An increasingly common question in medical interviews over recent months has been on the topic of 'globalisation of health'. This is a term that is often used but when asked directly what it means, many students can find it difficult to put their finger on it. So let's split it up, work it out and think of a five key points to show your interviewer you are worldly wise about medicine as a subject and a future career.
What is globalisation?
According to WHO (the World Health Organisation - if you don't know who they are and what they do then look it up now!), globalisation means
- The growth of international trade
- Improving global communications
- Increasing flows of goods, services and people
So more things are being sold between countries, communication across the world is better and more efficient and more goods (products), services and people are moving between countries. Cool. But what does this mean for health? Well, it has both a direct effect and also an indirect effect. In other words, it affects how we approach health but it also affects the health status of each individual.
1. Technology: Better sharing of information about disease outbreak
Through the improvement of communications technology, it is much easier for healthcare staff and even the general public to alert the relevant authorities to the outbreak of diseases. Furthermore, it is easy for people to share ideas and information on health issues and inherently, increased sharing of information leads to increased progression in how we approach these issues.
The huge rise in e-health is changing how we view medicine. Electronic communications, websites and apps are not limited by boarders and offer many potential benefits particularly from the point of view of medical education and professional training.
2. Migration and tourism: More people moving = more disease spread
The more that trade, tourism and migration increase (in other words the more that people move), the easier it is for diseases to spread. More than two million people cross international boarders every day and many will also be carrying disease into the new area they are entering. This isn't a new thing. In fact, it dates back to the 14th century where the example of the Black Death can be used as an example of how disease spread followed shipping routes.
*What is the Black Death? (You were thinking it, we said it!) The Black Death was one of the most devastating pandemics in human history resulting in the death of about 100 million people! It is thought to have been caused by a bacteria that caused several forms of plague.*
In fact, the spread of HIV across the world can be attributed to the globalisation that occurred during the 20th century.
3. Trade: Animals and Tobacco
More recently, the most concerning factor has been the spread of food borne disease. The increased trade (buying and selling) of live animals and animal products has led to diseases that previously started in animals mutating into variants that can be infectious, and often deadly, in humans. An example of this is Creutzfeldt-Jacob disease which is often referred to as 'foot and mouth'. This is a fascinating disease and keep your eyes peeled for an upcoming blog post dedicated to it!
The increasingly globalised production and marketing of cigarettes has a majorly negative impact on health. Firstly, transnational tobacco companies have increased the sales of tobacco in developing countries. Secondly, the variation in the rules and regulations between countries and more importantly, the differences in their willingness to control tobacco usage has made it harder to crack down on cigarette usage.
*Useful facts: Over 100,000 deaths a year are due to cigarette-related illnesses; 9 in 10 people wish they had never started smoking (Source: The Times)*
4. Environment: The effect of climate change on our health
Higher temperatures, more CO2, more greenhouse gases, ozone breakdown. From respiratory infections to higher rates of skin cancer, the changes in the global environment are affecting our health without a doubt, and not for the better!
5. Global public goods: Making change global
The concept of globalising public goods creates the potential to improve the health effects of globalisation itself by maximising the benefits of globalisation to benefit worldwide health.
I know everyone is thinking, what on earth is a public good? A public good is a service that once provided is available to all and people using/consuming the service does not prevent others from using/consuming it. These are often hugely beneficial to health. For example, water services, sanitation services, health education and many more. Normally, these services are provided on a local level - mostly due to the difficulty in financing them when they extend further than this. However, there are many examples where by expanding the services to global level would have greater benefits and impact than simply providing the services on a national level in individual countries.
Immunisation is a particularly important example of how this has worked in the past. Polio eradication is a perfect example. Only universal eradication of polio demonstrates the full benefits of the money and resource savings of preventative programmes and re-vaccination. Moreover, once polio is eradicated, everyone will benefit!
An example of something that could benefit from this is international coordination to reduce antimicrobial resistance. Combining and sharing knowledge about this issue could allow a united approach, increasing efficiency and could allow us to overcome this extremely pressing issue.
So, what does Applican think? What does globalisation mean for health?
Well, we think globalisation is cool. Huge increases in our ability to share information is the particularly exciting part. Look at this blog post - anyone around the world can read it! It is pretty exciting. However, as our approach to life shifts, so should our approaches to services and in particular health. Anyone who has been on an Applican course or is thinking about it, get one phrase into your head: "The shift from acute illness to chronic disease". Healthcare 100 years ago was focused on acute illness. Today, our issue is chronic disease: cardiovascular problems, cancer, obesity, diabetes, the list goes on. These issues require long term treatment and are expensive. More importantly, the longer that people live, the more of these chronic problems they are likely to accumulate. In other words, chronic disease and the ageing population go hand in hand. They also make our traditional model of healthcare completely outdated. We need a life approach to healthcare. What do we mean by a life approach to healthcare?
1. Primary health care: less specialist doctors, more generalists
Currently, the traditional model of healthcare is hospital centred with lots of doctors that strive for specialist niches that they can be experts in. This doesn't really lend itself to a situation where patients have problems from LOTS of specialities with issues arising from all of them. More than ever, we need doctors that are generalists in multi-tasking with diseases. We need generalists not specialists! People who can look at someone with 5 problems and know which order of priority they should be treated in and how to treat one problem without having knock on effects on the other underlying issues (also commonly referred to as 'co-morbities).
2. Intervening earlier: prevention rather than cure
Less fight fighting, more fire prevention. By intervening earlier in a person's life, we can truly impact future health and disease. A recent study looked at mice embryos that are just 4 days old. The study demonstrated how if the mothers of these mice were fed high fat diets the baby mice had higher blood pressure and higher BMIs later in life than the baby mice born from mothers fed a high protein diet. How crazy is that?! This has led to many studies looking at similar factors in humans with the consideration that many illnesses could be based on behaviour between conception and birth.
In conclusion, a life approach to healthcare would be the shift needed to meet the changes occurring due to globalisation. It is essential that globalisation allows for increased health promotion, rather than deterioration. This means managing globalisation to minimise the potential for the negative effects we have discussed above. This will inevitably mean designing international policies and rules that optimise health outcomes. It is essential that we also realise the sectors that are indirectly important to health and ensure funding is maintained in these areas. These include education, production of health-sector equipment and facilities and most important the producers of goods with positive and negative effects on health (such as foods, tobacco, alcohol and so on). For example, one suggestion is increasing tax on the goods that cause detrimental effects for health and increasing access to the positive ones.
Here at Applican, we are passionate about breaking down terms. Globalisation is one of those that people think they know about but actually have no idea. We hope that after reading this article you could give an excellent answer to any question regarding globalisation of health. Moreover, we hope you could give a passionate, insightful and balanced answer.
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