Health in an age of globalization

When economists write about globalization, they focus on the movement of goods, people, information, and ideas, and they look at the effects on economic growth, poverty, and inequality. Health is not a primary focus of their attention. By contrast, much of the literature in public health views globalization as a threat to international health. On the relatively few occasions when economists have addressed health, they focus on the indirect effects, arguing that the economic benefits of globalization are good for health—because poverty is the major determinant of health in poor countries—and that if there are unwelcome side effects on health, they can best be dealt with by suitable public health measures, not by policies that slow the globalization process. Both sides of this (mostly non-) argument have substance, and one aim of this paper is to present some of the arguments from the public health literature as seen through the eyes of at least one economist. There is also much to be learned from looking at previous episodes of globalization and at the history of trade and health, and it is with this that I begin. If it is true that income is the primary determinant of health—at least in poor countries—then the consequences of globalization for public health depend on its well-researched (although still disputed) consequences for economic growth, particularly for the poorest countries. Although the income-to-health mechanism is undoubtedly present—everything is easier with money, and some improvements are impossible without it—I argue that the transmission of health-related knowledge is ultimately more important. Social forces, including not only income but also education and politics, are central because they govern the way in which new knowledge is transformed into population health. The health and