Where is the real debate on globalisation?

Abstract

The debate section of the September 2001 issue was dedicated to the complex issue of globalisation.1–5 All the authors note the polarisation of the current debate and the importance of finding specific strategies to move forward.

Our point here is not to take sides as to the results of globalisation but to address the question of why these debates are so polarised. That is, precisely part of the problem is that there is no true “debate” occurring here because there is no level playing field between rich and poor countries, between the winners and the losers of …

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LETTERS TO THE EDITOR
Socioeconomic differences in
road traffic injuries
We greatly appreciate the attention brought to
the growing problem of road traffic injuries in
your journal and especially welcome the focus
on socioeconomic differentials in the distribu-
tion of such injuries.12However, we feel that
the impact of road traffic injuries is far greater
in the developing world and feel the need to
raise the following issues for consideration by
colleagues around the world.
• Road traffic injuries are estimated to be the
ninth leading cause of death for all ages
globally and are expected to become the
third leading cause by 2020.3The loss of
healthy life from injuries (measured in
terms of disability adjusted life years per
100 000 people) is four times greater in low
to middle income countries than in high
income nations. Moreover, fatality rates
from road traffic injuries are highest in the
developing world, especially Africa.
• Empirical work is now being done in the
developing world to understand the burden
of road traffic injuries and its distribution
related to population characteristics.4Our
work at national level in Pakistan has dem-
onstrated that injuries are the fifth leading
cause of loss of healthy life, and the second
leading cause of disability.5A40year
analysis of public sector data in Pakistan
demonstrates the public health impact—
mortality, morbidity, and costs—to society
in the developing nation.6While a national
health survey in Pakistan demonstrated the
overlapping frequencies of childhood inju-
ries and diarrhoea in children for the first
time in the early 1990s.7
• We have conducted one of the first nation-
ally representative injury surveys in Paki-
stan focusing on this neglected public
health issue.8Highlights of this sample of
nearly 29 000 people interviewed in rural
and urban areas will soon be published in a
peer reviewed journal. The survey indicates
that 70% of childhood injuries occurred to
children whose mothers had no education,
and this variable was used to reflect some
measure of social and economic status. In
addition, the relative risk of transport inju-
ries was three time higher in those with
manual labour as a profession, compared
with those in the service sector.8These
findings reflect the beginnings of the type
of inequality analysis proposed by Hassel-
berg et al, which is a challenge in resource
poor settings.
Such work from the developing world indi-
cates the great need for better data on road
traffic injuries, and especially disaggregated
data that permit subanalysis. It is therefore
critical that researchers in developing coun-
tries ensure that their study designs include
aspects of equity analysis.
A A Hyder
Program in International Health, The Johns Hopkins
Bioethics Institute, USA
A Ghaffar
Health Services Academy, National Injury Research
Centre, Islamabad, Pakistan
Correspondence to: Professor A A Hyder, Johns
Hopkins University, Bloomberg School of Public
Health, Department of International Health, 615 N
Wolfe Street, Suite E-8132, Baltimore, Maryland
21205, USA; ahyder@jhsph.edu
References
1Hasselberg M, Laflamme L, Weitoft GR.
Socioeconomic differences in road traffic
injuries during childhood and youth: a closer
look at different kinds of road users.
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2Plasencia A, Borrell C. Reducing
socioeconomic inequlities in road traffic
injuries: time for a policy agenda.
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3Murray CJL, Lopez AD.
The global burden of
disease and injuries 1990
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10/90 Report on Health Research
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5Hyder AA, Morrow RH. Applying burden of
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6Ghaffar A, Hyder AA, Mastoor MI,
et al
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7Pakistan Medical Research Council.
Health
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Islamabad: Government of Pakistan, 1997.
