Globalization: the global marketplace and social determinants of health

Co-authored with Ronald Labonte; in Improving Equity in Health by
Addressing Social Determinants, edited by
The Commission on Social Determinants of Health Knowledge Networks,
Jennifer H Lee and Ritu Sadana (Geneva: WHO, 2012).  This is the long-awaited compilation of findings from the knowledge networks that supported the work of the WHO Commission.

Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda

Co-authored with  Piroska Östlin, Ritu Sadana and many other active participants in the knowledge networks that supported the Commission on Social Determinants of Health.  PLoS Medicine 8(11): e1001115.

Summary Points:

    Based on extensive review of global evidence, the recommendations of the WHO Commission on Social Determinants of Health highlight the need for strengthening research on health equity with a focus on social determinants of health.
    To do so requires a paradigm shift that explicitly addresses social, political, and economic processes that influence population health; this shift is under way and complements existing research in medicine, the life sciences, and public health.
    Reflecting further synthesis and stakeholder consultations, an agenda for future research on health equity is outlined in four distinct yet interrelated areas: (1) global factors and processes that affect health equity; (2) structures and processes that differentially affect people's chances to be healthy within a given society; (3) health system factors that affect health equity; and (4) policies and interventions to reduce health inequity.
    Influencing regional and national research priorities on equity and health and their implementation requires joint efforts towards creating a critical mass of researchers, expanding collaborations and networks, and refining norms and standards, with WHO having an important role given recent mandates.

Why Are Some Settings Resource-poor and Others Not? The Global Marketplace, Perfect Economic Storms, and the Right to Health

Published in Canadian Journal of Public Health 102 (2011): 204-206.

Analyses of how health system priorities should be set in resource-poor settings are routine in the health ethics and policy analysis literature. Less attention is devoted to asking why some settings are resource-poor and others not. Asking this question must be considered a central task of global health research. Comparison of the relatively meager resources devoted to improving the health of the poor with the sums routinely mobilized for other purposes serves as a basis for ethical reflection and a route into necessary questioning of power imbalances in the world economy. The 2008 financial crisis and related developments underscore the urgency of such questioning, and the value of research and advocacy collaborations (for example, between the human rights and public health research and practice communities) focused specifically on the destructive consequences of the global
marketplace for health.

Canada: A land of missed opportunity for addressing the social determinants of health

Co-authored with Toba Bryant, Dennis Raphael and Ronald Labonte; published in Health Policy 101 (2011): 44-58. Please contact Prof. Schrecker for a copy.

The first 25 years of universal public health insurance in Canada saw major reductions in income-related health inequalities related to conditions most amenable to medical treatment. While equity issues related to health care coverage and access remain important, the social determinants of health (SDH) represent the next frontier for reducing health inequalities, a point reinforced by the work of the World Health Organization's Commission on Social Determinants of Health. In this regard, Canada's recent performance suggests a bleak prognosis. Canada's track record since the 1980s in five respects related to social determinants of health: (a) the overall redistributive impact of tax and transfer policies; (b) reduction of family and child poverty; (c) housing policy; (d) early childhood education and care; and (e) urban/metropolitan health policy have reduced Canada's capacity to reduce existing health inequalities. Reasons for this are explored and means of advancing this agenda are outlined.

The health case for economic and social rights against the global marketplace

Published in Journal of Human Rights 10 (2011): 151-177.  Originally presented as part of a symposium at the triennial conference of the International Society for Equity in Health, Crete, 2009.  Please contact Prof. Schrecker for a copy of the article.

Over the past few decades, most of the world's economies and societies have been integrated into the global marketplace, revealing and deepening various socioeconomic divisions.  In this article I undertake three major tasks.  First, I  outline the processes that have led to that deepening, identify the underlying set of values, and indicate the connection with influences on population health.  Second, I compare and contrast a policy perspective that takes seriously economic and social rights related to health with the values of the global marketplace.  Third, I argue that emerging aspects of globalization underscore the urgency of the human rights challenge to the global marketplace. I also suggest a research agenda focusing on the conditions under which governments are likely to respond in ways that strengthen their commitment to economic and social rights domestically and internationally, while at the same time offering some rather pessimistic observations about the prospects for policy change. 

