https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61690-6.pdf

Closing the gap in a generation: health equity through action on the social determinants of health

From a world history perspective, the most noticeable trend in the history of the late 19th century was the domination of Europeans over Non­Europeans. This domination took many forms ranging from economic penetration to outright annexation. No area of the globe, however remote from Europe, was free of European merchants, adventurers, explorers or western missionaries. Was colonialism good for either the imperialist or the peoples of the globe who found themselves subjects of one empire or another? A few decades ago, the answer would have been a resounding no. Now, in the wake of the collapse of the Soviet Union, the more or less widespread discrediting of Marxist and Leninist analysis, and the end of the Cold War, political scientists and historians seem willing to take a more positive look at Nineteenth Century Imperialism. One noted current historian, Niall Ferguson has argued that the British Empire probably accomplished more positive good for the world than the last generation of historians, poisoned by Marxism, could or would concede. Ferguson has argued that the British Empire was a \" liberal \" empire that upheld international law, kept the seas open and free, and ultimately benefited everyone by ensuring the free flow of trade. In other words, Ferguson would find little reason to contradict the young Winston Churchill's assertion that the aim of British imperialism was to: give peace to warring tribes, to administer justice where all was violence, to strike the chains off the slave, to draw the richness from the soil, to place the earliest seeds of commerce and learning, to increase in whole peoples their capacities for pleasure and diminish their chances of pain. It should come as no surprise that Ferguson regards the United States current position in the world as the natural successor to the British Empire and that the greatest danger the U.S. represents is that the world will not get enough American Imperialism because U.S. leaders often have short attention spans and tend to pull back troops when intervention becomes unpopular. It will be very interesting to check back into the debate on Imperialism about ten years from now and see how Niall Ferguson's point of view has fared! The other great school of thought about Imperialism is, of course, Marxist. For example, Marxist historians like E.J. Hobsbawm argue that if we look at the l9th century as a great competition for the world's wealth and …

The New Imperialism

Drivers of tuberculosis epidemics: the role of risk factors and social determinants.

The author describes the development of demography in Hungary from 1928 to the present with a focus on the contribution of Hungarian demographers to the activities of the International Union for the Scientific Study of Population (IUSSP). This paper is part of an IUSSP project that deals with the history of the Union and involves the preparation of papers on such activities in several countries. (summary in ENG RUS) (ANNOTATION)

Contribution of Hungarian demographic science and Hungarian demographers to the work of the International Union for the Scientific Study of Population

The abstract should provide a summary of the HiT in no more than 250 words The Box provides an example from the Philippines HiT, 2011 Philippines HiT abstract Consistent with its commitment to the Alma Ata in 1978, the Philippine Government adopted the Primary Health Care (PHC) approach in 1979 to achieve health for all Filipinos by year 2000 The promulgation of the Local Development Code (RA 7160) in 1991 was in line with the community participation ideals of PHC (1992-1999) as it devolved responsibility for health care was devolved to Local Government Units The Health Sector Reform Agenda was introduced in 2005 to address problems in health care delivery at local level brought about by the devolution proves Issues of poor accessibility, inequities and inefficiencies of the health system have been the target of health reforms over the last 30 years Hospital, public health, financing, local health system and regulatory reforms comprised the HSRA approach In 2005, the DOH streamlined the reform program to ensure access and availability of essential and basic health packages by reducing the four reform areas, namely: 1) designating providers of basic and essential health service package in strategic locations; 2) assuring the quality of both basic and specialized health services; and 3) intensifying the current efforts to reduce the public health threats brought about by endemic, vaccine-preventable and priority diseases Although studies have yet to be done on the impact of reforming health service delivery, implementation of strategies to improve the hospital services and public health programs have shown some positive gains However, huge disparities in health outcomes across income groups and geographic areas and challenges in ascertaining physical and financial access to health services as evidenced by high out-of-pocket expenditures, concentration of physical and human resources for health in urban areas and migration of health professionals still exist The focus of future developments in health should be towards providing universal health care for Filipinos, starting with improving access of the poor and vulnerable to health services Source: APO, Philippines HiT Vol 1 No 2 2011

https://www.euro.who.int/__data/assets/pdf_file/0018/231516/HiT-Estonia.pdf

Health systems in transition.

