Introduction
Individuals
or communities whether healthy or not is determined by many factors combined
together. These factors are called determinants of health. Factors such as
where people live, state of the environment, genetics, income and education
level and the relationship with families and friends (The Determinants of
Health, 2011). All these factors can be classified into three main categories.
They are economic, socio-cultural and ecological determinants of health (Huynen,
Martens, Hilderink, 2005 a). Traditionally,
founders of modern economy argued that impacts of globalisation are limited to
the movement of goods and services for the purposes of economy only (Deaton,
2004). However, this trend has changed as globalisation not only affects the
economy but the culture, politics, social life, ecology and of course the
organisation of health services and facilities of a country (Globalisation Pros
and Cons, 2013). The need for good health is now accepted as an international
goal (Huynen, Martens, Hilderink, 2005 b) and this makes it possible to
classify globalisation as a new determinant of health. Globalisation is the
constellation of processes by which nations, businesses and people are becoming
more connected and interdependent across the globe through increased economic
integration and communication, cultural diffusion and travel (Labonte, 2011).
This process, has argued by economists, would bring equality and liberty, flow
of capital goods and services, infusion of new ideas, technologies and global
economic growth (Azevedo & Johnson, 2011). Globalisation of the health care
system would include openness to foreign health goods and services, ideas,
policies and people which were once a national function (Globalisation of
Health, 2011). This paper would discuss health and globalisation in history,
globalisation and health system change, impacts of globalisation on PNG Health and
an analysis of the impacts of globalisation on PNG health
Health and
Globalisation in History
Indeed,
the idea of globalisation is quite old and has been changing gradually over
centuries of trade and international commerce (Michael Noll, 2001). It can be
questioned that would the new trend of globalisation today be different from
that of distant past. As identified by Noll, 2011, globalisation of today is
much more efficient than in the past due to the movement of information, goods
and services using fast moving, conducive mode of transportation compared to
manual powered boats, horses and camels used in the past. The production
process in the past was dominated by people who were replaced by machines
today. The use of information technology and telecommunication in globalisation
today has also helped a lot compared to the past. Up to date, as argued by Deaton,
2004, never in the critical discussions of the impacts of globalisation did the
economists mention how globalisation would affect the health of the people. Diseases
had been an unwelcome companion of trade in the past which has been documented
to go to the extent of nearly killing an entire population of countries. For
example, plague in Athens in 430 BC which killed nearly two thirds of the
population and the black rats which transmitted bubonic and pneumonic plague to
Europe in 1347 (Deaton, 2001b). The suspected sources of disease outbreaks at
that time were the trading ships, animals and merchants. From then, some countries
in Europe, such as Italy, setup first quarantine measures on national and
international trades in an attempt to control reoccurrence of the epidemic.
Foreigners were expelled from these countries, example Jews, and access to
trade was restricted. However, it did not last long as the need for health is
second to that of trade. Dispute between health and trade broke in 1652 and
gates had to be opened for trade (Deaton, 2001c). PNG has never undergo such an
ordeal so would the impacts of globalisation on PNG health be the same of that
in the past or would it be more devastating are some questions still left
unanswered. For now, experiences encountered by other countries can be used as
a guide to be prepared before the advent of full scale globalisation of the
health care system.
Impacts of
Globalisation on Health Care System
As
mentioned earlier, health sector has been a national focus before
globalisation. It cannot be disagreed that globalisation is bad.
Globalisation liberates flow of health consumables such as medicines,
equipments, human resources, policies and information across borders of
countries. Countries form alliance with each other for dependency, aid and
paramount of all is survival. However, there are also adverse consequences of
such coalition. Examples of such consequences may include mobility of health
professionals and patients between countries, establishments of private and
foreign companies providing health services, use of new technologies to provide
health services (Globalisation of Health, 2011), transmission of new diseases,
restructure of health care system, changes in people’s and worker’s disease
patterns and utilisation of health services (Diep, Huong & Tu, 2004).
Analysis of the impacts
Movement
of health professionals abroad would certainly create problem for PNG. What
happens is that inadequate number of them would be available to cater for the
health needs of the people. For example, United Kingdom recruiting nurses from
developing countries. People may fear
coloured doctors and would not discuss their health problems openly or do the
worse thing, avoid them. If the patients decided to travel abroad seeking
better medical care, it would be costly. Before it is late, PNG should develop
strategies to retain its skilled health professionals before they start
migrating. Similarly, establishments of private and foreign health care
practitioners would create competition between themselves and the health
services already provided by the government. People may resort to their health
services and it is not wise for the government to provide health services which
people are not benefiting from. It would be a waste of resources. Who knows,
foreigners would also be providing health services which are not consistent
with PNG Health Laws like selling expired medicines or dummies to the local
people. Many people would not want that and would pressure the government to
address such things. Furthermore, use of new technologies like robots and
machines in hospitals would chase the people away. Besides, how can PNG afford to
offer such expensive technologies? If it does, these technologies would only be
used by those who can offer the attached cost of using these services while
those who cannot afford would be left out. To address such issues, should the
government provide two types of health services, one for the lucky ones and the
other for the unfortunate ones? Again it would be a waste of resources and
duplication of services which is economically bad. Therefore, the government
should plan carefully before taking globalisation of health aboard. Access to
foreign foods and drinks can lead to new lifestyle disease such as diabetes.
Environmental pollution by chemical wastes from factories can be a threat to
public health. During the development of economy and the society, certain health
problems such as injuries, accidents, cancer, sexually transmitted infections
and heart problems can be increased as argued by Diep, Huong & Tu, 2004. Merchants
travelling in can bring new diseases such as chikungunya, similar to malaria
but more lethal, into the country. This can alter the disease patterns of the
people and the working class, causing the government to spend more on treating
these varieties of diseases. If nothing is done quickly they can kill the whole
population as in the past. Restructure of health services is also obvious.
Currently, PNG is trying to implement “One System Tasol” under the new Provincial
Health Authority to integrate public hospital services and rural health
services into one system. However, not every province has successfully
implemented this Act because it requires expert knowledge and resources. This
concept is adopted from foreign countries and it worked well for them but may
not for us. Not forgetting that people may fear losing their jobs during the
restructure. All these are adverse consequences of globalisation if the
government is not careful to avoid.
Concluding thoughts
Many
questions and issues can arise from globalisation. Role of globalisation in
mass media has significantly influences a lot of people that they become
threatened and display acts of terrorism. PNG government should question the
movement for globalisation before accepting it as it might be leading to new
world order by super global governments with the intentions of exploitations
and threats to national sovereignty. If that is to be true, around the globe,
people would be fighting for nationalism. The way out for PNG is still unknown
as it requires in-depth research and study. For now, let us use the experiences
other countries have faced and plan in advance on how to use globalisation to
our advantage.
Recommendation
One
way to limit the negative impacts of globalisation in health is to reform and
develop health system to suit the onset of globalisation. This should be the priority
of health sector in the coming years and it requires comprehensive review of
health policies and laws in order to meet the people’s increasing needs of both
quantity and quality health care (Diep, Huong & Tu, 2004)
Getting ready for a field trip to Yagaum HSC,Ambenob District,Madang Province,2013
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