Global Development and Population Health

Co-authored with Ronald Labonte; in J. Nriagu, ed., Encyclopedia of Environmental Health (Burlington: Elsevier, 2011), pp. 976-986.  Please contact Prof. Schrecker for a copy.

Grand Challenges Canada: Inappropriate Emphasis and Missed Opportunities in Global Health Research

Co-authored with Charles P. Larson, Slim Haddad, Anne-Emanuelle Birn, Donald C. Cole, Ronald Labonte, Janet Hatcher Roberts, Daniel Sellen and David Zakus, Canadian Journal of Public Health 102 (2011): 149-151.

In May 2010, Grand Challenges Canada (GCC) was launched with the mandate to identify global challenges in health that could be supported through the Government of Canada’s Development Innovations Fund (DIF: $225 million over five years). The GCC offers a potentially excellent mechanism for
taking Canada’s participation in global health challenges “to a higher level”. Recent GCC announcements raise new questions about the emphasis being placed on technological discovery or “catalytic” research. Missing so far are opportunities that the Fund could offer in order to support innovative research addressing i) health systems strengthening, ii) more effective delivery of existing interventions, and iii) policies and programs that address broader social determinants of health. The Canadian Grand Challenges announced to date risk pushing to the sidelines good translational and implementation science and early career-stage scientists addressing important social, environmental and political conditions that affect disease prevalence, progress and treatment; and the many unresolved challenges faced in bringing to scale proven interventions within resource-constrained health systems. We wish to register our concern at the apparent prioritization of biotechnical innovation research and the subordination of the social, environmental, economic and political context in which human health is either protected or eroded.

The state of global health in a radically unequal world: patterns and prospects

Co-authored with Ronald Labonte; in S. Benatar and G. Brock, eds., Global Health and Global Health Ethics (Cambridge: Cambridge University Press, 2011), pp. 24-36. Please contact Prof. Schrecker for a copy.

The Growing Impact of Globalization for Health and Public Health Practice

Published in Annual Review of Public Health 32 (2011), pp. 263-283. Co-authored with Ronald Labonte and Katia Mohindra.  I am pleased to provide you complimentary one-time access to this article as a PDF file for your own personal use. Any further/multiple distribution, publication, or commercial usage of this copyrighted material requires submission of a permission request addressed to the Annual Reviews Permissions Department, email permissions@AnnualReviews.org.

In recent decades, public health policy and practice have been increasingly challenged by globalization, even as global financing for health has increased dramatically. This article discusses globalization and its health challenges from a vantage of political science, emphasizing increased global flows (of pathogens, information, trade, finance, and people) as driving, and driven by, global market integration. This integration requires a shift in public health thinking from a singular focus on international health (the higher disease burden in poor countries) to a more nuanced analysis of global health (in which health risks in both poor and rich countries are seen as having inherently global causes and consequences). Several globalization-related pathways to health exist, two key ones of which are described: globalized diseases and economic vulnerabilities. The article concludes with a call for national governments, especially those of wealthier nations, to take greater account of global health and its social determinants in all their foreign policies.

Globalization

Co-authored with Ronald Labonté; published in D. Vlahov, J. Boufford, C. Pearson and L. Norris, eds., Urban Health: Global Perspectives (New York: Jossey-Bass/John Wiley & Sons, 2010): 13-26.  Please contact Prof. Schrecker for a copy.

Un abordaje radicalmente nuevo para la salud global: Salud para todos

Co-authored with Françoise Barten and David Woodward; translated from the English and published in F. Barten, M. Rovere y Eduardo Espinoza, compiladores, Salud para todos:una meta posible (San Salvador: Ministerio de Salud, Gobierno de El Salvador, 2010), pp. 211-224.

