Foundations Of Nursing Globalization PDF

722.553 FOUNDATIONS OF NURSING Globalization and Health  LEARNING OUTCOMES Course Learning outcome 6 and 7: Discuss the concept of primary health care in relation to international initiatives in the provision of health care Explain the structure of the New Zealand...

722.553 FOUNDATIONS OF NURSING Globalization and Health  LEARNING OUTCOMES Course Learning outcome 6 and 7: Discuss the concept of primary health care in relation to international initiatives in the provision of health care Explain the structure of the New Zealand health system with special attention to issues of funding, policy, and spheres of influence. Lesson Outcomes: 1. Define globalization 2. Discuss globalization in relation to health 3. Discuss the aspects of globalization which may impact on health  WHAT IS GLOBALIZATION? Mixing of customs and Technological advances cultures Integration of the world economy over Integration of the last 25 years national economies Easier travel and communication Liberalization or openness  Globalization economic opening cross-border flows goods, services, capital, people, ideas, information international rules and institutions national economy and health-related sectors risk household health factors economy services HEALTH  GLOBALIZATION Considering what globalization is – we cannot view national health, interventions and policies in isolation from: Other countries Other sectors (Travel, finance etc)  WHICH ASPECTS OF GLOBALIZATION AFFECT HEALTH? General effect on health from changes in national economic growth – link between ‘health and wealth’ Environmental degradation (e.g. air, water pollution) Workplace Hazards Improved access to knowledge and technology Marketing of harmful products & unhealthy behaviours Conflict & security Migration Cross-border transmission of disease  HEALTH AND INTERNATIONAL TRADE Context: Effects of trade liberalisation on public health Trade Liberalisation: removal of impediments to trade in goods and services (especially via WTO) Public health: organised measures (public &/or private) to prevent disease, promote health or prolong life of the population as a whole  SPECIFIC PUBLIC HEALTH ISSUES Infectious disease control Food safety Tobacco Environment Access to drugs Food security Biotechnology Technology Health services  FOUR “MODES OF SUPPLY” Cross Consumptio boarder n abroad delivery Commercial Movement presence of personnel  CROSS BOARDER DELIVERY OF SERVICES Shipment of laboratory samples, diagnosis and clinical consultations by mail E-health Tele diagnostics Tele surveillance Teleconsultation Tele treatment Tele products (especially pharmaceuticals)  CROSS BOARDER DELIVERY OF SERVICES OPPORTUNITIES Enable health care delivery to remote and underserviced areas – promoting equity Alleviate (some) human resource constraints Enable more cost-effective disease surveillance Improve quality of diagnosis and treatment Upgrade skills, disseminate knowledge through interactive electronic means  CROSS BOARDER DELIVERY OF SERVICES RISKS Relies on telecommunications and power sector infrastructure Capital intensive, possible diversion of resources from basic preventive and curative services Equity issue if it caters to a small segment of the population - urban affluent  CONSUMPTION ABROAD Movement of patients from home country to the country providing the diagnosis/treatment Movement of health professionals from home to another country to receive medical education and training  CONSUMPTION ABROAD OPPORTUNITIES For exporting countries Generate foreign exchange earnings to increase resources for health Upgrade health infrastructure, knowledge, standards and quality For importing countries Overcome shortages of physical and human resources in speciality areas Receive more affordable treatment  CONSUMPTION ABROAD RISKS Create dual market structure May crowd out local population – unless these services are made available to local population Diversion of resources from the public health system Outflow of foreign exchange for importing countries  COMMERCIAL PRESENCE Establishment of hospitals, clinics, diagnostic and treatment centres and nursing homes and training facilities through foreign direct investment – cross border mergers/acquisitions, joint venture/alliance Opportunities for foreign commercial presence also in management of health facilities and allied services, medical and paramedical education, IT and health care  COMMERCIAL PRESENCE OPPORTUNITIES Generate additional resources for investment in upgrading of infrastructure and technologies Reduce the burden on public resources Create employment opportunities Raise standards, improve management, quality , improve availability, improve education (foreign commercial presence in medical education sector)  COMMERCIAL PRESENCE RISKS Large initial public investments If public funds/subsidies used - potential diversion of resources from the public health sector Two tier structure of health care establishments Internal brain drain from public to private sector Crowding out of poorer patients, cream skimming phenomena  MOVEMENT OF HEALTH PROFESSIONALS Includes doctors, nurses, paramedics, midwives, consultants, trainers, management personnel Factors driving cross border movements  wage differentials between countries  search for better working conditions/standards of living  search for greater exposure/training/qualifications  demand and supply imbalances between countries Approach towards mode 4 trade in health services by exporting and receiving countries varies - some countries encourage outflow, others create impediments  MOVEMENT OF HEALTH PROFESSIONALS OPPORTUNITIES From sending country Promote exchange of knowledge among