Student Revision Note: Globalization and Health (NURS5302)

Course: NURS5302 - Globalization and Health
Institution: HKU School of Nursing
Lecturer: Dr. Fung Tai Chun John
Topic: Lecture 2 - Globalization and Health (Global Dimensions, ID, Financing, Pharma)

1. Core Definitions [Key Exam Concepts]

What is Globalization?

• Definition: The process of the contemporary world becoming increasingly interconnected.
• Key Characteristic: Events occurring in one part of the world have a direct or indirect impact elsewhere.
• Impact on Health: Globalization restructures human societies, affecting the broad determinants of health (Employment, Housing, Education, Water/Sanitation, Agriculture).

Types of Disease Emergence

• Newly Emerging: Diseases that have not been seen before (e.g., SARS, MERS-CoV).
• Re-emerging: Known diseases that were controlled but are resurging (e.g., Tuberculosis, Dengue).
• "Deliberately Emerging": Bioterrorism threats (e.g., Anthrax).

Foreign Direct Investment (FDI)

• Definition: An investment made by an enterprise from one country into an entity in another, reflecting a long-term interest. This is a primary mechanism for Transnational Corporations (TNCs) to enter new markets (often bringing unhealthy commodities like tobacco/processed food).

2. Important Numbers & Statistics [Memorize These]

Economic Impact of Infectious Outbreaks (1990-2003)

• BSE (UK): US$ 39 billion
• SARS (Asia): US$ 30 billion
• Plague (India): US$ 1.7 billion
• E. coli 0157 (USA): US$ 1.6 billion
• Cholera (Peru): US$ 770 million.

Migration & Healthcare Workforce (The "Brain Drain")

• Global Migrants: Estimated 214 million people (approx. 3.1% of world population) live outside their country of birth.
• The Philippines Case:
  • 85% of Filipino nurses work overseas.
  • Over 150,000 nurses exported (2003 data).
• Inequality in Staffing (Density per 100,000 people):
  • Malawi: 17 nurses.
  • Rich Countries: ~1,000 doctors/nurses.

Pharmaceutical Industry Economics

• Global Sales Growth:
  • 2003: $492 billion
  • 2009: $750 billion (nearly doubled).
• Top Revenue (2015): Johnson & Johnson ($70.07 billion), followed by Roche and Novartis.
• Blockbuster Drugs (2008 Revenue):
  • Nexium: $5.2 billion
  • Celebrex: $2.5 billion.

Climate Change & Vectors

• IPCC Prediction: Temperature rise of 1.8°C to 4°C by 2100.
• Hajj Pilgrimage: 3 million people from 160+ countries (Mass mobility risk).

3. Global Dimensions of Infectious Disease

Drivers of Spread

1. Urbanization: Increases "crowd diseases" (Influenza, SARS) due to close contact.
2. Mobility: Mass gatherings (e.g., Hajj) allow secondary epidemics to last over 2 years.
3. Climate Change: Warmer temps expand vector ranges (Mosquitoes: Malaria, Dengue) to new regions (e.g., outbreaks in the US and Papua New Guinea high rural areas).

Governance: International Health Regulations (IHR)

• Reform Years: Updated in 2005, fully reformed in 2007.
• Cycle of Protection:
  1. DETECT (Surveillance)
  2. ASSESS (Evaluate threat)
  3. REPORT (Notify WHO/Intl community)
  4. RESPOND (Decision making)
• New Obligation: Must report "Public Health Emergencies of International Concern" (PHEIC) regardless of source.

4. Globalization of Chronic Diseases

The Mechanism

• Trade Liberalization: Lowers prices and increases marketing of Tobacco, Alcohol, and Processed Foods.
• Livestock Production: Dramatic increase in meat/dairy consumption + oilseeds/corn for feed.
• FDI Spike: Investment in food/beverage sectors spiked dramatically between 2004 and 2008.

Two Political Approaches to Prevention

5. Pharmaceuticals & Access

Key Regulations

• WHO Essential Drugs List (1977): Contains 220 drugs deemed most cost-effective.
• TRIPS Agreement: Protects Intellectual Property (patents), preventing generic copying.
• Doha Declaration (2001):
  • Allows Compulsory Licenses and Parallel Importing during public health crises.
  • Extended patent exemptions for poorest countries until 2016.

The Gap

• Focus: R&D priorities are on "lifestyle" drugs (obesity, impotence) for the rich world, rather than diseases affecting the poor.
• Status: The industry is "Globalizing" (process), not yet fully "Globalized" (state), as production/consumption is still concentrated in high-income areas.

6. Globalization and Nursing

Impact Summary

• Positive: Higher salaries, better standards of living, increased "local" treatment to retain staff, diverse employment settings (corporate/edu).
• Negative: Brain Drain depletes workforce in developing nations; weakens healthcare systems in places like Malawi and the Philippines.

Future Skills Required

• "Learning how to learn" (Producing vs just using knowledge).
• Transcultural Health: Moving from local to universal focus.
• Policy Participation: Nurses must engage in health policy to create cost-effective systems.