globalization as a driver or bottleneck for sustainable development: some empirical, cross-national reflections on basic issues of international health policy and management

background this article looks at the long-term, structural determinants of environmental and public health performance in the world system.   methods in multiple standard ordinary least squares (ols) regression models, we tested the effects of 26 standard predictor variables, including the ‘four freedoms’ of goods, capital, labour and services, on the following indicators of sustainable development and public health: avoiding net trade of ecological footprint global hectare (gha) per person; avoiding high carbon emissions per million us dollars gdp; avoiding high co2 per capita (gha/cap); avoiding high ecological footprint per capita; avoiding becoming victim of natural disasters; a good performance on the environmental performance index (epi); a good performance on the happy life years (hlys) scale; and a good performance on the happy planet index (hpi).   results our research showed that the apprehensions of quantitative research, critical of neo-liberal globalization, are fully vindicated by the significant negative environmental and public health effects of the foreign savings rate. high foreign savings are indeed a driver of global footprint, and are a blockade against a satisfactory hpi performance. the new international division of labour is one of the prime drivers of high co2 per capita emissions. multinational corporation (mnc) penetration, the master variable of most quantitative dependency theories, blocks epi and several other socially important processes. worker remittances have a significant positive effect on the hpi, and hlys.   conclusion we re-analysed the solid macro-political and macro-sociological evidence on a global scale, published in the world’s leading peer-reviewed social science, ecological and public health journals, which seem to indicate that there are contradictions between unfettered globalization and unconstrained world economic openness and sustainable development and public health development. we suggest that there seems to be a strong interaction between ‘transnational capitalist penetration’ and ‘environmental and public health degradation’. global policy-making finally should dare to take the globalization-critical organizations of ‘civil society’ seriously. this conclusion not only holds for the countries of the developed “west”, but also, increasingly, for the growing democracy and civil society movements around the globe, in countries as diverse as brazil, russia, china, or ever larger parts of the muslim world.