professionals Upgrade skills and standards (provided service providers return to the home country) Gains from remittances and transfers From host country Meet shortage of health care providers, improve access, quality and contain cost pressures  MOVEMENT OF HEALTH PROFESSIONALS RISKS From sending country Permanent outflows of skilled personnel - ‘brain drain’ Loss of subsidised training and financial capital invested Adverse effects on equity, availability and quality of services  Universal Declaration of Human Rights Proclaimed 10 December 1948 30 Articles in total Article 1 All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood. (United Nations 2021)  CONSIDER Viewing health as a human right redirects the focus of addressing health issues from a top-down, government-driven approach, to a people-led approach, where addressing inequality between people and nations is seen as a priority.  HEALTH PROMOTION AND GLOBALISATION Proximal Factors directly cause Distal Factors are a step removed disease or health gain from the individual Choosing a healthy diet Health/Social Policy https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1208931/  LIFESTYLE CHOICES CAN BE DOMINATED BY GLOBAL TRADE Fast Food Chains Milk Production/Deregulation Urbanisation Global climate changes  ACTIONS TO BLUNT THE NEGATIVE IMPACT OF GLOBALISATION Recognition of access to all resources as a human right Reframing globalisation in terms of social obligations (Labonte 2008) Public policy development based on a vision of the world that social justice is paramount Shift in thinking towards improving health and wellbeing rather than health as a commodity associated with capitalising on pharmaceuticals etc. Focus on individual security such as housing, income, healthcare etc. rather than national security  WHO MILLENIUM DEVELOPMENT GOALS In September 2000, 189 countries put together the Millennium Declaration which became a long term road map for goals to be achieved by 2015……… MILLENIUM DEVELOPMENT GOALS  WHO MILLENNIUM DEVELOPMENT GOALS What progress has been made? http://www.un.org/millenniumgoals/  DESPITE MAJOR IMPROVEMENTS- X Gender inequality persists Women continue to face discrimination in access to work, economic assets and participation in private and public decision-making. Women are also more likely to live in poverty than men. X Big gaps exist between the poorest and richest households, and between rural and urban areas X Climate change and environmental degradation undermine progress achieved, and poor people suffer the most Global emissions of carbon dioxide have increased by over 50 per cent since 1990. X Conflicts remain the biggest threat to human development By the end of 2014, conflicts had forced almost 60 million people to abandon their homes—the highest level recorded since the Second World War X Millions of poor people still live in poverty and hunger, without access to basic services Despite enormous progress, even today, about 800 million people still live in extreme poverty and suffer from hunger. Over 160 million children under age five have inadequate height for their age due to insufficient food. The maternal mortality ratio in the developing regions is 14 times higher than in the developed regions. Just half of pregnant women in the developing regions receive the recommended minimum of four antenatal care visits. Only an estimated 36 per cent of the 31.5 million people living with HIV in the developing regions were receiving ART in 2013. In 2015, one in three people (2.4 billion) still use unimproved sanitation facilities, including 946 million people who still practise open defecation. Today over 880 million people are estimated to be living in slum-like conditions in the developing world’s cities. With global action, these numbers can be turned around. A Question of Vulnerability (United nations, 2020) SDG Report 2022 https://unstats.un.org/sdgs/report/2022/  GLOBALISATION: WHAT IS IT AND HOW DOES IT AFFECT HEALTH? Kelly Lee (2004) Best defined in terms of 3 changes : 1. Spatial 2. Temporal 3. Cognitive  SPACIAL The way we perceive space and physical territory The movement of people, goods and services has intensified and in some ways has caused boarders to become irrelevant Movement of illegal and dangerous substances across boarders – authorities struggling to contain it Global village – the way we communicate segregated views of either fragmenting or coming together New concepts of space – cyber space  TEMPORAL Relates to the way time is perceived In some ways we are speeding up – multi tasking and minimizing time spent In other ways we are slowing down – stress, overload of pressure – gridlock roads and bureaucracy  COGNITIVE Relates to how we see ourselves and the world in which we live Influences such as: Mass media Advertising industry Consultancy firms Research institutions Political parties Religious groups Leading to a change in culture, wants, values, beliefs and needs  REFERENCES http://globalisationguide.org Guinness, P. (2003). Globalisation. London: Hodder & Stoughton. Mcmurray , A., & Clendon, J. (2010). Community health and wellness. Victoria, Australia: Elsevier Sinclair, D. (2005). Health Implications of Globalisation. Health Promotion Forum of New Zealand, 8 (4), 1-4. Steger, M. (2003). Globalization: A very short introduction. New York: Oxford University Press Inc.  REFERENCES Baum, F. (2002). The new Public Health.(2nd Ed.). Victoria, Australia: Oxford University Press. - Chapters 5, 15 and 26 Baum, F. (2000). The new Public Health. Melbourne: Oxford University Press. - Chapters 13 and 14 Pettman, R. (2005). (Ed.). New Zealand in a globalising world. Wellington, NZ: Victoria University Press. www.FlorenceNightingale2010.net