Keywords

1 Introduction

In its essential meaning, Global Health (GH) is inherently linked to the “effects of globalization on health” and the interactions of global determinants (including political, economic, social, cultural, and ecosystemic) with national and local systems [1].

Globalization can be understood as the growing interconnection between human societies beyond geographical and political boundaries, whereby the acceleration of those processes, mainly mediated by technological progress on the one side and the expansion of capitalism and market economy, have been the characterizing features since the second half of the twentieth century [1]. Development instinctively associated with human progress and a positive social and economic transformation to eradicate historical injustices, has instead become a metaphor of economic growth. Economics prevailed over all other aspects of life and well-being influencing the international “development” agenda and the establishment of an unsustainable growth society with severe impact on ecosystems and human health.

In this chapter, an overview is presented of the links between globalization, development, and health.

2 Three Interconnected Dimensions of Globalization

As a result of globalization, social relations have undergone transformations in three essential dimensions: space, temporal, and cognitive [2].

The transformation of the spatial dimension refers to changes in the way people interact in physical and territorial space. Information and communication technology allowed for the creation of virtual communities and social networks no matter an individual’s location. The concept of geographical boundaries becomes increasingly blurred. In a licit or illicit way, people, money, technology, goods, information, ideas, pollution, but also vectors and etiologic agents of diseases easily cross these boundaries.

Alongside the traditional international community of Nation States, powerful non-state transnational actors, both private entities (businesses, foundations, non-governmental organizations, social movements) and hybrids (multi-stakeholder alliances, initiatives, and public-private partnership organizations), contribute to modifying the world’s power and governance structures (see Chap. 62). They all play a role in influencing policies and decision-making processes, previously an exclusive prerogative of international, i.e. intergovernmental institutions [1].

In its temporal dimension, globalization affected the use and value of time [2]. Our lives are moving at speeds we have never experienced before and so does our consumption and waste production. Pollution and climate change reflect the acceleration of global transformation processes. Equally, the spread of communicable diseases across national boundaries is achieved with unprecedented speed, thanks to population mobility and the speed of transport.

Finally, the cognitive dimension concerns change in the production and exchange of knowledge, ideas, laws, beliefs, values, cultural identities, and other mental processes that define our ability to interpret reality [2].

Financed, dominated, and often literally colonized by the market and the few hegemonic interconnected global forces behind it, too often mass media, educational institutions, expert committees, scientists, consulting companies, and communication experts all serve this transformation [2]. Globalized behaviours are part of the daily life of the vast majority of world population. Global brands became an integral part of daily life [3]. Global health policies are not exempt of these influences, and there is an increasing quest for their “decolonization”. Indeed, they have been associated to development strategies, and the idea itself of “development” equally needs to be decolonized [4].

3 Development

In the aftermath of World War II, “development” emerged as a new discourse serving the emerging power of the USA to justify the dismantling of colonial empires and gain access to new markets [5]. “A bold new program” for the “improvement and growth of underdeveloped areas” would contribute to the expansion of US commerce [6].

Development became the universal ideal that should guide the progress of the “underdeveloped” world, i.e. “economically backward regions”. The term “development” became a metaphor of economic growth measured through the increase of the gross domestic product (GDP), and economics towered over all other aspects of life and well-being. Conceived in technocratic and quantitative terms, “development” soon became “the password for imposing a new kind of dependency, for enriching the already rich world and for shaping other societies to meet its commercial and political needs” [7].

The evidence of the quantitative restraints of the ecosystem and the “limits to growth” were authoritatively pointed out since the early 1970s by a Club of Rome commissioned report. Despite the call for “a fundamental revision of human behavior and, by implication, of the entire fabric of present-day society” to avoid “the tragic consequences of an overshoot” [8], growth has been considered the most desirable effect of “development” and has been converted into a “global faith” [5].

Neoliberal ideas, championed in the 1980s by the Reagan Administration in the USA and the Thatcher Government in Great Britain and fostered by the International Monetary Fund (IMF) and the World Bank (WB) further emphasized the dominion of the market, promoted the reduced role of the State and the removal of every barrier blocking any market penetration. Neoliberal structural adjustment policies (SAPs) initially imposed to developing countries were later globalized, especially after the fall of the Berlin wall and following economic crises. They came with large-scale privatizations, reduced taxation for the benefit of higher incomes, cuts in public spending and the dismantling of education, health and social systems, the financial deregulation and the free movement of capital, the uncontrolled exploitation of environmental resources and lastly, the export-oriented industrial production. Inequalities grew and wealth concentrated in the hands of small sectors that emerged from the expansion of the economy [1].

