Study Guide for Chapter 9 of Introducingglobalization

Health:

Study Guide for Chapter 9 of IntroducingGlobalization

Prepared by Matthew Sparke for students using

Introducing Globalization: Ties, Tensions, and Uneven Integration, Oxford: Wiley-Blackwell, 2013.

Learning objectives:

After completing this chapter, you should be able to:

1)describe global ecological interdependency in terms of the anthropocene;

2)understand how ecological interdependencies involve social inequalities;

3)explain the emergence of biological citizenship and personalized medicine;

4)link personal body-counting with other worlds of population body counts;

5)trace the ties and impacts of the social determinants of health globally;

6)evaluate how humanitarian efforts to correct market failure use market tools.

Main arguments:

Global health is the ultimate way in which the interdependencies of globalization come together to shape destinies. In a very basic ecological sense, of course, life on the planet has always been globalized. But human-centric forms of globalization have fundamentally changed these ecological interdependencies, making us the dominant global species and creating today what some scientists refer to as a new ecological-turned-geological era: the anthropocene. While the global ties and consequences of the anthropocene are inescapable, they are embodied in radically different and unequal experiences of interdependency. The first part of Chapter 9 explores these socio-economic inequalities within ecological interdependency, focusing in particular on unequal vulnerability and unequal capacity for resilience in the face of the dangers posed by global climate change.

One especially telling example of unequal risk management relates in turn to access to medicine and health services, including diagnostics and screening for personal risk. Important innovations in bio-molecular medicine have made it possible for those with access to resources to manage their risks on a personal scale using new kinds of personal body counts. From cholesterol counts to CD4 counting to all the many other complex counts coming out of CT scans, PET scans, and MRIs, these personal body-counting technologies can be employed by individuals to manage personal vulnerability to disease. In so far as these technologies are globally mobile and individually tailored, they can also be easily transferred across international borders, and this has led some commentators to suggest that they present us with the possibility of a newly post-national kind of biological citizenship for all human beings. Unfortunately, however, notwithstanding the inclusive global promise of the new technologies, only a small sub-set of humanity actually has the resources to engage in such biological risk management on an ongoing basis and respond to new diagnoses with personalized therapies recommended by their physicians. Most other people in poor countries and communities around the world – including the slums and homeless encampments of the richest global cities – continue to count the loss of generations and friends in the bleakly simple counting of dead bodies. It would seem on first impressions, then, that the two forms of body-counting are worlds apart. However, the central argument of the central section of Chapter 9 is instead that the new world order of biological citizenship is globally connected to the multiple communities of sub-citizenship that are excluded from its privileged forms of risk management.

The molecular risk management afforded by personalized body counting is in fact tied quite closely to the macro risks registered by big body-counts in poor communities. Four sorts of connections stand out in this respect, namely: 1) the ties of drug development; 2) the ties of pandemic disease surveillance; 3) the ties of organ trading; and 4) the ties of traveling health workers. Each of these ties illustrates how personalized risk management for some often imposes new risks on already more vulnerable others. New drug therapies are increasingly tested in poorer communities, driven by the need to test them on so-called treatment-naïve bodies (bodies that are not already full of pharmaceuticals) as much as by the competitive advantage of low-cost labs. Victims of new flu and TB reassortments in poor countries are carefully counted and their tissue tested, but not so much for their own benefit as for the protection of distant strangers. Commercial living donors sell their organs to wealthy recipients just in order to make a living. And doctors and nurses from poor countries that are already understaffed travel to rich countries to staff hospitals and clinics that boast the best doctor-to-patient ratios in the world.

Set against all the inequalities in risk and risk management around the world, one more hopeful development has been the recent rise in funding for global heath programs. Reversing the molecular focus of personalized medicine, much of the inspiration for this global health work begins from more macro analyses of the social, political, and economic conditions that determine vulnerability to diseases and health outcomes at a population scale (see Figure 9.4 reproduced below). By taking this approach, many global health policy-makers and practitioners commonly imagine their interventions in terms of addressing global market failures, and in particular the failure of structural adjustment plans and neoliberal policies to deliver on the pre-debt crisis 1978 Alma Ata vision of “health for all.” Nevertheless, when it comes to organizing global health programs, many also believe that by addressing particular diseases in particular places with “vertical” interventions by NGOs, they can give local populations the chance to recover and finally benefit from market integration. This dominant approach is neither market fundamentalist nor a radical repudiation of pro-market neoliberalism. Instead, it is animated by hopes of market foster-care, of reversing claims that “wealth is healthy” and hoping instead that “the healthy will become wealthy.” Such hopes have led in turn to a long list of disease-specific, donor-driven vertical programs that, because of their reliance on grant competitions, cost–benefit calculations, and financial ideas about investment for health for growth, remain profoundly shaped by market forces.

Determinants of health from global to national to local to personal.

Diagram by Matthew Sparke based with permission on the teaching slides of Steve Gloyd

Key conclusions:

1)Ecological globalization has taken a new form with global climate change.

2)Today’s environmental interdependencies are deeply shaped by inequalities.

3)Genomics and biomedicine open unequal access to biological citizenship.

4)Inequalities shape the ties of disease, drugs, organ trading, and health workers.

5)Globalization influences non-biological social determinants of health.

6)Debate over the impact of market capitalism shapes global health policy.

7)Both market fundamentalism and critiques of market failure have increasingly lost ground to ideas about global health as market foster-care.