EULALEE THOMPSON
Interdependence has created opportunities for positive global action.
- Jamaica Human Development Report 2005.
WHEN I think of the term 'globalisation', I think of other concepts such as 'economic integration', 'trade liberalisation' and just generally, receding barriers - real or artificial - between states that will impact trade, investment, communication and so on.
Defining globalisation seems like an elusive activity, but the Jamaica Human Development Report 2005, the second such report commissioned by the Planning Institute of Jamaica and the United Nations Development Programme, offers quite a few clear definitions from various sources. I like this one:
"Globalisation is a set of practical features in the international community (including the removal of trade and investment barriers, and the removal of barriers to communication, transport and migration) as well as a philosophy that seeks to encourage the development of those features."
And now that we have got the definition of globalisation out of the way, you must be wondering why am I even discussing this topic in a health feature. The fact is, (and the report indicates this), the global economy and the philosophy of globalisation impact the social sectors - health, education and labour. Sometimes, the impact is negative, sometimes positive.
Here are some of the opportunities and threats to Jamaica's health care system (that is, the financing of public health, health policy and health care delivery) presented by globalisation as discussed in the report (Chapter 5; authors: Orville Taylor, et al):
1 Privatisation and the will to collect user fees may enhance efficiency within the system, but it could also lead to the perception that hospitals and health centres are profit centres.
2Jamaica is committed to introducing health policies that have their origins in international health programmes, so the country could soon enjoy the benefit of such international framework such as - the Framework Convention on Tobacco Control (ratified 2004 by Jamaica); international effort to lower costs of patented drugs such as the antiretroviral therapy used in HIV/AIDS treatment; given according to the report through reliance on the Doha Declaration, which maintains in essence that priority be given to public health considerations even in some cases where pharmaceutical companies may have proprietary rights over particular drugs; family planning benefit through support from the United States Agency for International Development; in the future more reliance on telemedicine; health tourism.
3Structural adjustment policies of lending agencies such as the World Bank and IMF are impacting international health policies. The lending agencies sometimes demand cuts in funds allocated to health, impose conditions such as the introduction of user fees and the privatisation of specific non-medical services. The ultimate agenda appears to be the creation of a market-driven health financing and delivery system.
4Trade agreements such as General Agreement on Trade in Services (GATS) and Trade-Related Aspects of Intellectual Property Rights (TRIPS) also impact health care offered to the public. GATS, for instance, promotes the removal of barriers to trade and regulations on health services are no exception. This requirement could make access to healthcare less equitable and more costly, restrict choice and override national regulations.
5Decentralisation and other health reform initiatives were started in 1997 and the report notes that between 1997 and 2002, there has been fewer visits to primary care facilities. The reduction could be linked to the introduction of user fees and reduced access to health care (there was cutback in health centres especially in the rural areas).
6In terms of disease patterns, the report notes that western lifestyles (particularly the change in eating patterns) have permeated developing countries resulting in significant increases in chronic diseases associated with that lifestyle. HIV/AIDS is noted as an example of the international transfer of microbes and the effects of increased international travel.
You can send your comments to eulalee.thompson@gleanerjm.com.
