The success of a socio-economic transformation in any country should be evaluated in terms of benefits and opportunities made available to an ordinary individual. For an individual, a healthy and secured life – free from illness and ailments and a reasonable lifespan — remains a vital consideration. Good health benefits an individual by providing an opportunity to develop abilities required to achieve personal goals. Gains increase if the individual is vulnerable and living in poverty, as a healthy body is the primary productive asset (WHO, 1999), which can be deployed for facilitating earnings and minimising the risk of falling deep in poverty.
Healthcare has also been declared as a human right under Article 25 of the Universal Declaration of Human Rights. Good health reflected in the declining incidence of morbidity, mortality and disability helps society by contributing to its economic growth through higher work productivity, and releasing resources that otherwise would have to be spent on public healthcare. The health promotion, therefore, assumes the role of a vital public good and a basic human right of people.
In the area of health, a multiplicity of changes are taking place at both micro and macro levels, ranging from healthcare requirements to health-seeking behaviour to actual health outcomes. Issues such as inequitable access to basic services, inefficiencies resulting into waste, suboptimal utilisation of existing resources, declining ethical norms, and patient rights and citizens’ entitlement to basic health services (preventive, promotive and curative) have assumed greater importance. At the same time, the world economy is changing rapidly with globalisation policies getting deep-rooted and widespread all over, challenging the established development paradigms.
This is true for India too. In the late 1980s, India fell deep into an economic crisis with its internal and external economic imbalances reaching unprecedented heights and international creditworthiness questioned. This backdrop created the compelling grounds for the country to adopt the World Bank-designed development paradigm by adopting a new market-oriented macro economic policy framework.
This process, popularly captioned as liberalisation, privatisation and globalisation (LPG), has not only increased interdependence on and interconnection with the international markets, but it has also brought far reaching implications for the administrative and socio-economic and political structures of the country (Arora 2002).
With the opening of the economy and an increased participation from the private sector, both domestic as well international, the health sector has been explicitly recognised as an industry as well as a service sector. Gains are considered to be substantial with the rapidly rising health sector (as pointed out by the study conducted by Confederation of Indian Industry (CII) – Mckinsey Study 2002) and also from promoting India as a global health destination (Union Budget, 2003-04).
Liberalisation of the economy has increased the responsibility of the government to provide an efficient health system covering health education, preventive programmes and curative services. The market-oriented development process has caused changes in lifestyles, increased urbanisation and connectivity, and enhanced access to information and services not available earlier. These and other factors, in one way or another, have profoundly impacted the epidemiological and health-seeking behaviour patterns of the people along with exposing inadequacies of the present health system — both in public and private domains.
Globalisation policies are being aggressively pursued when structural changes are taking place in the health sector. During the 1990s, while mortality rates reached a plateau, there emerged a challenging dual disease burden. Communicable diseases have become more difficult to encounter because of the development of insecticide-resistant strains of vectors, antibiotics resistant strains of bacteria; and the emergence of HIV infection for which there is no therapy. With India’s health achievements not at pace with requirements, in spite of the fact that health development has remained one of the major thrust areas for social development, the subject of health has only grown complex.
The process of globalisation brings dual effects. Some of its effect are beneficial, whereas some are not:
Globalisation is one of the key challenges facing health policy-makers and public health practitioners. Although there is a growing literature on the importance of globalisation for health, there is no consensus either on the pathways and mechanisms through which globalisation affects the health of populations or on the appropriate policy response. There is, however, an increasing tension between the new rules, actors and markets that characterise the modern phase of globalisation, and the ability of countries to protect and promote health.
It would be overly simplistic and inaccurate to describe globalisation as either “good” or “bad” for health. For example, spatial changes are leading to an increased migration of people throughout the world. For high-income countries, the debate surrounding globalisation and health tends to focus on the perceived threat, from low- and middle-income countries, of acquiring certain acute and epidemic infections, such as HIV/AIDS, tuberculosis, plague and, more recently, severe acute respiratory syndrome (SARS).
Richer countries also fear the potential financial burden of unhealthy populations migrating from the developing world. What are less appreciated are the risks that high-income countries may export to other parts of the world through products such as tobacco and fast food and, more indirectly, macroeconomic policies affecting foreign direct investment and debt burdens.
There is also a tendency to overlook the benefits to high-income countries from population mobility — migration of health professionals from poorer countries offers benefits to the understaffed health systems in high-income countries (but at the expense of capacity in the developing world). In other words, the increased movement of people and other items creates a complex equation of pluses and minuses for each society.
Similarly, temporal change affects the spread of disease. The speed of modern transportation systems means that infections can potentially move around the world within a few hours (as illustrated by the SARS outbreak in 2002–03). On the other hand, modern technology potentially enables the health community to respond more quickly to such emergencies. For example, an international network of institutions coordinated by the World Health.
We all know how the Covid-19 pandemic has adversely affected populations across the world. The virus was first identified in September 2019 in China, with no surge in cases in China till March 2020, when nearly 80,000 people got infected from the virus. From then on, the virus got transferred all over the world. While China recovered from the pandemic early on, it started manufacturing and exporting masks and sanitisers to other countries due to globalisation. China even over-exported these masks and sanitisers all over the world due to over-production.
India exporting a medicine names hydroxychloroquine to the US can also be recognised as a great example of globalisation in the current scenario.