From: Subject: information_bulletin_1 Date: Mon, 9 Feb 2004 16:47:02 -0600 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0000_01C3EF2C.57F2DF40"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1165 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C3EF2C.57F2DF40 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: file://C:\Boletin_informativo\Information_Bulletin%203\TMPiedk7su9x4.htm information_bulletin_= 1

	Number 1, January=20 2004

Globalisation and=20 Health

Welcome=20 to this month=92s Clearinghouse Electronic Bulletin which = concentrates=20 on the relationship between globalisation and health. The = debates on=20 globalisation and health are wide-ranging. Research falls = into two=20 main areas including:

- The effects of globalisation on the = determinants of=20 health

- The effects of specific global and = regional trade=20 agreements on health and health care

The=20 literature on globalisation and health is quite extensive = =96 plugging=20 globalisation and health into the search engine of http://www.pubmed.gov/=20 gives a good view of the range. Some of the literature in = this list=20 is highlighted below.

Another=20 excellent site for getting an overview of current concerns = is www.ukglobalhealth.org. Look in the = papers section=20 of global change and health and health and trade. The Medact = website=20 www.medact.org also=20 contains an overview of globalisation literature in the = section in=20 the global economics and health folder =96 look in the World = Trade=20 Organisation file and the economic change, adjustment and = health=20 file. For a developmental perspective, see Third World = Network=92s=20 website at http://www.twnside.org.sg/=20

Some of=20 the documents below are publicly available, others (marked = with an=20 asterix) are interesting articles referred to in the = academic=20 literature. If you have difficulty obtaining any of the = links send=20 an e-mail to mikerowson@medact.org

Articles

A. EFFECTS OF GLOBALISATION ON THE = DETERMINANTS=20 OFHEALTH

The=20 literature in this area is potentially vast, but not = well-collected=20 together. Below we present a number of the best overview = papers on=20 the global impacts on health of globalisation.

The=20 Bulletin of the World Health Organisation has issued a = special issue=20 on globalisation, which is useful for an overview of the = main=20 debates on globalisation and health

David=20 Dollar of the World Bank gives a positive spin to the = globalisation=20 and health debate, concentrating on the effects of economic = growth=20 on globalising economies in the Third World.

http://www.medact.org/tbx/docs/Dollar%20-= %20Is%20Globalisation%20good%20for%20your%20health.pdf

GA=20 Cornia from the University of Florence gives another = perspective,=20 emphasising that trends in child mortality and other health=20 indicators have not been so positive in the globalisation=20 era.

http://www.medact.org/tbx/docs= /Cornia%20-%20Globalisation%20and%20health%20-%20results%20and%20options.= pdf

Also in=20 this issue of the bulletin, a framework by Woodward et al. = for=20 analysing the health effects of globalisation is especially=20 useful.

Weisbrot M, Baker D, Kraev E, Chen J.The = scorecard on=20 globalization 1980-2000: its consequences for economic and = social=20 well-being.

This paper looks at the major = economic=20 and social indicators for all countries for which data are=20 available, and compares the last 20 years of globalization=20 (1980-2000) with the previous 20 years (1960-1980). These = indicators=20 include: the growth of income per person, life expectancy, = mortality=20 among infants, children, and adults, literacy, and = education. For=20 economic growth and almost all of the other indicators, the = last 20=20 years have shown a very clear decline in progress as = compared with=20 the previous two decades.

http://www.cepr.net/globalization/scorecard_on_globalization.htm

* Bond P, Dor G. Uneven health outcomes = and=20 political resistance under residual neoliberalism in Africa. = Int J=20 Health Serv. 2003;33(3):607-30.

Africa=20 has suffered two decades of policy implementation associated = with=20 the "neoliberal" macroeconomic as well as micro-development=20 paradigm, and the health status of this continent has = deteriorated=20 markedly. Notwithstanding the discrediting of such policies = since=20 the late 1990s, they continue to be applied in Africa, = especially by=20 the World Bank and IMF, through Poverty Reduction Strategy = Papers=20 and the Highly Indebted Poor Countries debt relief = initiative.=20 Evidence can be found in the inadequate fiscal allocations = to the=20 health sector; the inadequate conceptualization of health in = relation to other sectors; insufficient consultation with = civil=20 society; ongoing implementation of cost-recovery and = user-fee=20 provisions; a failed strategy to access pharmaceutical = products, by=20 respecting unnecessary Trade in Intellectual Property Rights = provisos; and, most importantly, glaring insufficiencies in = reducing=20 Africa's foreign debt.