Advancing Health Equity in the Global Marketplace: How Human Rights Can Help

Co-authored with Audrey R. Chapman, Ronald Labonte and Roberto de Vogli, Social Science & Medicine 71(2010): 1520-1526; http://dx.doi.org/10.1016/j.socscimed.2010.06.042. Please contact Prof. Schrecker for an offprint of published version.

The WHO Commission on Social Determinants of Health (CSDH) ascribed health disparities within and between countries to “a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics.” This article analyzes the relevance of the international human rights framework (IHRF) to the Commission’s goal of reducing health disparities with reference to both social scientific and legal scholarship. We begin with an overview of the IHRF, demonstrating its potential as a challenge to the normative foundations of the emerging global economic order. We then survey the research literature on mechanisms to ensure accountability for realization of health-related rights, emphasizing the potential effectiveness of making human rights enforceable through the courts, and the special need for mechanisms to hold countries and international institutions accountable for obligations related to the human right to health. We conclude by identifying three key directions for further research, policy and advocacy: comparative human rights litigation, specifically the willingness of courts to address broad policy and budgetary issues; the conditions under which governments legislate or constitutionalize economic and social rights; and how rich, powerful countries affect economic and social rights outside their borders.

Priorities for research on equity and health

Co-authored with Piroska Östlin, Ritu Sadana, and numerous other researchers who were actively involved in the work of the Commission on Social Determinants of Health

This recent paper, commissioned by the Equity Analysis and Research Unit of WHO, aims to stimulate further thinking, debate and refinement of strategic approaches focusing WHO support and collaborations to advance global research on equity and health. It sets forth broad parameters for a global research agenda on equity and health, taking stock of contemporary efforts, stakeholder discussions, relevance to Member States and expected innovations. …

Recommends an agenda for research in the following four distinct but interrelated areas:
(1) global factors and processes that affect health equity;
(2) structures and processes that differentially affect people's chances to be healthy within a given society;
(3) health system factors that affect health equity; and
(4) policy interventions to reduce health inequity, that is how to influence (1)-(3) effectively, for example by identifying policy and programme interventions with the potential to reduce inequities in the determinants of health and health services and opportunities to transfer the findings of research to potential users with maximum effectiveness.

Globalization, health, and the future Canadian metropolis

Published in R. Labonte, ed., Forgotten Families: Globalization and the Health of Canadians, Transdisciplinary Studies in Population Health Series 2, no. 2 (Ottawa: Institute of Population Health, University of Ottawa, 2010).

This chapter represents a preliminary effort to understand the health implications of transnsational economic integration (globalization) for population health in Canadian metropolitan areas, and to inform the development of policy responses and strategies of resistance. Special emphasis is placed on health equity as it is affected by social determinants of health.

I first provide a stylized description of the rationale for concentrating on major metropolitan areas, rather than on
Canadian society as a whole, with reference to the evidence base on place-related effects on health.  I then summarize the major channels of influence leading from globalization to social determinants of health in metropolitan areas. These involve labour markets; the attractiveness of urban ‘revitalization’ schemes in a context of changing opportunities for capital accumulation and growth promotion; and migration. The chapter concludes with some rather pessimistic observations about the prospects for increased health equity, given today’s neoliberal drift in public policy and
pressures for policy convergence around economic competitiveness.

‘The Best of Times, The Worst of Times?’ The G8 and Prospects for a Global Health Ethic

In S. Maclean, S. Brown and P. Fourie, eds., Health for Some: The Political Economy of Global Health Governance (Houndmills: Palgrave Macmillan, 2009), pp. 21-38; to order go to https://www.palgrave.com/products/title.aspx?pid=327197.

The Growing Economic Gap: What it means for Canadian families and the Canadian future

Co-authored with Armine Yalnizyan; published in R. Labonte, ed., Forgotten Families: Globalization and the Health of Canadians, Transdisciplinary Studies in Population Health Series 2, no. 2 (Ottawa: Institute of Population Health, University of Ottawa, 2010).

The Power of Money: Global Financial Markets, National Politics, and Social Determinants of Health

In O. Williams and A. Kay, eds., The Crisis of Global Health Governance: Political Economy, Ideas and Institutions (Houndmills: Palgrave Macmillan, 2009); to order go to http://www.palgrave.com/products/title.aspx?PID=295403.

