is globalisation bad for your health?

IS GLOBALISATION BAD FOR YOUR HEALTH? A paper presented as a panel presentation at the national conference of the Home Economics Institute of Australia, 12–15 January 2005, Hobart, Tasmania

Hilary Bambrick, PhD The Australian National University Canberra, ACT 0200 Tel: (+61) 2 6125 8595 (W) Fax: (+61) 2 6125 0740 Email: [email protected]

is a necessary driving force for such inventions.

INTRODUCTION What does ‘Globalisation’ mean to you? For many people, the term conjures up TV news images of internationally-recognised corporate logos and fervent antiglobalisation protestors.

Paradoxically, globalisation implies inclusiveness—yet promotes divisiveness. The dark side of globalisation pits rich against poor, north against south, power against the powerless, black against white. And good against evil.

In a nutshell, globalisation means trade liberalisation, the ‘freeing up’ of trade between countries. It means the removal of subsidies and tariffs, and other barriers to trade. For Australia this sometimes means the removal of quarantine restrictions on imported goods. Globalisation means increased competition, greater economic efficiency.

Perhaps these views are extreme. Unarguably, however, globalisation is promoting social and ecological change on an unprecedented scale, reshaping the ways that we interact with our environment. One area on which globalisation is having a profound influence is in transforming patterns of health and disease.

The idea sounds fairly attractive—level playing field, harmony. But the playing field isn’t level. Those able to compete best are the ones who are ahead initially. This is where the terms McDonaldisation, or CocaColonisation, come in, with their 90% recognition in the global marketplace.

Is the path of globalisation set in stone? What can, or should, be changed? Is the process itself inevitable? How will it change our world? And what does it mean for each of you?

By definition, globalisation requires increased production and consumption, and as a result, increased generation of waste. Concepts of sustainability are not considered. Those seeking to initiate such a debate are labelled as anti-progress, as luddites. Among the few that have given biophysical limits any thought, they persuade themselves that future, as yet uninvented, technologies will keep us from the brink of environmental catastrophe. Indeed, they believe even that globalisation

ECONOMIC COMPETITION, HEALTH AND WELLBEING Prime Minister John Howard, like many leaders of our time, believes economic competition—the cornerstone of globalisation—increases productivity and trade, which in turn raise living standards. Fundamental to living standards is human health, but health is all too frequently omitted from the globalisation equation. In Australia, overall wealth and health indicators are in good shape, but extreme

Proceedings of the national biennial conference of the Home Economics Institute of Australia: The choice is ours: Sustainable futures and home economics. 12-15 January 2005, Hobart, Tasmania

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socioeconomic inequalities are evident. For example, the 20-year shortfall in indigenous life-expectancy when compared with the rest of the population; one half of indigenous males die before they reach the age of 50 (Australian Institute Health and Wellbeing, 2002).

Australia remains the leading producer of greenhouse gas emissions. Globalisation is thus a catalyst for climate change, creating more favourable environments for disease vectors such as ticks and mosquitoes and extending the geographic and seasonal range of diseases such as malaria and dengue fever.

Nowadays, economic growth is too frequently seen as an end in itself, rather than as providing the means to improve health and wellbeing. These do not simply piggy-back on economic growth, but must be explicitly sought after. Without an explicit investment in human capital through specific public health measures, economic growth benefits the wealthy far more than it can ever benefit the poor.

People move around much more than they used to. With increased human mobility, infectious disease can spread from one side of the world to the other within a day. We are reminded each winter how easily this occurs, with the rapid transmission between northern and southern hemispheres of the newest influenza strains, and more recently with outbreaks of SARS in cities as geographically and culturally distinct as Toronto and Beijing. Forget the golden arches and the Nike swoosh, SARS is the new globalisation pin-up.

Let us now look more globally, and at the effects of trade liberalisation on global health and human capital. Economic pressure builds uncertainty for those in rural areas, and promotes urban immigration, causing crowding and poor sanitation, which amplify infectious disease transmission. Diseases such as tuberculosis thrive in such conditions, especially when general immunity is already depressed through inadequate nutrition and a continuous presence of other infections. Urbanisation is also positively correlated with air pollution, which in developing countries contributes to 130,000 premature deaths annually and up to 70 million incidents of respiratory illness (McMichael, 2000).

