1. Introduction

The term "Globalization" has become a buzzword in today's world of revolutionized systems of Information technology and of travel & communication. The global processes have affected human societies in many aspects for the last many centuries but the practical realization and analysis of these processes at a global level is possible only recently because of the revolutions in telecommunications and media.

Globalization is the process whereby nations increase their inter-relatedness and interdependency through the spread of democracy, the dominance of market forces, the integration of economies in a worldwide market, the transformation of production systems and labor markets, the spread of technological change and the media revolution that results in sets of increasingly transnational and multinational economies and political structures and processes.

Globalization is not country based but company based and participation in global economy is not a choice but becomes a necessity. It is a transformation of global society resulting in the negation of territorial frontiers. There are various transnational factors that are considered as determinants of globalization such as macro-economic prescriptions, trade & travel, migration, food security, environmental degradation, technology & communication and foreign policy.

2. Effects of Globalization

The effect of globalization is felt in various sphere of the services sector of a nation. The major effects of globalization are international transfer of risks and trade liberalization.

2.1 International transfer of risks:
There are five main issues under international transfer of risks such as:

2.1.1 Overuse of environmental resources: e.g. exploitation of oil resources, logging of forest as in Cambodia and Nepal, Bangkok pollution cars.

2.1.2 Cross border movements: Cross border movements between states & nations does affect transmission of communicable diseases such as malaria, yellow fever, SARS and HIV

2.1.3 Trade in harmful products: In developed countries, tobacco and medicines are banned while there is limited restriction on its transfer and sale in many developing countries making these countries at potential risk of drug addiction and misuse of certain medicines.

2.1.4 Drug Trafficking: The Golden Triangle, Golden Crescent and Latin American countries like Columbia have become the major drug trafficking centers in the world and illegal drugs are being trafficked through the international highways affecting many vulnerable regions that share their borders with such countries.

2.1.5 Technology: Newer technological products like biological, chemical, nuclear weaponry and nuclear plants are developed, processed and sold.

2.2 Trade Liberalization:

Due to trade liberalization, some pertinent issues are encountered that have adverse effects especially in developing nations.
2.2.1 Multinational dictates trade conditions: The phenomenon of globalization has

led to rapidly growing international trade in services, both in developing as well as developed countries. GATS (General Agreement on Trade in Services) constitute one of the new domains of competence that is assigned to WTO (World Trade Organization).

It is the first set of multilaterally agreed and legally enforceable rules to cover international trade in services. They are in fact binding on all members of WTO. MFN (Most favored nation treatment) requires Members States under GATT (General Agreement on Tariffs & Trade) to comply with a general obligation to apply most favored nation treatment.

2.2.2 Search for cheap labor: There is major influx of laborers from the developing countries where labor is cheap to developed ones.

2.2.3 Sales of harmful products to developing countries: As a result of MFN, there is less restriction on sales of harmful products to developing countries.

2.2.4 Arms sales: There is increasing production and selling of weaponry from the developed countries to developing countries.

2.2.5 Promotion of non-essential drugs

3. Globalization is Shaping the World

In other words, globalization is shaping the present and future state of the world. No nation is truly independent and we live in an era of economic colonialism as reflected on the role of IMF (International Monetary Fund), WB (World Bank), UN (United Nations) etc. Almost all the nations face the political and economic pressure from WTO such as imposition of economic sanctions, increased role and interference from human rights activism i.e. gender issues, child labor, drug trafficking etc.

There is more regional integration like SAARC, APEC, ASEAN and also in the health sector like Act-Malaria, South to South Collaboration Project which was formed to build capacity in reproductive health, etc. To highlight and to address some of the cross border issues like malaria, HIV/AIDS, drug trafficking, exchange of surveillance information, lobbying at international level like WHO & UN, transfer of technology and capacity building etc, we need international health collaborative efforts and cooperation. A global civilization is the need of the hour that is based on respect for multiculturalism and mutual respect.

4. Public health & Globalization

Globalization has a far-reaching consequence on the health status of individual and the population. The health status of the population and the economic condition of a nation is closely related and health is one of the major indicators of the developmental, economic progress of any nation. The population of developed nations is undoubtedly healthier than the developing nations.

The definition of "Health" as given by WHO "as a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity" has never been the ideal definition and people relate that health is dynamic in nature and besides the three dimensions, there are also spiritual, vocational, behavioral and environmental dimensions that need to be considered. The modern concept is that health can be considered as a package that can be bought.

"Public health" is the art and science of preventing disease, promoting health, prolonging life through organized efforts of society. Medicine and public health are two complimentary and interacting approaches for promotion and protecting health. Yet medicine and public health can, and must be differentiated, because they are not the same in many ways.

Public health gives emphasis on population while medicine essentially focuses on individuals. Public health identifies and measures threats to the health of populations, develops government policies in response to these concerns, and seeks to assure certain health and related services.

In contrast, medical care focuses upon individuals-diagnosis, treatment and rehabilitation. In short, public health and medicine are principally distinguished by their focus on collectivities or on individuals, with a series of subsidiary differences involving methods of work, systems of analysis & measurement, emphasis on primary versus secondary or tertiary prevention, types of expertise and relevant skills, setting in which work is conducted and client /public relationships and expectations. There are six essential elements of public health theory and practice as follows:

Emphasis on collective responsibility for health and protecting and promoting health is the prime role of the state.
It focuses on the whole population rather than individual cases.
Emphasis on prevention, especially the population strategy for primary prevention.
Different determinants of health and disease like socio-economic, environmental, etiological agents and other risk factors are taken into consideration.
Involves multidisciplinary approach incorporating qualitative and quantitative methods that is appropriate.
Partnerships with the populations served

4.1 Public health issues related to Globalization

There are many pertinent public health issues related to globalization. In the 1950's the main public health problems used to be communicable diseases while in 21st century, we face more of non-communicable diseases but in developing countries we see multiple burdens such as non-communicable diseases, communicable diseases, new infections, re-emerging diseases like TB, aging and HIV/AIDS.