Beyond the Matrix: Thinking Three-dimensionally about Social Determinants of Health

Co-authored with Ronald Labonte; in A. Gatti and A. Boggio, eds., Health and Development: Toward a Matrix Approach (Houndmills: Palgrave Macmillan, 2009), pp. 56-78; to order go to http://www.palgrave.com/products/title.aspx?PID=270477.

Introduction; Globalization's Challenges to People's Health

Co-authored with Ronald Labonté; in R. Labonté, T. Schrecker, C. Packer and V. Runnels, eds., Globalization and Health: Pathways, Evidence, and Policy (New York: Routledge, 2009)

Special Report: Health for All

Co-authored with Francoise Barten and David Woodward; published in The Broker (online) no. 12, May 2009

The global health policy landscape has changed considerably over the past decade. There is more money available to allocate to health initiatives than ever before, a large percentage of which has come from private funds and public private partnerships (PPPs). Some experts have welcomed these changes, while others have had considerable reservations. Despite positive developments, such as increased access to antiretroviral therapy for patients with HIV/AIDS, the health situation in poor countries and for the poor communities of rich countries remains abominable. It is often in the world’s poorest countries that the highest percentage of health costs is met with private, out-of-pocket spending. 

Labor Markets, Equity, and Social Determinants of Health

In R. Labonté, T. Schrecker, C. Packer and V. Runnels, eds., Globalization and Health: Pathways, Evidence, and Policy (New York: Routledge, 2009)

Globalization and Policy Space for Health and Social Determinants of Health

Co-authored with Meri Koivusalo and Ronald Labonté; in R. Labonté, T. Schrecker, C. Packer and V. Runnels, eds., Globalization and Health: Pathways, Evidence and Policy (New York: Routledge, 2009).

Rights, Redistribution, and Regulation

Co-authored with Ronald Labonté; in R. Labonté, T. Schrecker, C. Packer and V. Runnels, eds., Globalization and Health: Pathways, Evidence and Policy (New York: Routledge, 2009).

Globalisation and Health: The need for a global vision

Co-authored with Ronald Labonte and Roberto De Vogli; published in The Lancet 372 (2008): 1670-1676

The reduction of health inequities is an ethical imperative, according to the WHO Commission on Social Determinants
of Health (CSDH). Drawing on detailed multidisciplinary evidence assembled by the Globalization Knowledge Network that supported the CSDH, we define globalisation in mainly economic terms. We consider and reject the presumption that globalisation will yield health benefi ts as a result of its contribution to rapid economic growth and associated reductions in poverty. Expanding on this point, we describe four disequalising dynamics by which contemporary globalisation causes divergence: the global reorganisation of production and emergence of a global labour-market; the increasing importance of binding trade agreements and processes to resolve disputes; the rapidly increasing mobility of financial capital; and the persistence of debt crises in developing countries. Generic policies designed to reduce health inequities are described with reference to the three Rs of redistribution, regulation, and rights. We conclude with an examination of the interconnected intellectual and institutional challenges to reduction of health inequities that are created by contemporary globalisation.

Denaturalizing scarcity: A strategy of inquiry for public health ethics

published in Bulletin of the World Health Organization, 86 (2008): 600-605

Most scarcities that underpin health disparities within and among countries are not natural; rather, they result from policy choices and the operation of social institutions. Using examples from the United States of America: the Chicago heat wave and hurricane Katrina, this paper develops “denaturalizing scarcity” as a strategy for enquiry to inform public-health ethics in an interconnected world. It first describes some of the resource scarcities that are of greatest concern from a public-health perspective, and then outlines two (not mutually exclusive) lines of ethical reasoning that demonstrate their importance. One of these involves the multiple relationships that link rich and poor across national borders in today’s interconnected world. The paper then briefly describes ways in which globalization and the associated institutions are linked to health-threatening scarcities. The paper concludes that denaturalizing scarcity represents a valuable alternative to mainstream health ethics, directing our attention instead to why some settings are “resource poor” and others are not.

