities has been accompanied by the transfer of culture and ideas The international mobility of labour has brought about significant culture contact producing ‘hybrid’ forms and conceptions of personal identity The downside of globalization: The downside of globalization The world economy has grown hugely – the average value of foreign exchange transactions grew from $215 billion in 1973 to £1.2 trillion in 1995 (Sutherland 1998). With de-regulation this has led to: financial volatility – as affected Mexico and SE Asia, and created unemployment and hardship; marginalization – many low income countries are hardly part of the global economy (unless they are repaying debts or providing cheap labour); labour insecurity, with the political authority of the state corresponding less and less to the geography of markets. All of these have an impact on health Globalisation: Development or Stagnation?: Globalisation: Development or Stagnation? More than 80 countries still have per capita incomes lower than they were a decade or more ago The income gap between the world’s richest fifth and its poorest fifth has more than doubled to 74 to 1 over the past three decades. 20% of the world’s population live in absolute poverty, with an income of less than $1 per day. Surviving on less than $2 a day is a reality for almost half the people on the planet (Brundtland 1999). · A growing poverty gap = rising health inequalities : A growing poverty gap = rising health inequalities Some 1.3 billion people do not have access to clean water About 840 million are malnourished Those living in absolute poverty are five times more likely to die before reaching five years of age than those in higher income groups. AIDS is now a poor people’s epidemic with 95% of all HIV infected victims in the Third World Life expectancy gains from the 1950s on are falling in some countries – due to AIDS and growth in poverty. In Botswana life expectancy has fallen from 70 to around 50 years. In many countries of the world health systems have deteriorated: access is poor, quality is poor, drugs are not available. In some low income countries over 70% of the health budget is comes from external sources which tie it to certain conditions, such as population control and sexual abstinence policiesOther consequences: Other consequences As public health systems have broken down, so has the spread of infectious diseases become increasingly labile – hitting the poor disproportionately. Attention on emerging and re-emerging infectious diseases has risen over the past decade, partly because of growing drug resistance, partly because of new diseases such as AIDS, and partly because of self-interest. Tuberculosis was described as ‘conquered’ in the industrialized world in the 1950s, but began to re-emerge in the late 1980s. There were also unexpected outbreaks of cholera, dengue, ebola, E.coli, diphtheria – even the dreaded plague in 1997 The response of the developed countries is often couched in terms of ‘new threats’ to the health of their populations, leading to restrictions on immigration, racism and other forms of discrimination. The corporate sector strikes again!Vietnam: A case study: The corporate sector strikes again! Vietnam: A case study In 1986 free market reforms under the guidance of the WB – IMF was launched. Vietnamese farmers were encouraged to switch to ‘high value’ cash crops for export. The ‘local level self sufficiency in food’ policy which was devised to prevent regional food shortages was done away with 1994 famine occurred in a border province with China which affected 50,000 people. In the Mekong Delta, World Bank data revealed that more than a quarter of the adult population had a daily energy intake below 1800 calories. From free health care to free market: From free health care to free market Until 1989, the district hospitals and commune level health centres provided medical services and essential drugs free of charge. With reforms, a user fees system was introduced and cost recovery and the free market sale of drugs were applied. Consumption of essential drugs (through public distribution) declined by 89 percent. With complete deregulation of the pharmaceutical industry and the liberalisation of drug prices, imported branded drugs sold exclusively in the free market at enormous costs have displaced domestic drugs. By 1989 domestic production of pharmaceuticals had declined by over 98 percent compared to its 1980 level. A large number of drug companies closed down and Vietnam’s pharmaceutical and medical supply industry was pushed into bankruptcy. From free health care to free market: From free health care to free market The government discontinued budget support to the health sector (under the guidance of the donors) which paralysed the public health system. There was no money for medical equipment and maintenance; salaries and working conditions declined. With the emergence of private practice, tens of thousands of doctors and health workers fled the public health sector. By 1991, commune level health centres were not working. There was no annual check-up for TB; no medicines, and farmers could not afford user fees at district hospitals. With the public health system in shambles, there was a resurgence of infectious diseases like malaria, tuberculosis and diarrhoea. A WHO study revealed that malaria deaths increased threefold in the first four years of reforms with the collapse of curative health and soaring prices of anti-malarial drugs. Consequences of globalization in Vietnam: Consequences of globalization in Vietnam According to the World Bank: ‘Vietnam has a higher proportion of underweight and stunted children (of the order of 50 percent) than in any other country in South and Southeast Asia with the exception of Bangladesh. Food & Agriculture Organisation nutrition study revealed that Vitamin A deficiency (which causes night blindness) is widespread among children in all regions of the country except Hanoi and the southeast. The FAO study also confirmed a situation of severe under-nourishment with the adult mean energy intake per capita per day for the country 1,861 calories with 25 percent of the adult population below 1,800 calories. In nine percent of households, energy intake by adults was less than 1,500 calories . And just when you thought it couldn’t get worse….: And just when you thought it couldn’t get worse…. Except for China, no Third World country is self sufficient in essential drugs. Some 2.5 billion people have little or no access to essential drugs (UNDP 1991). WHO estimates that some countries pay 150-250 percent more than the world market prices for essential drugs while others are faced with unreliable suppliers and poor quality drugs. In the Third World, a full course of antibiotics for pneumonia can cost a month’s wages. The standard triple treatment for HIV costs some US$10,000 per year, while the per capita expenditure on drugs in is only $8. Treatment that can save lives for people with HIV/AIDS is beyond the reach of many in the poor countries. Medicines for other life threatening diseases like TB, malaria and meningitis are equally out of reach. For example, most of the 100,000 TB patients suffering from multi-drug resistant strains cannot afford the new standard combination therapy which is estimated at US$15,000 per course. You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.