1. Global health and
globalisation
what are they, and how are they relevant

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. A few initial points…
• Massive area
• Short amount of time
• More questions than answers!
(hopefully!)
• Do ask questions!

4. What does ‘global health’
mean?

5. Global health IS NOT
• just Infectious diseases medicine

6. Perspectives
• ‘peeling onions’!
• Taking it further: actions

7. the big issues that matter
in health:
globalisation…
poverty…
development…

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. Globalisation

11. Unlearning…

12. What is globalisation?
• Economic globalisation:
–obstacles to trade and movements
between countries progressively
reduced

13. 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

15. 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)

16. 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 )

18. What are the effects?
• Economic growth
• Economic instability
• Rise in inequalities
• Effects of trade agreements – eg TRIPS

19. Growth
• Positive effects:
– (expected) increased openness of countries
to trade and investment
• Negative effects:
– un-preparedness of economies for global
competition
– effects of instability

20. 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?

21. where are they?

22. TRIPS
What?

23. •Trade-
•Related aspects of
•Intellectual
•Property
•Rights

25. 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).

26. 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…

27. 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

28. 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)

29. • ‘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

30. 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?

31. 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?

32. 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

33. 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

34. 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

35. 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?

36. 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

37. Final thoughts
• Complicated issues…
… but important!
• ‘Themes’
– Power relationships; trade and finance decision-
makers; commercial interests; governments
– increasing influence of CSOs

38. questions?questions?