impact of globalization on healthcare

Dr. Abdulaziz Saddique Pharm.D., CPHQ,CSSMBB

7th Arab Conference “New Trends in Hospital Administration”“Performance improvement and cost containment in light of current national &

International Changes”

Growing liberalization of trade (in goods and services and in

money), and accelerated integration into a global economy

Growing dominance of Western forms of political, economic,

and cultural life

Proliferation of new information technologies, intensification

of and acceleration of global communication

Weakening of local and national boundaries in many areas of

human endeavour

Weakening of the role of the State relative to the role of the

Market

“The State has become too small for the big problems and

too big for the small problems” (Wade Davis)2Dr. Saddique

1500-1840

1850-1930

1950s

1960s

Best average speed of horse-drawn coaches and

sailing ships, 10mph.

Steam locomotives average 65mph. Steamships

average 36mph.

Propeller aircraft 300-

400 mph.Jet passenger aircraft 500-

700mph.

The Shrinking Globe The Shrinking Globe

Is Distance Dead? Is Distance Dead?

The cost of information transfer decreased by 98% in the last 40 years.

The cost of Goods transport is reduced by 50 %in the last 40 years.

Globalization is associated with “time and space contracting”:

3Dr. Saddique

Bretton Woods Institutions: World Bank, IMF and World Trade Organization. “Washington consensus”: Rules imposed by

World Bank, the IMF, in consultation with US to encourage deregulation, privatisation, free trade, export oriented growth

Transnational corporations (TNCs/MNCs)

Leaders of the G-7, now G-8 Canada, France, Germany, Italy, Japan,

Russia, UK, US

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Drive for Change

Globalization

Governance

Local Governance

Citizens / Industry

•WTO•IMF•WHO•World Bank

•WTO•IMF•WHO•World Bank

•Laws•Rules•Regulations•Guidelines

•Laws•Rules•Regulations•Guidelines

•Implementation•Performing•Execution

•Implementation•Performing•Execution

•Economic developments effects all

•Economic developments effects all

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“We have global governance without global government, one in which a few institutions – the

World Bank, the IMF, the WTO, and a few players – finance and trade ministries, closely linked to certain financial and commercial interests –

dominate the scene, but in which many of those affected by their decisions are left almost

voiceless” Joseph Stiglitz, 2002

(author of “Making Globalization Work” and

“Globalization and its Discontents”)

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South-South linkages to reduce dependency on Northern markets: Brazil, India, China, South Africa (BRICs) Shanghai Cooperation Organisation: China, Russia,

Kazakhstan and other former Soviet territories Rise of social movements in the Civil Society

sector to protest unequal benefits and promote “alter-globalism” World Social Forum, 2001 Porto Allegre, calling for a

fair system of trade, full employment, guaranteed basic goods such as education and health, local prosperity, sustainable growth

7Dr. Saddique

Globalization and the Globalization and the World’s PoorWorld’s Poor

Critics argue that globalization has not helped poor 1870: per capita income of 17 richest nations was 2.4x that of all

other countries. 1990: it was 4.5x larger.

Other factors may have influenced the gap Totalitarian governments. Economic policies that destroyed wealth creation. Little protection of property rights. Expanding populations. War.

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Internationalization-interaction & interdependence of people in different countries

Globalization-worldwide, universal

Universalization-spread of people & cultures worldwide

Westernization-values, behaviors of Western societies

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• Inevitable

• Universal

• Pro-active pays

• Uncertainties

• Stressful

What are the pros and cons of globalization on health care?

(Herhock et al., 2007)

Globalization is: The product of the emergence of a

global economy, expansion of transnational linkages between

economic units creating new forms of collective decision making,

development of intergovernmental and quasi-supranational institutions, intensification of transnational

communications, and the creation of new regional and military orders

(Hershock, Mason & Hawkins, 2007, p. 30).