PRODUCTION, CONSUMPTION, HEALTH AND WELLBEING Food, tobacco and pharmaceuticals are three obvious health-related commodities that are greatly influenced by the ‘freeing up’ of trade. Food Food is increasingly traded on a global scale, while the move towards cash-crops such as tobacco and coffee exacerbates shortfalls in food supply and inequitable distribution between and within countries (Gopalan, 2001). Ever-increasing mechanisation, although economically cheap, is environmentally unsustainable; sometimes more energy may be expended during production than is actually available through the food produced.

Globalisation increases pressure for producers, manufacturers and countries to be economically competitive. This means corners may be cut in workers’ health and safety, working conditions can be abhorrent. It also means that economic pressures encourage industry to burn cheap fossil fuels rather than explore more expensive—but cleaner—alternatives. Asia’s ‘brown cloud’ illustrates this, as does Prime Minister Howard’s fear of regional economic disadvantage, which he frequently cites as the reason for his refusal to ratify the Kyoto Protocol. And this while per capita

Production methods are also potentially detrimental to health in the short-term. Monocropping not only reflects the specialisation ideals of globalisation, but requires intensive pesticide use and the blanket use of veterinary drugs. Residues remain on foods, persist in the environment


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and accumulate in our bodies. The development of resistance among pests and diseases means ever increasing amounts of pesticides and veterinary drugs are used. Hormone disruption, cancers and the emergence of antibiotic resistant superbugs are the consequences (Colborn, Dumanowski, & Myers, 1996). The use of the veterinary antibiotic Avoparcin in chicken farming has been blamed for the emergence of Vancomycin-resistant enterocci (VRE) a few years ago, a deadly gastro-intestinal illness resistant to the strongest antibiotics.

internationally dangerous.

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Tobacco A recent survey in Australia showed that, for the first time since it was popularised, cigarette consumption has dipped below 20%. Anti-smoking campaigns in rich countries have been quite successful, so now tobacco companies must look elsewhere to increase their market. Developing countries, those with new ‘disposable’ income, are the latest targets. An increase in lung cancers and cardiovascular disease in developing countries is not the only health concern of tobacco consumption. Its cultivation displaces food crops and requires massive irrigation, causing further environmental degradation in what are often already marginal areas. Farm workers are exposed to frequently unregulated pesticides, and at harvest suffer from ‘green tobacco sickness’, which is the overdosing on nicotine that gets absorbed through the skin. Even the curing of tobacco has further global environmental and health implications through its contribution to greenhouse gases. One tree is burned for every 300 cigarettes produced (Moyner, 2000)—or about 40 trees per year for every pack-a-day smoker.

Not only have production methods changed, but so have patterns of food consumption, towards much more in the way of energydense foods. People in rich countries eat too much. Food producers in America—and increasingly in Australia—have in fact been blamed for the rapid rise in obesity, as they aggressively market food and encourage people always to eat more, rather than less. The over-consumption of food, combined with the reduced physical activity of our sedentary lives, increases the likelihood that we will develop obesity, diabetes, cardiovascular disease and cancer. Obesity and its allies are not just the problem of rich countries anymore. Developing countries are also beginning to experience the worst of both worlds; where infections remain the primary cause of sickness and death, so-called ‘diseases of affluence’ are gaining prominence. In particular it is the urban elite in poor countries who are suffering the effects of an ‘affluent’ diet.

Pharmaceutical As for pharmaceuticals, the recent free trade agreement between the US and Australia has highlighted the powerful political role of the pharmaceutical industry. Drug companies want to increase the consumption of their wares by marketing direct to consumers. We already see this with over-the-counter medications, but the push is for prescription drugs to be marketed this way too. Doctors who do not prescribe a certain medication at the request of their patients run the risk of becoming a rare commodity. It becomes about who has the best advertising campaign, rather than which is the best treatment.

