A paradox of traveling far from home is that, after traversing half the globe, the further one travels, the nearer one returns to home. The measures of near and far merge. So it may appear with promotion of health in that the more we promote health in distant populations, the better may be our health protection at home.
In the modern, globalized world, populations are increasingly interdependent on health preservation and promotion. Distant disasters may call for international aid and transportation of health care workers, and infections in far-away regions can reach us at the speed of jet aircraft. In 2003, for instance, a Canadian woman visiting family in China flew back carrying the virus for severe acute respiratory syndrome (SARS), from which 44 people, including health care workers, soon died in Toronto.
The dynamics of population health globalization are varied, eroding the extent of sovereignty over their populations’ health care that nation states once enjoyed. A recent admirable and wide-ranging literature review by Ng and Prah Ruger, entitled Global Health Governance at a Crossroads (SSRN working paper, abstract #1699185, 2010), analyzes the role of various agencies in promoting population health globalization, sets out different ways in which health concerns may be framed, and identifies major issues and challenges in global health governance. These include lack of momentum to address key problems and lack of coordination among agencies.
Powerful, predominantly Western states such as the G8 nations support efforts to advance population health in resource-poor countries. However, they also undermine health, for instance by protection of the tobacco industry and of restrictive practices by pharmaceutical companies. The role of the World Health Organization and other agencies of the United Nations appears diminished by such initiatives as the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which was formed under G8 auspices.
Organizations primarily addressing international trade—such as the World Trade Organization, World Bank, and the G8 and G20 countries—also play a significant part in global health governance. For example, their influence over access to therapeutic drugs and health services and over major health risk factors such as tobacco, unsafe food, and unhealthy diets affects population health in economically developed and developing countries alike.
Nongovernmental organizations (NGOs), civil society organizations, and public–private partnerships (PPPs) are also aiding globalization of population health. For instance, most PEPFAR funding is distributed through NGOs located in resource-poor countries. A merit of these kinds of organizations is that they can give a voice to aid recipients and reflect grassroots values. However, they have no democratic accountability, may be subject to restrictive ideologies such as religious directives that limit the supply of contraceptives, and must compete against their peers for funding and visibility. PPPs in particular promise to bring private-sector management skills and financial resources into the service of public, international agendas and were found, in a 2004 review for the UK Department for International Development Health Resource Centre, to target the most burdensome diseases and the most-needy countries relatively well. They engender some skepticism, however, regarding private-sector motives, public transparency, and accountability.
Finally, globalization proves dysfunctional when it permits populations to evade addressing domestic sources of disease by blaming external agents. This was apparent in the early years of AIDS, during which even sophisticated populations claimed that the disease was introduced by outsiders. Similarly, although an outbreak of cholera was a predicted risk of turmoil after the earthquake in Haiti, protesters blamed UN peacekeeping soldiers from Nepal. Regardless of whether investigation will support this claim, this example illustrates how the presence of personnel from afar can induce populations to avoid seeking causes of disease that lie closer to home.