One manifestation of globalization is medical tourism. As its implications remain largely unknown, we reviewed claimed benefits and risks. Driven by high health-care costs, long waiting periods, or lack of access to new therapies in developed countries, most medical tourists (largely from the United States, Canada, and Western Europe) seek care in Asia and Latin America. Although individual patient risks may be offset by credentialing and sophistication in (some) destination country facilities, lack of benefits to poorer citizens in developing countries offering medical tourism remains a generic equity issue. Data collection, measures, and studies of medical tourism all need to be greatly improved if countries are to assess better both the magnitude and potential health implications of this trade.

Medical tourism today: What is the state of existing knowledge?

1. Introduction: Globalization's Challenges to People's Health Ronald Labonte & Ted Schrecker 2. An Empirical Investigation of the Relation Between Globalization and Health Giovanni Andrea Cornia, Stefano Rosignoli & Luca Tiberti 3. Global Political-Economic and Geopolitical Processes, Structures and Trends Patrick Bond 4. Labor Markets, Equity and Social Determinants of Health Ted Schrecker 5. Globalization and Policy Space for Health and Social Determinants of Health Meri Koivusalo, Ted Schrecker & Ronald Labonte 6. Liberalization "Shocks" and Social Protection Policies: Lessons from the East Asian Financial Crisis Aniket Bhushan & Chantal Blouin 7. Global Financing for Health: Aid and Debt Relief Sebastian Taylor & Michael Rowson 8. Globalization and Health Systems Change John Lister & Ronald Labonte 9. Globalization and the Cross-Border Flow of Health Workers Corinne Packer, Ronald Labonte and Vivien Runnels 10. Globalization, Trade and the Nutrition Transition Corinna Hawkes, Mickey Chopra & Sharon Friel 11. Intellectual Property Rights and Inequalities in Health Outcomes Carlos M. Correa 12. Global Governance for Health Kelley Lee, Meri Koivusalo, Eeva Ollila, Ronald Labonte, Claudio Schuftan & David Woodward 13. 'Rights, Redistribution and Regulation' Ronald Labonte & Ted Schrecker 14. Globalization, Social Determinants and the Struggle for Health David Sanders

Globalization and health : pathways, evidence and policy

Globalisation, in a broad sense, holds considerable potential for improving human health,
while presenting many challenges. At base, the key challenge for the Commission is to
understand how globalisation affects people’s access to social determinants of health (SDH)
and, given an explicit concern with equity, how that access is distributed. The approach
taken by the Globalisation Knowledge Network (GKN) to assist with this task emphasized the
economic aspects of globalisation since the 1970s on the basis that the policies driving
global market integration are the most important with respect to SDH.
There is some evidence of positive global responses to this challenge. Efforts have been
made to cut across existing national, international and institutional boundaries to address
issues of transnational reach, whether articulated as goals (e.g. the Millennium Development
Goals), broadly stated themes (e.g. poverty alleviation, social exclusion, gender
empowerment) or control of such health-damaging products as tobacco (e.g. the Framework
Convention on Tobacco Control). Even disease-specific global initiatives are increasing their
response to the challenge of contemporary globalisation. Efforts to tackle the HIV/AIDS
pandemic, as one example, have broadened from an initial biomedical focus to issues
concerning human rights, poverty and gender. Yet much more needs to done to manage the
multiple ways in which globalisation affects SDH.
Globalisation affects health and SDH through changes in social stratification, differential
exposure or vulnerability, health system characteristics and differential consequences. These
changes arise through globalisation’s effects on power, resources, labour markets, policy
space, trade, financial flows (including aid and debt servicing/cancellation), health systems
(including health human resources and health services), water and sanitation, food security
and access to essential medicines. While not exhaustive, this list covers the principle
pathways linking globalisation to health that were examined by the GKN.

Towards health-equitable globalisation : rights, regulation and redistribution : final report to theCommission on Social Determinants of Health.