Trade policy and health equity: Can ‘policy coherence’ avoid a collision?

Co-authored with Ronald Labonte and David Sanders; published in C. Blouin, N. Drager and J. Heymann, eds., Trade and Health: Seeking Common Ground (Montréal: McGill-Queen’s University Press, 2008), pp. 226-261; to order go to http://mqup.mcgill.ca/book.php?bookid=2124.

Globalization and social determinants of health: Introduction and methodological background (part 1 of 3)

Co-authored with Ronald Labonte; published in Globalization and Health, 3 (2007) [highly accessed article]

Globalization is a key context for the study of social determinants of health (SDH). Broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives.

In this first article of a three-part series, we describe the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We explain our rationale for defining globalization with reference to the emergence of a global marketplace, and the economic and political choices that have facilitated that emergence.

We identify a number of conceptual milestones in studying the relation between globalization and SDH over the period 1987–2005, and then show that because globalization comprises multiple, interacting policy dynamics, reliance on evidence from multiple disciplines (transdisciplinarity) and research methodologies is required. So, too, is explicit recognition of the uncertainties associated with linking globalization – the quintessential "upstream" variable – with changes in SDH and in health outcomes.

Globalization and social determinants of health: Promoting health equity in global governance (part 3 of 3)

Co-authored with Ronald Labonte; published in Globalization and Health, 3 (2007) [highly accessed article]

This article is the third in a three-part review of research on globalization and the social determinants of health (SDH). In the first article of the series, we identified and defended an
economically oriented definition of globalization and addressed a number of important conceptual and metholodogical issues. In the second article, we identified and described seven key clusters of pathways relevant to globalization's influence on SDH. This discussion provided the basis for the premise from which we begin this article: interventions to reduce health inequities by way of SDH
are inextricably linked with social protection, economic management and development strategy.

Reflecting this insight, and against the background of the Millennium Development Goals (MDGs), we focus on the asymmetrical distribution of gains, losses and power that is characteristic of globalization in its current form and identify a number of areas for innovation on the part of the international community: making more resources available for health systems, as part of the more general task of expanding and improving development assistance; expanding debt relief and taking poverty reduction more seriously; reforming the international trade regime; considering the implications of health as a human right; and protecting the policy space available to national governments to address social determinants of health, notably with respect to the hypermobility of financial capital. We conclude by suggesting that responses to globalization's effects on social determinants of health can be classified with reference to two contrasting visions of the future, reflecting quite distinct values.

Globalization and social determinants of health: The role of the global marketplace (part 2 of 3)

Co-authored with Ronald Labonte; published in Globalization and Health, 3 (2007) [highly accessed article]

Globalization is a key context for the study of social determinants of health (SDH): broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives.

In the first article in this three part series, we described the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We identified and defended a definition of globalization that gives primacy to the drivers and effects of transnational economic integration, and addressed a number of important conceptual and methodological issues in studying globalization's effects on SDH and their distribution, emphasizing the need for transdisciplinary approaches that reflect the complexity of the topic.

In this second article, we identify and describe several, often interacting clusters of pathways leading from globalization to changes in SDH that are relevant to health equity. These involve: trade liberalization; the global reorganization of production and labour markets; debt crises and economic restructuring; financial liberalization; urban settings; influences that operate by way of the physical environment; and health systems changed by the global marketplace.

Foreign Policy Matters: A Normative View of the G8 and Population Health

Co-authored with Ronald Labonte; published in Bulletin of the World Health Organization 85 (2007):185-191

Breaking faith with Africa: The G8 and population health post-Gleneagles

Co-authored with Ronald Labonte and David Sanders; published in A.F. Cooper, J.J. Kirton and T. Schrecker, eds. Governing Global Health:  Challenge, Response, Innovation (Aldershot: Ashgate, 2007), pp. 181-205. Please contact Prof. Schrecker for a copy.