By definition, the ‘freeing up’ of trade means the removal of barriers. Australia’s stringent quarantine regulations are seen by trading partners as a barrier to trade. Australia is under increasing pressure to reduce food and agricultural safety standards to the minimum levels that are considered internationally acceptable (Bambrick, 2004). But as the near global spread of mad-cow disease has shown, a practice that is

Furthermore, the industry wants to charge more for their drugs, which are currently


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price-protected under Australia’s Pharmaceutical Benefits Scheme (PBS). The PBS has been held up as a benchmark in other countries, including the US, for providing quality medications that are affordable (Lokuge & Denniss, 2003). Once again, quality is assured because the efficacy of the drug is assessed, not its image. Drug companies want to charge more for their medications ostensibly as cost recovery for research and development. But far more money is spent on marketing than is ever spent on research and development.

organisations such as UNAIDS. Although not uniformly successful (developing countries still very much bear the brunt of the epidemic) this achievement highlights the value of sharing information and technologies. For example, through peer education, young people in Uganda are aware of safer sex practices and the incidence of new infections is declining, while the availability of generic antiretroviral therapy is slowing the Brazilian epidemic. However, rather than enlisting the wealth of opportunities for global co-operation, the globalisation paradox of inclusion–exclusion is instead becoming more evident. Many Western nations are becoming more insular, closing their borders to refugees and leaving poorer countries to deal with the legacies of globalisation on their own. International support for public health measures, so crucial to capitalising on the informationand technology-sharing opportunities of globalisation, is made less available as political conditions are placed on providing aid. Two years ago, the United States offered to assist Palestine only if Yasser Arafat was no longer leader. The only outcome of such measures will be to exacerbate detrimental effects of economic and sociocultural disruption, particularly in poorer countries, as they struggle to compete economically in a global market.

GLOBALISATION, EQUITY AND OPPORTUNITY Globalisation does not benefit—or cost— everyone equally. People who seek refuge from conflict, famine and political tyranny, are at particular risk from disease as they find themselves in makeshift camps near borders, or held in detention. Even when major physical needs are met, there is tremendous psychological stress. For example, children who are institutionalised fail to grow adequately even in the absence of obvious organic causes (Boddy, Skuse & Andrews, 2000), a condition potentially detrimental to their long-term health. The process of globalisation has reached crisis point. The current trajectory is damaging to health and is neither environmentally nor socially sustainable.

CONCLUSION

Perhaps reassuringly, despite the serious threats to health arising from globalisation, there is also considerable opportunity to employ it to the advantage of global human health and wellbeing. Globalisation not only increases the flow of goods and capital, but also the flow of information, knowledge and technology, and hence a potential to mobilise, on a very large scale, specific public health interventions.

Improving public health requires specific intervention and investment in human, social and environmental capital. We cannot continue to ignore the geohistorical accidents that moulded the world into its current inequitable form. We have an obligation to ensure that the detrimental effects of globalisation are minimised, particularly among developing countries which are under intense economic pressure not to invest in public health. The drive towards ever accelerating production and consumption, that is at the very heart of globalisation, is unsustainable. Biophysical limits are reached and human health suffers.

Some of this potential has already been demonstrated by international efforts to reduce the spread of HIV/AIDS, as global public health campaigns are implemented with the support of international


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On its current trajectory, globalisation truly is a serious health hazard.

REFERENCES Australian Institute of Health and Welfare. (2002). Australia's Health 2002. Canberra: Australian Institute of Health and Welfare. Bambrick, H. (2004). Trading in food safety? The impact of trade agreements on quarantine in Australia. The Australia Institute. Discussion Paper Number 73, October 2004. Boddy, J., Skuse, D., & Andrews, B. (2000). The developmental sequelae of nonorganic failure to thrive. Journal of Child Psychology and Psychiatry and Allied Disciplines, 41(8), 1003–1014. Colborn, T., Dumanowski, D., & Myers, J. (1996). Our stolen future. Abacus. Gopalan, C. (2001). Achieving household nutrition security in societies in transition: an overview. Asia Pacific Journal of Clinical Nutrition, 10 (supplement), s4–s12. Lokuge, K. & Denniss, R. (2002). Trading in our health system? The impact of the Australia-US Free Trade Agreement on the Pharmaceutical Benefits Scheme. The Australia Institute. Discussion Paper Number 55, May 2003. McMichael, A.J. (2000). The urban environment and health in a world of increasing globalization: issues for developing countries. Bulletin of the World Health Organization, 78(9), 1117–1123. Moyner, D. (2000). The Tobacco Reference Guide. UICC GLOBALink; Retrieved 28 October from http://new.globalink.org/tobacco/trg


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