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Global health and
globalisation
what are they, and how are they relevant
Session overview
• What is global health?
• Is it different to international health?
– Theoretical/practical
• What is it ...
A few initial points…
• Massive area
• Short amount of time
• More questions than answers!
(hopefully!)
• Do ask questions!
What does ‘global health’
mean?
Global health IS NOT
• just Infectious diseases medicine
Perspectives
• ‘peeling onions’!
• Taking it further: actions
the big issues that matter
in health:
globalisation…
poverty…
development…
A (brief) definition
• We believe that global health is a broad discipline that
develops students' understanding of the lo...
Globalisation
Unlearning…
What is globalisation?
• Economic globalisation:
–obstacles to trade and movements
between countries progressively
reduced
Economic globalisation
• Is it happening?
– YES
– World exports of goods and services almost tripled in
last thirty years
...
Economic globalisation
• Why is it happening?
– Competition and the search for new
markets
– Technological changes (partic...
Globalisation - broader definition
• Globalisation canalso be defined as processes that are
changing the ways in whichpeop...
What are the effects?
• Economic growth
• Economic instability
• Rise in inequalities
• Effects of trade agreements – eg T...
Growth
• Positive effects:
– (expected) increased openness of countries
to trade and investment
• Negative effects:
– un-p...
Changes in income inequalities
• Global distribution of income has
worsened
• At national level, many countries seem
to ha...
where are they?
TRIPS
What?
•Trade-
•Related aspects of
•Intellectual
•Property
•Rights
Progress must be made. It is estimated
that by improving access to existing
medicines and vaccines, approximately
10 milli...
A timeline: GATT to WTO
• 1947: Geneva 23 countries
• 1949: Annecy 13
• 1951: Torquay 38
• 1956: Geneva 26
• 1960-1: Dillo...
WTO
• Currently over 150 members (and growing)
• Mandate:
– Trade liberalisation
– Trade negotiations
– Dispute settlement...
TRIPS
• (one aspect of) globalisation in action
• Uruguay 1994
• Legally binding
• AND enforceable
• Global patent protect...
• ‘Our combined strength enabled us to
establish a global private sector-
government network which laid the
groundwork for...
Trade vs Health
• 1998: first WHO guidance re implementation
of TRIPS
• “considerable concern among the
pharmaceutical ind...
The Doha Declaration
“…while reaffirming our commitment to the
TRIPS Agreement, we affirm that the
Agreement can and shoul...
Doha declaration 2001
• TRIPS should be interpreted in a manner
which supports governments’ attempt to
protect public heal...
Fast forward to 2007
• Doha declaration never used (but
nearly!)
– ? unworkable
• Countries without domestic generic
indus...
Emerging issues
• Regional free-trade agreements e.g. FTAA
– IP included under the agreement
– US proposals would
• restri...
Emerging issues
• NGOs attempting to strengthen developing
countries’ capacity to make use of flexibilities
in TRIPS
• Pro...
Importance of networks
• US Commercial interests needed
support from across the world to make
TRIPS happen
• Surveillance ...
Final thoughts
• Complicated issues…
… but important!
• ‘Themes’
– Power relationships; trade and finance decision-
makers...
questions?questions?
Globalisation and Health
Globalisation and Health
Globalisation and Health
Globalisation and Health
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Globalisation and Health