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Liberal arts Language Flexibility Attitude Acceptance Communication

12Dr. Saddique

School of Nursing

Having a global perspective is to have a very expansive perspective of the world from a liberal arts background, to the skill of a language or knowledge of multiple languages, being acceptable of differences with an attitude of acceptance of differences and being able to communicate across intergenerational, international, and interprofessional barriers.

Steps to CCC Attitudes for CCC Self awareness Individual respect & Knowledge acceptance of differences Communication Inclusive

Q What is the stand of the JCAHO re: client centered & cultural competent care?

Client centered (CC): Treating person as a whole. CC entails: advocacy, empowerment, respect, self-determination & participation.

13Dr. Saddique

School of Nursing

Becoming cliented centered and culturally competent in your care comes closer to being more global in your care. Your own self awareness, and your knowledge of multiple cultures as well as having command of the language of the client you are serving plus, an attitude of respect and acceptance is more culturally competent in your care. Treating the person as a whole is being client centered. The JCAHO standards specify what is considered client centered as well as culturally centered.

….. "health problems that transcend national boundaries, that may be influenced by circumstances or experiences in other countries, and that are best addressed by cooperative actions, and solutions; whether they occur in developing countries, countries in advanced transition, or industrialized countries" (UNC-CH, 2007, p.3).

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Access: Sheer numbersWho pays? Use of ER/hospital careCommunication-interpretersNeed for client centered careUse of CAMSAdherence/compliance

Q What is the impact of immigration globally?

(Brush, 2008, 40(1):20-25; www.ilo.org;public/english/dialogue/sector/papers/health/wp209.pdf)

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2000 2050

% ofpop

Q What demographic shifts are occurring globally? 16Dr. Saddique

Mass communication Sharing media Global traveling Advancements

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Caring Economics: A Global Agenda

CARING is big business!Caring is marketing.Caring & outcomesCaring takes time.Caring is a basic human need.

Q Is caring a business commodity?

(Eisler, R., 2007, Creating a Caring Economics: The Real Wealth of Nations)

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Health Disparities: mortality & morbidity of poor

Infectious Diseases More effective health care Systems Tobacco addiction

Q What other issues can you identify?

19Dr. Saddique

School of Nursing

The world's health issues are multiple and need every nation's best individuals to resolve them. Mortality/morbidity among the poorest nations as well as tobacco addition, infectious disesase command a more effective health care system to deal with such perplexing problems. Health disparities along with natural disasters and the threat of terrorism compel all of us to work together collaboratively to resolve health care problem through economic and educational means.

#1 France #6 Singapore #10. Japan #15. Iceland #20. Switzerland #25. Germany #30. Canada #37. USA #61. Mexico #144. China

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Access to health care Individual profile Social:

education/economics Environment Infant mortality Life expectancy

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USA 7.09 male deaths/1000 births UK 5.67 Canada 5.15 Australia 5.02 Switzerland 4.84 Spain 4.76 Germany 4.56 Japan 3.58 Iceland 3.43 Sweden 2.92

(Retrieved from www. Who.org , 2007) 22Dr. Saddique

Male FemaleUK 78.8 83.1Australia 78.5 83.3Japan 78.5 85.5Iceland 78.5Germany 77.4 84.4Malta 77.0 81.9 France 75.9 83.1Spain 74.5 82.0USA 74.8 80.1 (17th.

in world)Sweden 70.4 78.4(www.INED.fr/en/pop_figures, 2006; Holtz, 2008, p. 5) 23Dr. Saddique

http://www.ined.fr/en/pop_figures

Cardiovascular/hypertensionDiabetesCancerObesity & nutritionHIV/AIDSTobacco/alcohol addictionSubstance abuseInjury/violenceImmunizations

24Dr. Saddique

School of Nursing

The global burden of illness are depicted on this slide with cardiovascular remaining at the top. However, the mad cow disease clearly depicts the universal concern when an illness occurs in one country which may be equally as devastating to another country. Countries in partnership may be better able to lessen this burden in working collaboratively to resolve health care problems globally.