* Collins T. Globalization, global = health, and=20 access to healthcare.
Int J Health Plann Manage. 2003=20 Apr-Jun;18(2):97-104.

It is now = commonly=20 realized that the globalization of the world economy is = shaping the=20 patterns of global health, and that associated morbidity and = mortality is affecting countries' ability to achieve = economic=20 growth. The globalization of public health has important=20 implications for access to essential healthcare. The rise of = inequalities among and within countries negatively affects = access to=20 healthcare. Poor people use healthcare services less = frequently when=20 sick than do the rich. The negative impact of globalization = on=20 access to healthcare is particularly well demonstrated in = countries=20 of transitional economies. No longer protected by a = centralized=20 health sector that provided free universal access to = services for=20 everyone, large segments of the populations in the = transition period=20 found themselves denied even the most basic medical = services. Only=20 countries where regulatory institutions are strong, domestic = markets=20 are competitive and social safety nets are in place, have a = good=20 chance to enjoy the health benefits of = globalization.

* Milanovic, B. The Two Faces of Globalization: = Against=20 Globalization as We Know It World Development April 2003, = Pages=20 667-683

This=20 paper [from World Bank economist Branko Milanovic] shows = that the=20 current view of globalization as an automatic and benign = force is=20 flawed: it focuses on only one, positive, face of = globalization=20 while entirely neglecting the malignant one. The two key = historical=20 episodes that are adduced by the supporters of the = "globalization as=20 it is" (the Halcyon days of the 1870=961913, and the record = of the=20 last two decades of development) are shown to be = misinterpreted. The=20 "Halcyon days" were never Halcyon for those who were = "globalized"=20 through colonization since colonial constraints prevented = them from=20 industrializing. The record of the last two decades = (1978=9698) is=20 shown to be almost uniformly worse than that of the previous = two=20 (1960=9678).

A=20 further issue pertinent to globalisation is the effects of = the East=20 Asian financial crisis. Here two articles are worth pointing = to:

Kim et al. Changes in morbidity and = medical care=20 utilization after the recent economic crisis in the Republic = of=20 Korea. Bulletin of the World Health Organization=20 2003;81:567-572.

http://www.medact.org/tbx/docs/Kim%2= 0et%20al.%20-%20Effects%20of%20Korean%20crisis%20on%20health.pdf

Simms C and Rowson M. Reassessing the = Health Effects=20 of the Indonesian Economic Crisis on Health: Donors versus = the Data.=20 Lancet 2003; 361: 1382=9685

http://www.medact.org/tbx/docs/Simms%20and%20Rowson%20-%20Reasse= ssment%20of%20health%20effects%20Indonesia.pdf

B. WORLD TRADE ORGANISATION AGREEMENTS AND=20 HEALTH

There=20 is a growing literature on both the effects of the General = Agreement=20 on Trade in Services and the Trade Related Aspects of = Intellectual=20 Property Rights Agreement. Here we summarise a few of the = most=20 up-to-date articles of interest on these = agreements.

A good=20 place to start on the issue of IPRs is at the website of the = Consumer Project on Technology http://www.cptech.org/; = see also=20 the website of Health Action International http://www.haiweb.org/. = Further=20 literature is available at http://www.medact.org/ = in the=20 Global Economic Change and Health folder =96 look in the = World Trade=20 Organisation and Health file.

Labonte, R. Dying for Trade: Why = Globalization Can Be=20 Bad for Our Health

This=20 paper examines the impact of trade agreements on health and = health=20 care systems and what governments can do to ensure that = health and=20 human development are not sacrificed at the altar of =91free = trade.=92=20 It begins with a discussion of how globalization affects = global=20 health through changes in economic growth, poverty, = inequality and=20 the sustainability of our environment

http://www.socialjustice.org/pdfs/dyingfortrade.pdf

* Pollock A, Price D. The public health = implications of world=20 trade negotiations on the general agreement on trade in = services and=20 public services. Lancet 2003; 362: = 1072=9675.