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Globalisation and Health

  1. 1. Global health and globalisation what are they, and how are they relevant
  2. 2. Session overview • What is global health? • Is it different to international health? – Theoretical/practical • What is it not? • What is globalisation? • What is ‘driving’ it? • TRIPS and the WTO • Health worker Migration
  3. 3. A few initial points… • Massive area • Short amount of time • More questions than answers! (hopefully!) • Do ask questions!
  4. 4. What does ‘global health’ mean?
  5. 5. Global health IS NOT • just Infectious diseases medicine
  6. 6. Perspectives • ‘peeling onions’! • Taking it further: actions
  7. 7. the big issues that matter in health: globalisation… poverty… development…
  8. 8. A (brief) definition • We believe that global health is a broad discipline that develops students' understanding of the local, national and international determinants of health and healthcare delivery. • Through studying global health, students examine the wider influences of health such as poverty, debt, globalisation, healthcare financing, human rights, famine, environment, violent conflict and the movement of populations. Global health draws from a number of disciplines including politics, economics, sociology, demography, anthropology, epidemiology and philosophy.
  9. 9. Globalisation
  10. 10. Unlearning…
  11. 11. What is globalisation? • Economic globalisation: –obstacles to trade and movements between countries progressively reduced
  12. 12. Economic globalisation • Is it happening? – YES – World exports of goods and services almost tripled in last thirty years – Levels of commercial investment (FDI) have increased substantially – Daily turnover in world’s foreign exchange markets has increase from $1 billion in 1970 to over $1 trillion today – Huge declines in transport and communication costs
  13. 13. Economic globalisation • Why is it happening? – Competition and the search for new markets – Technological changes (particularly in the communications sphere) – International policies and agreements (e.g. WTO agreements)
  14. 14. Globalisation - broader definition • Globalisation canalso be defined as processes that are changing the ways in whichpeople interact across boundaries, notably physical (such as thenation-state), temporal (such as instantaneous communication via email), and cognitive (such as cultural identity). The resultis a redefining of human societies across many spheres, economic,political, cultural, technological and so on. As such, globalisationaffects the health of different people in very different ways.How good or bad globalisation happens to be for you will be influencedby socioeconomic status, sex, education, age, geographical location,and otherfactors. » Lee, K et al. BMJ 2002;324:44 ( 5 January )
  15. 15. What are the effects? • Economic growth • Economic instability • Rise in inequalities • Effects of trade agreements – eg TRIPS
  16. 16. Growth • Positive effects: – (expected) increased openness of countries to trade and investment • Negative effects: – un-preparedness of economies for global competition – effects of instability
  17. 17. Changes in income inequalities • Global distribution of income has worsened • At national level, many countries seem to have experienced a worsening of income inequalities • Why? Could it be related to globalisation?
  18. 18. where are they?
  19. 19. TRIPS What?
  20. 20. •Trade- •Related aspects of •Intellectual •Property •Rights
  21. 21. Progress must be made. It is estimated that by improving access to existing medicines and vaccines, approximately 10 million lives could be saved every year: 4 million in Africa and South-East Asia alone. [DIFD, 2004, p8] • estimated 1.7 billion people lack access to essential medicines • unchanged for two decades (WHO, 2004) • particularly concentrated in Africa and India; – around 80% in low income countries – remaining 20% are almost all poorest in middle income countries (WHO, 1999).
  22. 22. A timeline: GATT to WTO • 1947: Geneva 23 countries • 1949: Annecy 13 • 1951: Torquay 38 • 1956: Geneva 26 • 1960-1: Dillon Round 26 • 1964-7: Kennedy Round 62 • 1973-9: Tokyo Round 102 • 1986-94: Uraguay Round 123 • 1995: established…
  23. 23. WTO • Currently over 150 members (and growing) • Mandate: – Trade liberalisation – Trade negotiations – Dispute settlement • Established 1st January, 1995 • 1999: Failed to launch new round, Seattle • 2001: Doha Round Launched • 2003: Cancun… • 2005: Hong Kong… struggling on
  24. 24. TRIPS • (one aspect of) globalisation in action • Uruguay 1994 • Legally binding • AND enforceable • Global patent protection (allows monopoly production and sale for life of patent)
  25. 25. • ‘Our combined strength enabled us to establish a global private sector- government network which laid the groundwork for what became TRIPS’ – Edmund Pratt, CEO, Pfizer
  26. 26. Trade vs Health • 1998: first WHO guidance re implementation of TRIPS • “considerable concern among the pharmaceutical industry”, “that no priority should be given to health over intellectual property considerations” Directorate General for Trade of the European Commission, 1998 • 1999: Seattle: Battles re Essential Medicines Patents • 2001: Doha Declaration – a success?
  27. 27. The Doha Declaration “…while reaffirming our commitment to the TRIPS Agreement, we affirm that the Agreement can and should be implemented in a manner supportive of WTO Members’ right to protect public health and, in particular, to promote access to medicines for all.” • Go ahead for generic production/import?
  28. 28. Doha declaration 2001 • TRIPS should be interpreted in a manner which supports governments’ attempt to protect public health – emphasised flexibility already in TRIPS – extension for LDCs until 2016 – recognised problem of compulsory licensing in countries with insufficient or no manufacturing capacity and resolved to find a solution to this issue
  29. 29. Fast forward to 2007 • Doha declaration never used (but nearly!) – ? unworkable • Countries without domestic generic industries? • WTO paralysis? • TRIPS+ • India Glivec court case… watch out
  30. 30. Emerging issues • Regional free-trade agreements e.g. FTAA – IP included under the agreement – US proposals would • restrict grounds for compulsory licensing • extend patent holders monopoly beyond 20 years • give five years ‘data exclusivity’ on pharmaceutical test data, delaying entry of generics
  31. 31. Emerging issues • NGOs attempting to strengthen developing countries’ capacity to make use of flexibilities in TRIPS • Proposals for R&D funds for neglected diseases – raises issue of public sector R&D and how it is exploited • Drug donation; corporate social responsibility or PR smokescreen?
  32. 32. Importance of networks • US Commercial interests needed support from across the world to make TRIPS happen • Surveillance + economic coercion crucial to maintaining commercial power in this area • Weaker actors also have to create global networks as a counterpoint
  33. 33. Final thoughts • Complicated issues… … but important! • ‘Themes’ – Power relationships; trade and finance decision- makers; commercial interests; governments – increasing influence of CSOs
  34. 34. questions?questions?

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