Photo: Karsten Würth/Unsplash.
This era of public health aims to address health-related issues using a holistic approach, by empowering individuals and communities to protect their own health. On the other hand, by redefining thought processes, and territorial and temporal boundaries, globalisation has been changing the perspective of human interaction in many spheres, including health. It tries to focus on decreasing the burden of diseases by integrating cultural, social, economic, political and technological changes associated with global health.
How can we reconcile these two perspectives?
An important global milestone was the UN’s adoption of the agenda for sustainable development, which sets out 17 sustainable development goals (SDGs). The body has also established a roadmap to achieve them at the subnational level. This resource provides a useful starting point to consider globalisation while trying to understand health and health risks at the local level.
Globalisation contributes positively to the health sector by increasing the spread of knowledge and advancing technology. Its effects manifest in trade, information, financial services, etc., all of which affect health directly or indirectly. One example is people being able to afford cheaper and/or better healthcare services in other countries, resulting in medical tourism.
However, such opportunities can also lead to economic inequality, insecurity and vulnerability – or could increase pathogen flow, resulting in infectious diseases crossing borders. COVID-19 is a case in point. So while the complex phenomenon of globalisation provides many ways to improve health, it also threatens certain other aspects of public health – and as such needs to be linked to health assessment.
In 2011, the Alliance for Food Sovereignty in Africa (AFSA) identified local and ecological food-production systems like farming as a major source of feeding and nourishment of the world’s population. The globalisation and industrialisation of agricultural systems took root with the idea of increasing global trade and introducing technological changes so as to improve food security. However, as the AFSA policy document noted, doing so led to poverty, climate change and loss of biodiversity, all of which ultimately affected health.
The inclusion of agriculture under the World Trade Organisation’s General Agreement on Tariffs and Trade (GATT) led to the corporate and government sectors dominating the global food system – and communities losing control over their food, seed, markets, livelihood and the environment.
In effect, while indigenous food production systems empowered communities to grow and eat healthy food in a sustainable manner, globalisation erased food diversity and narrowed people’s diets largely to imported staple food. This is why it’s important to consider the effects of globalisation when addressing health.
The downstream effects include health ailments – physical as well as mental – and migration due to poverty, ecosystem collapse and climatic effects. To understand the problem better and craft an action plan, we need to deploy rapid health assessment (RHA) methods – to first collect reliable and objective information. And globalisation, specifically its integrative effects, could contribute technology to RHA programmes that assess health issues in the community.
For example, in 2016, researchers from Australia, Spain and the US studied Twitter activity before, during and after Hurricane Sandy to get a sense of the calamity. They concluded that there was a strong relationship between proximity to the hurricane’s path and social media posts related to it. Ergo, social media could improve community awareness about a situation, disseminating warnings and coordinating relief efforts.
Geographic information systems (GIS) in RHA have also made it easier for researchers to survey disaster areas, as they allow local public health professionals to quickly track and identify areas where more healthcare assistance is required.
So while globalisation could precipitate or accentuate local health effects, it can help in matters of disaster preparedness, mitigation, response and recovery.
Dr Yash Milind Prasade is an Ayurvedic practitioner pursuing a Master of Public Health (Global Health) degree. Dr Parul Malik is a medical doctor with a Master of Public Health. Dr Arathi P. Rao coordinates the MPH Programme and is the head of the Manipal Health Literacy Unit. All are at/with the Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal.