Health Care & Globalization
The relationship between health care and globalization is becoming more defined as issues such as the AIDS epidemic, malnutrition, unsanitary conditions, and the lack of medical treatment are recognized as problems faced by developing countries.
The merger between health care and globalization has resulted in a two-sided debate over the approach to resolving the administration of health care in developing countries in the context of globalization. For example, on the pro-globalization side, the argument for improving the administration of health care has been based on utilizing market incentives and employing private business innovation to combat the lack of health care. In contrast, others argue that the lack of health care in developing countries is the result of an international system that largely displaces economic and social systems. Furthermore, the argument is that the source of failing health care in developing countries is tied to social distribution and a lack of resources or equity relative to developed countries.
- Rena Eichler, "Performance-Based Payment to Improve the Impact of Health Services: Evidence from Haiti," World Bank Institute Online Journal, Apr. 2001, available at http://tiny.cc/va8oj.
The author asserts various means by which performance-based payment systems that encompass the application of free market incentives may positively affect health care in developing countries. Using Haiti as a specific case study, Eichler identifies ways in which this country implemented performance-based payment systems to hold health care institutions accountable for achieving defined results. Linking reimbursement to results, Eichler argues, can be a powerful strategy to improve health system performance. Thus, the lack of health services in developing countries can be characterized as a lack of appropriate economic incentives.
Using the principal-agent economic theory, the author illustrates how the payer (i.e., the government, donors, or private payer) can purchase services from an agent (i.e. a health care provider). Within a performance-based system, a contract is then designed that provides incentives to the agent to perform in the way the principal would like because it is in the agent's best interest to do so. Where the administration of health care is defined in terms of market incentives, health impact, consumer satisfaction, and performance monitoring, the result according to Eichler is improvements in immunization and health administration, all of which are lacking in developing countries.
- Salih Booker, William Minter, "Global Apartheid," Nation, Jul. 7 2001, available at http://www.thenation.com/article/global-apartheid.
The premise of the authors is that health care in developing countries needs to be viewed in the context of "global apartheid." The article promotes the notion that there exists an international system of minority rule resulting in an environment where life-saving medicine and care for people living with HIV and AIDS is determined by race, class, gender, and geography.
The process of assessing the current status of particular health issues in developing countries in the context of global apartheid is very revealing. For instance, the authors cite to the observation that the AIDS epidemic exposes the fact that the distribution of current suffering associated with global inequality is linked to place and race. This is supported by the fact that out of approximately three million AIDS-related deaths worldwide, approximately 2.4 million come from Sub-Saharan Africa.
The authors also argue that AIDS is not only fueled in part by unequal access to medical care, but also by economic and social inequalities. Poverty and gender inequality fuel the epidemic; malnutrition also greatly reduces resistance to disease. In addition, migrant labor patterns raise the risk of infection. These are all variables common to developing countries. The most significant contribution to global apartheid in developing countries is unsustainable debt and weakened health care systems that are a result of policy conditions imposed by international creditors.
- I. Potrykus, Grains of Delusion: Golden Rice Seen From the Ground, Feb. 2001, available at http://www.grain.org/briefings/?id=18.
The article begins by describing the role of the multinational biotech lobby in promoting the idea of genetically engineered (GE) crops as a method of solving the problems of malnutrition, disease, and related health issues in developing countries. The first example cited is a genetically produced rice containing higher than normal levels of beta-carotene and iron. Referred to as "golden rice", biotech companies are promoting the development of such engineered foods among agencies such as the U.S. Agency for International Development. Other examples of genetically produced crops being promoted by the biotech lobby are high-nutrition potatoes, high-iron corn, and ferritin-rich lettuce.
The criticism of such genetically engineered foods as a means to address health care problems in developing countries is twofold. The author submits that the main agenda of the biotech lobby is to garner support and acceptance for genetically engineered food. Advocating genetically engineered food as the solution to the health care crisis in developing countries distracts the attention from the more important issues such as deficiencies in social and economic structures that are the source of ineffective health care systems.