8Ghaffar A, Siddiqui S, Shahab S,
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Where is the real debate on
globalisation?
The debate section of the September 2001
issue was dedicated to the complex issue of
globalisation.1–5 All the authors note the
polarisation of the current debate and the
importance of finding specific strategies to
move forward.
Our point here is not to take sides as to the
results of globalisation but to address the
question of why these debates are so polar-
ised. That is, precisely part of the problem is
that there is no true “debate” occurring here
because there is no level playing field between
rich and poor countries, between the winners
and the losers of the globalisation process.
Indeed, the power of the pro-economic liber-
alisation forces is so great that in some senses
this neo-liberal view of the world is taken to
be “natural,” inalterable, and rejection of
aspects of globalisation is portrayed as a
return to the “Dark Ages.”4
So long as governments in the South inter-
nalise their role in this distorted economic
system and those who are supposed to be
critical thinkers accept that the basic proc-
esses of globalisation can only be ameliorated
but not reformed, other academics and activ-
ists will always be in the position of protesting
irately from the outside. As any heretics ques-
tioning an orthodoxy, they are forced to make
the case ever more dramatically that the veil
of “naturalness” must be pierced.
In this sense, as Krieger has pointed out:
frameworks matter.67The way we think about
things determines what we do about them.
We argue that a human rights approach to
health brings these dynamics of power into
focus and possibly provides what so many in
the South have lost: hope for their future in
this new world order. Taken together, the
norms in international human rights instru-
ments set out a vision of the world in which
power is greatly diffused and entrenched
disparities—with their obvious effects on
health—are attacked at their root causes. A
human rights approach is concerned with
non-discrimination and equity, authentic so-
cial participation in health, and access to
effective judicial remedies in the event of vio-
lations. In a larger sense it connects health to
broader struggles for democracy and social
justice. Conceptualising health issues as
rights issues also provides a powerful way to
place and keep them on the public agenda—a
need expressed by various authors.
Clearly we need more systematic thinking
about how to actually apply alternative
frameworks, such as that suggested by human
rights, to the issue of globalisation and health.
Moreover, if the veil is to be pierced, not only
health professionals but future generations of
health professionals—who are still forming
their views of what lies in the realm of the
possible—must be made aware of these issues
and mobilised. Indeed, because transnational
trends determine the very possibilities for the
provision of services as well as the health con-
ditions in which populations live, it is
especially crucial that future health profes-
sionals be exposed to these issues early on in
their education and included in this debate.
J J Miranda
EDHUCASalud Founder Member, Civil Association
for Health and Human Rights Education, Lima, Peru;
and Peruvian Programme, Health Unlimited,
Ayacucho, Peru
A E Yamin
Joseph L Mailman School of Public Health,
Columbia University, New York, USA and
EDHUCASalud Advisor, Lima, Peru
Correspondence to: Dr J J Miranda;
jjmiranda@terra.com.pe
References
1Hernandez-Aguado I, Alvarez-Dardet C.
Globalisation and health: action now!
J
Epidemiol Community Health
2001;55:609.
2Baum F. Health, equity, justice and
globalisation: some lessons from the People’s
Health Assembly.
J Epidemiol Community
Health
2001;55:613–16.
3Bettcher DW, Wipfli H. Towards a more
sustainable globalisation: the role of the
public health community.
J Epidemiol
Community Health
2001;55:617–18.
4Lee K. A dialogue of the deaf?The health
impacts of globalisation.
J Epidemiol
Community Health
2001;55:619.
5Labonte R. Liberalisation, health and the
World Trade Organisation.
J Epidemiol
Community Health
2001;55:620–1.
6Krieger N. Sticky webs, hungry spiders,
buzzing flies, and fractal metaphors: on the
misleading juxtaposition of “risk factor” versus
“social” epidemiology.
J Epidemiol
Community Health
1999;53:678–80.
7Krieger N, Gruskin S. Frameworks matter:
ecosocial and health and human rights
perspectives on disparities in women’s
health—The case of tuberculosis.
Journal of
American Women’s Association
2001;56:137–42.
J Epidemiol Community Health
2002;56:719 719
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