Health and Development

David Woodward, Nick Drager, Robert

Beaglehole,
& Debra Lipson
http://www.who.int/bulletin/archives/79(9)875.pdf

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 Complex relationship between globalization
and health
• How to assess the direct and indirect health effects
of different aspects of globalization, it is a problem
for health policy makers and health practitioners.
• Linkages between economic globalization and
health; which characterizes the modern phase of
globalization and the ability of countries to protect
and promote health.
• The economic aspects of globalization and impacts
on health.

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 The key themes of analytical framework

• An agreed framework is essential for reliable assessment

of the health effects of globalization
• The indirect effects of globalization operating through the
national and household economies are important for
health outcomes, as well as the more obvious and direct
effects on health risks and systems.
• The effects of globalization will be optimized only when
improvements in health and well-being become central
objectives of national economic policy-making and the
design and management of the international economic
system

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 Economic globalization: an overview
• Economic globalization is the driving force behind the over all
process of globalization.
• International trade has grown at an accelerating pace ----nearly 8.6%
per year over the period 1990-2009
• Financial flows from developed countries have been decreased in
terms of Official Development Assistance but has grown in respect
to MNCs from developed countries towards developing countries.
• World trade organization and WB and IMF drive to promote free
trade of goods and capital mobility.
• Trans border migration is not encouraged as it happened between
1870 to 1914; except to highly skilled people and those with capital.

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 Globalization and health: a conceptual
framework

1.The Household Economy

2.The National Economy
3.The international Economy

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 What to do?
The economic benefits of globalization need to be translated into
health benefits (the links from the national economy to the health
care system, health-related sectors, and the household economy).
This requires that the economic growth be sustainable and
consciously directed towards the poor, through better design of pro-
poor national economic policies, and more explicit consideration of
distributional effects in decisions at the global level. It also requires
that the resources generated by a globalization process more
favorable to developing countries are used to strengthen health
systems, to ensure universal access to cost-effective interventions,
and to improve other services essential to health, such as education,
water and sanitation, environmental protection and effective
nutrition and health safety net programs.

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 Health Facts of Pakistan
• Total population180,808,000
• Probability of dying under five (per 1 000 live births) 87
• Probability of dying between 15 and 60 years m/f (per
1 000 population)225/189
• Total expenditure on health as % of GDP (2009)2.6
• Salaries account for up to 86 percent of recurrent costs
in primary healthcare, while medicines are under-
funded and maintenance and repairs receive minimal
allocations.

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 Definition of Health System
“Health systems are composed of all the organizations, institutions, and
resources that are devoted to producing health actions”
This definition includes a full range of players engaged in the provision
and financing of health services including public, nonprofit, and for-
profit private sectors, as well as the international and bilateral donors,
foundations, and the voluntary organizations involved in the funding or
implementing health activities. Health systems are expected to serve
the population needs in an effective, efficient and equitable manner.
Health systems are at work at central, regional, district, community,
and household levels, and hence all these entities need to be
considered at all levels of discourse on health systems strengthening.

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 Strengthening Health System
Health system strengthening (HSS) is defined
as any array of initiatives and strategies that
improve one or more functions of the health
system, leading to better health through
improvements in the access, coverage, quality
and safety.

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The building blocks of the health systems: aims and
attributes. World Health Organization 2007.

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Issues in Health Sector of Pakistan
The dynamics of health planning in the history of Pakistan
have been predominantly influenced by either the strong
political agendas and manifestos or by the successive
military regimens, marked by corruption and poor
governance.
Difficult or no access to health care services, extreme
poverty, least awareness regarding maintenance of the
health among the population, inadequate emphasis on
addressing of the social determinants of health by the
policy makers are some of the factors that worsen the
situation of public health sector even more in the country.

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NGOs and government partnership for health
systems strengthening
Since many years, international and local non-
governmental organizations (NGOs) have
endeavored to fill the gaps in health service
delivery, research and advocacy. NGOs have
relatively performed better and achieved the
results because of the flexible planning and the
ability to design population based projects on
health education, health promotion, social
marketing, community development and advocacy.

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 Conclusion
Involving the NGOs for health system
strengthening may eventually contribute to
create a healthcare system reflecting an
increased efficiency, more equity and good
governance in the wake of the Millennium
Development Goals. Nevertheless, few
questions need to be answered and pre-
requisites have to be fulfilled before moving
on.
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