Due to irrational use of drugs by health personnel and patients alike, there is alarming rise in the drug resistance of certain drugs like anti-tubercular drugs, malaria drugs, common antibiotics and ARV for AIDS. The new emerging drug resistance calls for the need to invest in new products more sophisticated involving tedious and expensive research.

Moreover, the developing countries suffer from lack of specialized staff, advanced technology and state of the art laboratory infrastructure, which makes it unsuitable for these countries. Extensive transport and better communication facilitates trade, massive cross border movements of people rendering the local people vulnerable to harmful goods, disease and harmful lifestyles that directly or indirectly affect the health of the individual and community.

Today, many different international players are setting the global scene in public health such as UNDP, UNODC, UNICEF, UNFPA, WTO, WB, IMF, EC, and NATO etc.

4.2 Impact of Globalization on Public Health

Globalization includes a web of phenomenon and risks that affects the sustainability of health systems and public health. National health systems have become trans-nationalized. Governments and MOPH (Ministry of Public Health) are no longer the solely actors in national health systems and various actors such as WHO, UNICEF, WB, WTO, UNFPA, UNDP etc. next to regional cooperation affect directly or indirectly the functioning of national health systems.

The various risks pertinent to globalization may undermine national health systems and public health, e.g. The spread of HIV has been fueled by extensive travel and migration making them vulnerable to indulge in high-risk practices etc, adoption of unhealthy life styles and behaviors promoted through cross border communication means does adversely affects communities.

Some of the impacts of globalization on public health problems are as follows:
4.2.1 Dealing with triple burden of diseases and HIV/AIDS: The developing countries will face the triple burden of a combination of communicable diseases, non-communicable diseases and other new infections along with the worldwide burden of HIV.

4.2.2 Increases in health expenditure: The triple burden of disease and the fact that people can afford more and more expensive care and treatment results in an increase of health expenditures that confronts countries with real challenges on the ways to reduce or freeze health expenditures rather than utilizing the country's resources on the disease prevention programmes.

4.2.3 Inequity between and within countries: Private health care and the trend to launch autonomous public health care result in less access to basic health care for the poor within countries. There is widening gap between the developed and developing poor countries in terms of health care equity and mobilization & utilization of resources.

Developed countries, which comprised of hardly 10% of the world's nations, are consuming nearly 90% of research resources while the case is vice versa in developing countries. There are very limited research works and public health programmes focusing on primary prevention of diseases in these countries since most of the resources are being utilized for treatment of the vast sick population.

4.2.4 Inefficient and low quality of care: There is lack of access to basic health care services and inefficient utilization of tertiary care within the countries.

5. Public Health Responses to Globalization

The global health council was established to seek for global co-operation and support in dealing with public health issues at the global level. The Mexico conference on global health co-operation beyond 2000 developed a strategic framework for revitalizing global health cooperation and arrived at identifying 6 essential global health functions or areas for international cooperation.

They are communicable diseases control & surveillance such as SARC, regularization of public health laws, knowledge management such as research in public health, targeted problem solving as in brining research into action, vulnerable populations such as migrants, refugees, women & children and lastly health systems development/capacity building with international support of public health.

6. Conclusion

There is a need for international actors to remove the inefficient overlap of efforts, focus on all key functions, and establish improved dialogue with NGOs and transnational cooperation and support in national health systems reforms. The regional based organization such as APEC, ASEAN, Act Malaria are binding the concerned regions on public health at policy, research and actual programs & activities levels through negotiation, collaboration and cooperation, training, technical assistance and research.

Almost all the countries have a role to play in setting goals, priority setting, mobilization of funding and promote, advocate and develop mechanisms for international cooperation to gear up surveillance in public health besides strengthening institutional resource, human resource and technical development. The trade liberalization and economic globalization, although may seems both desirable and inevitable in today's changing world, yet they present formidable challenges and uncertainties in the promotion of health is many developing countries specially.

Lastly but not the least, the role of WHO in international trade agreements under WTO in ensuring that health is taken into account when trade policies are being framed, and in setting appropriate standards or formulating policies for promotion and protection of public health, needs to be re-emphasized and reviewed as per the necessity arises.

References:

Frenk J., Gwin C., Michaels B., Suwanela C., Walth G. (1998)
Rx for the global health cooperation beyond 2000. Washington DC: ODC Publications

International Trade Agreements and their implications on Health:
Regional Committee. Provisional Agenda item 10. RC-51. The Fifty First Regional Committee of the South-East Region. 2nd September 1998.
http://www.whosea.org Accessed on 14th October 2003

Micklethwait, J., Wooldridge, A. (2000) A future perfect: The challenge and hidden promise of globalization. NY: Times Books

Narula I.S. (1998) Globalization and the impact on health: An overview.
Paper for the Regional Consultative Meeting on International Health Development. Bangkok Thailand 16-18 November 1998

Walt, G. (1998) Globalization of international health. World Health, The Lancet Vol. 351 Feb. 7, 1998 pp. 434-437.