Universal INFECTION CONTROL

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Cultural competency

Diversity & Workforce

Diversity management

Equity/social justice

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System Outcomes

Quality Improveme

nt

Evidence-based

Practices

Performance MeasurementQ What are the expected outcomes of globalization and health care? 27Dr. Saddique

•Advocates for health are imperative•Society continues to change•Gatekeepers are necessary•Learning to cope is essential Q What do you predict for the globalization of

health care?

28Dr. Saddique

School of Nursing

The uncertainities are many but the answers are few. No doubt it is a different time and place. What we do know is that society is changing and advocates and gatekeepers are imperative as we move ahead in the midst of multiple changes. Nurses will be called on to serve in these roles. Learning to cope with the perplexing and multiple changes is a major challenge for all of us.

Global partnerships Government’s role Philanthropy Engagement/participation Transformational leadership

29Dr. Saddique

Health People 2015 in various countries Eight Millennium Development Goals 1990-2015 United Nations/World Health Organization shifts Ministries of health Non-Government Organizations, consumer/

professional/environmental groups Public/private partnerships & alliances

Q What needs to be done to activate clients in health care?

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•Cultural diversity

•HCP migration

•Nursing & Medicine shortages

•Service learning

•Health careers

Q What significant impact will globalization have on the role of the HCP? 31Dr. Saddique

Health care systems are in reform globally.

Globalization affects every system.

Inter-professional efforts are needed to improve health care globally.

Health care providers need to prepare, be

proactive and collaborate.

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In 2001, trade in goods accounted for 40% of the world’s GDP compared with 33% in 1990 19% for US but over 100% for many

developing countries In 2001, foreign direct investment

totaled 746 billion dollars compared with 203 billion dollars in 1990

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Foreign trade volume increased from 48 billion dollars in 1960 to 3.6 trillion dollars in 2006

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US-owned assets abroad 457 billion dollars in 1976 13.8 trillion dollars in 2006

Foreign-owned assets in the US 292 billion dollars in 1976 16.3 trillion dollars in 2006

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Normative theory What ought to be e.g.: “Globalization is ultimately good for poor

developing countries.” Positive theory

What is e.g.: “Globalization increases economic

inequality between rich and poor countries.”

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The impact of globalization on income inequality unemployment education health care women and children the environment homeland security, etc.

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Does globalization decrease levels of government spending on social services such as health care and education?

Yes: “race to efficiency” or “race to the bottom”

No: “race to the top” of human capital formation

How to empirically test these theories?

38Dr. Saddique

Social ImplicationsSocial Implications

Large technological transfer + cheap information technology: knowledge diffusion

Increase of skilled labor

Leapfrog development steps: high-speed transition towards a service economy

Economic efficiency economic growth poverty reduction

“Westernization” of governance: gender issues / democracy

Convergence of income / labor standards

Efficient allocation of labor between i) economic sectors ii) rural-urban areas

39Dr. Saddique

Important NoteImportant NoteThe move from Agricultural Society The move from Agricultural Society into Industrial Society was a move into Industrial Society was a move

in the type of products and in the type of products and production process.production process.

The move from Industrial Society The move from Industrial Society into Information Society into Information Society

(Globalization) is not limited to the (Globalization) is not limited to the type of products or the process of type of products or the process of production but it affects people in production but it affects people in

all their life aspects.all their life aspects.40Dr. Saddique

Globalization & Culture: The Globalization & Culture: The Story So FarStory So Far

Cultural HomogenizationCultural Homogenization

Cultural ImperialismCultural Imperialism

McdonaldizationMcdonaldization

Coca-ColonizationCoca-Colonization

AmericanizationAmericanization

WesternizationWesternization

41Dr. Saddique

Thanks you for your Participation

impact of globalization on healthcare

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