Trade=20 ministries from the World Trade Organization=92s (WTO=92s) = 144 member=20 states are presently deciding which publicservices to open = to=20 foreign competition under the complex liberalisation rules = of the=20 general agreement on trade in services (GATS). A frequent = criticism=20 of the WTO system is that it reduces national autonomy over = public=20 policy. However, respect for national sovereignty is = asserted in the=20 GATS treaty. Here, the authors examine claims made by the = WTO and=20 others that GATS exempts public services and does not = require their=20 privatisation. We discuss trade treaty processes that can = subject=20 public services to commercial rules, the treaty=92s = flexibility with=20 respect to national autonomy, and the effect of GATS in = situations=20 in which national autonomy is not protected. The authors = conclude=20 that national autonomy over health policy is not preserved = under=20 GATS, and that accordingly, there is a role for = international=20 standards that protect public services from the adverse = effect of=20 trade and market forces.

Medact=20 and IPHC, along with a coalition of other aid agencies, have = issued=20 a joint position paper on the health implications of GATS. = You can=20 download a copy from http://www.medact.org/ - = look in=20 the global economics and health folder and then inside the = WTO and=20 health file.

Hilary, J. The Wrong Model: GATS and = children=92s right=20 to health. Save the Children (UK) 2002. This paper gives a=20 comprehensive overview of the potential impacts of GATS on=20 children=92s health. It is available at http://www.scfuk.org.uk/development/global_pub/wrongmodel.pdf=

Chanda R. Trade in health services. Bull = World Health=20 Organisation. 2002;80(2):158-63.

www.who.int/bulletin=20

In=20 light of the increasing globalization of the health sector, = this=20 article examines ways in which health services can be = traded, using=20 the mode-wise characterization of trade defined in the = General=20 Agreement on Trade in Services. The trade modes include = cross-=20 border delivery of health services via physical and = electronic=20 means, and cross-border movement of consumers, = professionals, and=20 capital. An examination of the positive and negative = implications of=20 trade in health services for equity, efficiency, quality, = and access=20 to health care indicates that health services trade has = brought=20 mixed benefits and that there is a clear role for policy = measures to=20 mitigate the adverse consequences and facilitate the gains. = Some=20 policy measures and priority areas for action are outlined,=20 including steps to address the "brain drain"; increasing = investment=20 in the health sector and prioritizing this investment = better; and=20 promoting linkages between private and public health care = services=20 to ensure equity. Data collection, measures, and studies on = health=20 services trade all need to be improved, to assess better the = magnitude and potential implications of this trade. In this = context,=20 the potential costs and benefits of trade in health services = are=20 shaped by the underlying structural conditions and existing=20 regulatory, policy, and infrastructure in the health sector. = Thus,=20 appropriate policies and safeguard measures are required to = take=20 advantage of globalization in health services.

Oxfam. TRIPS and Public Health: the Next = Battle=20 (2002)

The=20 Declaration on TRIPS and Public Health agreed at the WTO = Ministerial=20 in Doha in November 2001 was an important step forward in = the=20 campaign for affordable medicines. It affirmed the primacy = of public=20 health over intellectual property rights, and the rights of=20 governments to make full use of the public health safeguards = in=20 TRIPS. Ministers also recognised a fundamental imbalance in = the=20 TRIPS Agreement and promised to find a solution before the = end of=20 2002. This concerns the way the TRIPS Agreement, by = restricting=20 countries like India from exporting cheap generic medicines, = will=20 prevent many developing countries from finding affordable = sources of=20 vital new medicines. There is a simple solution to this = problem in=20 TRIPS. However, rich-country governments, under pressure = from large=20 companies, are backsliding on their promises and seeking to = water=20 down potential solutions. This issue will test the = commitment of=20 rich countries to allow poor people access to the cheapest = possible=20 medicines. Failure will strengthen calls for a fundamental = redesign=20 of TRIPS.

http://www.oxfam.org.uk/what_we_do/issues/health/downloads/bp15_= trips.rtf

Medicins Sans Frontiers has produced a briefing on = the=20 threats posed by new higher standard IPRs which could be = imposed=20 through the negotiations on the Free Trade Agreement of the=20 Americas.

A=20 briefing is available at http://www.accessmed-msf.org/documents/FTAAdoc.pdf

Medact
601 = Holloway Rd /=20 London N19 4DJ
T:+44 020 7272 2020 / F:+44 020 7281=20 5717

The International People's = Health=20 Council
Apartado # 6152, Managua, Nicaragua
TF:+505 = 266-2225=20
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