Costs and Benefits
Costs and Benefits

As with many other issues, such as environmental protection and economic development, globalization presents both opportunities and challenges. Although the process of integration creates some new problems, it also offers the possibility of addressing old concerns.

The challenge of addressing international public health issues is in many ways similar to the concern about global warming: although improvements in global public health benefit everyone, the costs are often borne by individual countries, so there is less incentive by lesser-affected countries to make big investments. Compounding this problem is that the countries with the most significant public health problems typically have the fewest resources to respond to them.

The world’s low-income nations spend an average of $81 per person on total health expenditures per year. By way of comparison, in 2010 the United States spent an estimated $2.6 trillion on health care, almost $8000 per person (Geisel, 2013).  The figure below provides a historical glimpse of per capita spending on health care, from 1980 to 2009.


Source: The Commonwealth Fund

However, even though expenditures are expected to continue to rise swiftly, there are still millions of  individuals living in the United States without proper health care.  The Obama administration has tried to rectify this situation through the passage of H.R. 3200 America’s Affordable Health Choices Act of 2009.   Despite passing Congress in May 2010, various U.S. states are contesting this controversial health care bill and trying to weaken its influence on the state-level.

Because of this disparity between needs and resources, many people argue that the proper response to public health concerns requires that the wealthier countries of the world increase their spending on an improved international public health system, concentrating on developing countries.

Economist Robert Fogel performed an economic analysis of the effects of improvements in health and nutrition over Britain’s history. He found that these health benefits were responsible for at least 20 percent of Britain’s growth in national income over the period between 1780 and 1979.

Leading public health institutions, including the Centers for Disease Control and Prevention (CDC) and the WHO, have identified the need to establish and implement global health initiatives. Because infectious diseases know no borders, public health infrastructures need to expand beyond the national level to encompass international objectives.

Major international health initiatives underway include the polio eradication campaign, the Global Alliance for Vaccines and Immunization, and the newly established United Nations Global Fund to fight HIV/AIDS, Tuberculosis, and Malaria. Global health initiatives combine the skills of numerous organizations in combating morbidity and mortality around the globe. These initiatives have the capacity to make enormous strides in improved global public health.

Globalization plays a role in the dissemination of proven public health tools from the developed world to the developing world. The uses of modern technologies allow public health practitioners to provide state of the art interventions in regions where a few years ago interventions such as these would have been impossible.

New tools include vaccines, drugs, disease surveillance strategies, and behavioral or medical interventions that, prevent or eliminate, disease transmission. The use of these tools in international settings could have a dramatic effect in improving scientific, financial, and cultural barriers. Improved communication networks, computer technology, and innovations in medical technology have all played a valuable role in reducing morbidity and mortality rates around the globe.

As with so many other aspects of globalization, the new world we are entering presents opportunities as well as challenges. The increasing pace of international travel and trade unquestionably presents new concerns about global public health. Of course, this development is not new, but is in fact part of a centuries-long trend of increasing human interaction. However, if properly harnessed, globalization holds the possibility of offering new ways to address not only the new threats but also some very old problems.

Questions for Discussion:  

Do you agree with the argument that any effective response to the spread of global diseases must be global? Who would coordinate this effort? How would you prioritize your efforts if you were in charge (would you spend more money on prevention, treatment, or research? Would you allocate more money to particular countries than others)?  

What do the current trends in trade, migration, and development tell us about the future of infectious disease spread? 

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