International Journal for Quality in Health Care 14:339-340 (2002)
© 2002 International Society for Quality in Health Care
Book Review |
International Co-operation in Health. Martin McKee, Paul Garner and Robin Stott, eds.
International Co-operation in Health
Martin McKee, Paul Garner and Robin Stott, eds
Published in 2001 by Oxford University Press, Oxford, UK.
ISBN 0 19 263198 5 (hardback); Price £39.50.
The book International Co-operation in Health represents an important contribution to a growing but scant literature on the subject of globalization and its effects on health and health care. More specifically, the book seeks to inform and educate (public) health professionals about diverse threats to health on a global scale. These include risk factors that have traditionally been studied by epidemiologists (e.g. infectious diseases, tobacco, and diet) as well as other global phenomena that affect health but have not been traditionally studied in this context (e.g. climate change and migration).
As the editors point out, current epidemiological methods that dominate public health research are insufficient to understand the relationship between globalization and health. Theoretical frameworks and methods of inquiry drawn from political science, sociology, and economics are also required. Several authors draw on these approaches to analyze select social, political, and economic forces operating at the international level and the health consequences of these global phenomena. However, not all contributors make these frameworks equally explicit. The analysis of globalization and health would also benefit from concepts and methods drawn from the study of international relations. Although not stated as such, the most common theoretical perspective held by the editors and contributors to this volume seems to be that of a pluralist state and an interdependent international system where diverse groups can compete for influence and participate in a system of global governance [1]. It is within this context that well-informed health professionals (either as individuals or collectively) are contemplated as instrumental in shaping the global health agenda through research, education, and most of all, advocacy and concerted action. As the editors point out, the objective of this book is to provide health professionals with an understanding of the means by which international collaboration can be used to promote health. It is a call to action to health professionals to respond to the global threats to health and to draw on their unique capabilities to do so given the current absence of appropriate formal structures. Instruments and entities at the level of the individual states or among states including international organizations are, in general, seen as ineffective in addressing the emerging threats to the health of the public on a global level.
The book is well organized and the diversity of subject matter and perspectives is held together by the opening and closing chapters authored by the editors. In these, McKee, Garner, and Stott lay out the objectives of the work, provide a brief history of the area of international cooperation, explain the main concepts related to globalization, and exhort health professionals to take action. In the second chapter, Lee provides a conceptual framework for globalization and examines its relationship to the determinants of health. According to Lee, globalization is a process of change affecting societies along spatial, temporal, and cognitive dimensions. The first dimension refers to a view of the world as a ‘global village’ where health risks and opportunities transcend traditional geopolitical boundaries and where individuals (including health professionals) rather than states are the drivers of change. The second dimension refers to the high speed of technological change and the shortened timeframe available to address these health threats or take advantage of opportunities associated with globalization. The third dimension of globalization refers to the intensification of the exchange of knowledge and ideas that can negatively affect health but can also empower individuals to address the problems and opportunities associated with globalization. Lee and other authors of this volume call for the development of an agenda that addresses current gaps in our means of addressing the consequences of globalization and one in which health professionals have a critical role to play.
The contribution of Frenk and colleagues examines how health care services themselves are part of the globalization process. They present a framework for analyzing the various modes of trade in health services involving patients, health professionals, health care organizations, and knowledge, first laid out in a study by the Pan American Health Organization and the United Nations Conference on Trade and Development [2]. Most of the remaining contributors examine specific global threats to the health of the population rather than the role of health services as part of the process of globalization. For example, Lang examines how trade has affected diet on a global level and how this relationship has resulted in patterns of disease characterized by diet-related degenerative diseases such as diabetes, heart disease, and cancer. In addition to the often cited epidemiological transition where chronic diseases are replacing infectious diseases as the main causes of death [3], Lang describes a nutrition and cultural transition where diverse and centuries-old diets are being replaced by a single dominant western diet high in fat, salt, sugar, and meat, and low in cereals, legumes, and fruits. He describes the characteristics of the modern global food business and proposes ways in which health professionals can influence food and trade policy.
Additional contributions examine other factors associated with globalization that can affect the health of the population such as environmental factors, war, and migration. For example, McMichael and Woodward analyze environmental factors, specifically how human impact or our expanding ‘ecological footprint’ are associated with climate change and ozone depletion and how they affect human health. They discuss instruments to address these threats to health, such as the Kyoto protocol, which limits national emissions of greenhouse gases by high-income countries, and also provide some suggestions for action by health professionals.
Although international organizations are seen as largely ineffective in addressing current threats to health posed by globalization, the editors attempt to present a balanced view and include a chapter that examines the leadership role of the World Health Organization in tobacco control and multi-sectoral collaboration. In this chapter, Wipfli and colleagues lay out in great detail the context and the events that lead to the WHO Framework Convention on Tobacco Control (FCTC), which represents the first time that the member states of the WHO have developed a binding international agreement instead of the more common non-binding resolutions and policy documents. In his chapter, Weinberg examines the response of current national and international structures to the global challenge of infectious disease, in particular the role of the European Union. Lush and Campbell’s contribution describes a specific issue area—reproductive health—and how international cooperation and particular ideologies have shaped the agenda.
The varied set of contributions included in this volume clearly addresses one of the purposes of this work, i.e. to inform and educate health professionals about the relationship between globalization and health through the analyses of specific cases that describe in detail the challenges faced, the opportunities that exist, and specific responses to these phenomena. However, the authors are not all equally thorough in examining the actual or potential role of individual health professionals in addressing the challenges presented by globalization, which is the ultimate objective of the present volume. Perhaps this is because the instruments and means for furthering a global health agenda are not yet well defined in most areas. Further research is needed to examine how health professionals can participate in the global governance of health by establishing the rules and means by which they can set and achieve agreed-upon goals. The editors of International Co-operation in Health have assembled an impressive group of contributors drawn mainly from the British public health research community and the World Health Organization, and have provided the health policy and health care community with an excellent overview of the relationship between globalization and health. Perhaps this volume could have provided a richer introduction to the subject with additional contributions from authors from developing countries and from researchers drawn from fields beyond public health and health policy.
Margarita P. Hurtado
American Institutes for Research
Washington, DC, USA
Editorial Committee, International Journal for Quality in Health Care
References
- Alford RR, Friedland R. Powers of Theory: Capitalism, The State, and Democracy. New York: Cambridge University Press, 1985.
- Díaz D, Hurtado MP. International Trade in Health Services: Issues and Opportunities for Latin American and Caribbean Countries. A report of a study sponsored by the Pan American Health Organization (PAHO) and the United Nations Conference for Trade and Development (UNCTAD). Technical Report No. 33. Washington, DC: PAHO, Public Policy and Health Program, July 1994.
- Omran AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q 1971; 49: 509–538.[Web of Science][Medline]
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