This paper arises from a four-country study that sought to better understand the drivers of skilled health worker migration, its consequences, and the strategies countries have employed to mitigate negative impacts. The four countries—Jamaica, India, the Philippines, and South Africa—have historically been “sources” of skilled health workers (SHWs) migrating to other countries. This paper presents the findings from South Africa. The study began with a scoping review of the literature on health worker migration from South Africa, followed by empirical data collected from skilled health workers and stakeholders. Surveys were conducted with physicians, nurses, pharmacists, and dentists. Interviews were conducted with key informants representing educators, regulators, national and local governments, private and public sector health facilities, recruitment agencies, and professional associations and councils. Survey data were analyzed using descriptive statistics and regression models. Interview data were analyzed thematically. There has been an overall decrease in out-migration of skilled health workers from South Africa since the early 2000s largely attributed to a reduced need for foreign-trained skilled health workers in destination countries, limitations on recruitment, and tighter migration rules. Low levels of worker satisfaction persist, although the Occupation Specific Dispensation (OSD) policy (2007), which increased wages for health workers, has been described as critical in retaining South African nurses. Return migration was reportedly a common occurrence. The consequences attributed to SHW migration are mixed, but shortages appear to have declined. Most promising initiatives are those designed to reinforce the South African health system and undertaken within South Africa itself. In the near past, South Africa’s health worker shortages as a result of emigration were viewed as significant and harmful. Currently, domestic policies to improve health care and the health workforce including innovations such as new skilled health worker cadres and OSD policies appear to have served to decrease SHW shortages to some extent. Decreased global demand for health workers and indications that South African SHWs primarily use migratory routes for professional development suggest that health worker shortages as a result of permanent migration no longer pertains to South Africa.

/pdf/health-worker-migration-from-south-africa-causes-31954wzlw7.pdf

Health worker migration from South Africa: Causes, consequences and policy responses

Canada is a major recipient of foreign-trained health professionals, notably physicians from South Africa and other sub-Saharan African countries. Nurse migration from these countries, while comparatively small, is rising. African countries, meanwhile, have a critical shortage of professionals and a disproportionate burden of disease. What policy options could Canada pursue that balanced the right to health of Africans losing their health workers with the right of these workers to seek migration to countries such as Canada? We interviewed a small sample of emigre South African physicians (n = 7) and a larger purposive sample of representatives of Canadian federal, provincial, regional and health professional departments/organizations (n = 25); conducted a policy colloquium with stakeholder organizations (n = 21); and undertook new analyses of secondary data to determine recent trends in health human resource flows between sub-Saharan Africa and Canada. Flows from sub-Saharan Africa to Canada have increased since the early 1990s, although they may now have peaked for physicians from South Africa. Reasons given for this flow are consistent with other studies of push/pull factors. Of 8 different policy options presented to study participants, only one received unanimous strong support (increasing domestic self-sufficiency), one other received strong support (increased health system strengthening in source country), two others mixed support (voluntary codes on ethical recruitment, bilateral or multilateral agreements to manage flows) and four others little support or complete rejection (increased training of auxiliary health workers in Africa ineligible for licensing in Canada, bonding, reparation payments for training-cost losses and restrictions on immigration of health professionals from critically underserved countries). Reducing pull factors by improving domestic supply and reducing push factors by strengthening source country health systems have the greatest policy traction in Canada. The latter, however, is not perceived as presently high on Canadian stakeholder organizations' policy agendas, although support for it could grow if it is promoted. Canada is not seen as "actively' recruiting" ("poaching") health workers from developing countries. Recent changes in immigration policy, ongoing advertising in southern African journals and promotion of migration by private agencies, however, blurs the distinction between active and passive recruitment.

/pdf/managing-health-professional-migration-from-sub-saharan-4u6ercnen7.pdf

Corinne Packer

Papers

Medical tourism today: What is the state of existing knowledge?

Globalization and health : pathways, evidence and policy

Towards health-equitable globalisation : rights, regulation and redistribution : final report to theCommission on Social Determinants of Health.

Health worker migration from South Africa: Causes, consequences and policy responses

Managing health professional migration from sub-Saharan Africa to Canada: a stakeholder inquiry into policy options