What’s Politics Got to Do with It? Health, the G8, and the Global Economy

Co-authored with Ronald Labonte; published in I. Kawachi and S. Wamala, eds., Globalization and Health (New York: Oxford University Press, 2007), pp. 284-310. 

Class, Place and Citizenship: The Changing Dynamics of Environmental Policy

Published in R. Paehlke and D. Torgerson, eds., Managing Leviathan: Environmental Policy and the Administrative State, 2nd edition (Peterborough, Ontario: Broadview Press, 2005), pp. 125-144.  Please contact Prof. Schrecker for a copy.

Committed to Health for All? How the G7/G8 Rate

Co-authored with Ronald Labonte; published in Social Science and Medicine 59 (2004), pp. 1661-1676; reprinted in J. Kirton, ed., Global Health, Library of Essays in Global Governance series (Aldershot: Ashgate, 2009); to order the Ashgate volume go to http://www.ashgate.com/isbn/9780754626657.

The G7/G8 group of nations dominate the world political and economic order. This article reports selected results from an investigation of the health implications of commitments made at the 1999, 2000 and 2001 Summits of the G7/G8, with special reference to the developing world. We emphasize commitments that relate to the socioeconomic determinants of health (primarily to reducing poverty and economic insecurity) and to the ability of national governments to make necessary basic investments in health systems, education and nutrition. We conclude that without a stronger commitment to redistributive policy measures on the part of the G7/G8, historic commitments on the part of the international community to providing health for all are likely not to be
fulfilled.

Using Science in Environmental Policy: Can Canada Do Better?

Published in in E. Parson, ed., Governing the Environment: Persistent Challenges, Uncertain Innovations (Toronto: University of Toronto Press, 2001), pp. 31-72.  Please contact Prof. Schrecker for a copy.

The Ethics of Social Risk Reduction in the Era of the Biological Brain

Co-authored with Lisa Acosta, Margaret Somerville and Harold Bursztajn; published in Social Science and Medicine 52 (2001), pp. 1677-1687.  Please contact Prof. Schrecker for an offprint.

Patenting of Higher Life Forms and Human Biological Materials: An Introduction to the Issues

co-authored with Alex Wellington; published by the Canadian Biotechnology Advisory Committee, 2001. (Their web site has now been closed.)

The Cost of the Wild: International Equity and the Losses from Environmental Conservation

From D. Pimentel, L. Westra and R. Noss, eds., Ecological Integrity: Integrating Environment, Conservation and Health (Washington, D.C.: Island Press, 2000).  Reproduced by permission of Island Press; to order go to http://islandpress.org/bookstore/details.php?prod_id=853

Patenting of Biotechnological Innovations Concerning Animals and Human Beings

Co-authored with Alex Wellington; completed in 1999 and published by Canadian Biotechnology Advisory Committee, 2000. (Their web site has now been closed.)

An Ethical Analysis of the Mandatory Exclusion of Refugees and Immigrants Who Test HIV-Positive

co-authored with Barry Hoffmaster; published by the Canadian HIV/AIDS Clearinghouse, 2000.

Money Matters: Incomes tell a story about environmental dangers and human health

written for a non-specialist audience; published in Alternatives Journal 25 (Summer, 1999): 11-17.

Biotechnology, Ethics and Government

Co-authored with C. Barry Hoffmaster, Margaret A. Somerville and Alex Wellington; originally completed in 1996 and published in Renewal of the Canadian Biotechnology Strategy, Resource Document 3.4.1, Background Research Papers, Ethics (Ottawa: Industry Canada, March 1998): 135-261

Making Ethically Acceptable Policy Decisions: Challenges Facing the Federal Government

Co-authored with Margaret A. Somerville; published in Renewal of the Canadian Biotechnology Strategy, Resource Document 3.4.1, Background Research Papers, Ethics (Ottawa: Industry Canada, March 1998): 69-133.

The Borderless World and the Walled City

Presented at XVI World Congress of the International Political Science Association, Berlin, 1994.  For a variety of reasons, I never revised this paper for publication.  Having just received a request for a copy, I decided to post it here, as I think many of the arguments have stood the test of time rather well.