In 1987, the Our Common Future Report, led by Dr. Brundtland who would later become WHO’s DG, introduced the concept of “sustainable development” defined as: “development that meets the needs of the present without compromising the ability of future generations to meet their own needs” [9]. The report recognized the limits of the biosphere to absorb the effects of human activities, however insisted on technology as the way toward a new era of economic growth [9]. Sustainable development was just another masking operation to prevent the radical questioning of the effects of economic growth [5].

New approaches to development were proposed in the 1990s. The seminal work of the Nobel laureate Amartya Sen, inspired UNDP’s first annual flagship report in1990 where the concept of “human development” was adopted, questioning economic growth and GDP as efficient indicators of progress. The report stated that “the basic objective of development is to create an enabling environment for people to enjoy long, healthy and creative lives” [10].

In 2000, The Millennium Declaration, signed by all Heads of State and Government proclaimed the “fundamental values” of equality, freedom, solidarity, tolerance, respect for nature and shared responsibility [11]. However, the eight Millennium Development Goals (MDGs) to be reached by 2015, lacked a systemic vision and were focused only on low-income countries.

The development agenda was redefined again in 2015 with the launch of the “Agenda 2030” and its “universal” and “indivisible” 17 Sustainable Development Goals (SDG) [12] (see Chap. 71).

These goals aim to put an end to poverty by 2030, combat inequalities, ensure lasting protection of the planet and its resources, and create the conditions for “shared prosperity”, and “sustainable, inclusive and sustained” growth [12]. However, the latter is evidently an oxymoron: sustained growth is not sustainable.

The fundamental contradiction between sustainability and indiscriminate, sustained economic growth led to a vision of “de-growth”. An alternative post-growth societal project based on voluntary equitable downscaling of production and consumption that increases human well-being and enhances ecological conditions at the local and global level, counteracting the omnipresence of market-based relations in society [13].

Box 72.1 Degrowth as an Opportunity

“The construction of an alternative society requires the end of the infernal cycle of unlimited growth of needs and products—and of the endless frustration it breeds; it also requires to restrain selfishness, i.e. individualism resulting from massive uniformity. The first objective can be achieved by self-limitation leading to frugal affluence; the second, by the rehabilitation of the spirit of giving and the promotion of conviviality”.

“Degrowth is an opportunity, an invitation to find another possible world. It is also an invitation to live in it, here and now, and not just in some hypothetical future which we will probably never know, no matter how attractive it seems. This other world is already part of ours. It is also in us”.

(Serge Latouche, Degrowth and the paradoxes of happiness

Annals of the Fondazione Luigi Einaudi. Volume LIV, June 2020: 133–152).

That “growth has become humanity’s cancer” [4] is not just a metaphor. A direct relation exists between economic growth and the incidence rate of cancer, which increases linearly with per capita income, even after controlling for population ageing, improvement in cancer detection, and omitted spatially correlated variables [14]. Disease pathways of the globalized growth society can be synthetically represented (see Fig. 72.1).

Fig. 72.1
A network diagram of disease pathways. Globalized growth in society links to increased industrial production and competition, societal stress that further links to an unhealthy lifestyle, and the exploitation of natural resources, leading to mental disorders, malnutrition, cancer, and infectious diseases.

Disease pathways of globalized growth society

Full size image

There is an urgent need to “decolonize our imaginaries” dominated by growth, as a starting point for a paradigmatic shift in the inspiring values of human society [4].

Box 72.2 A Humanity of Humility

We must grow essential needs products, quality products, hygienic products, and degrow the unhealthy products of industrial agriculture, artificial products, and products that are only propelled by advertising but have no intrinsic value. We should account for what must grow and what must degrow […].

As for globalization, we should favour everything that fosters cooperation and culture and, at the same time, be able to partially unglobalize so to save territories, natural environments, and cultures that are under the threat of desertification. We should think the world over […].

Today, one of humanity’s big problems is that we are sorcerer’s apprentices who created machines that are becoming more powerful than we are and dominate us. We created forces that can annihilate us.

We have become too proud, and we must fall back to a humanity of humility […].

Today we see more and more, especially as part of transhumanism, the pride of human beings who set out to conquer nature at the same time when, because of this pride, they are destroying it.

(Edgar Morin. Uniting the best of Africa and the West. New African—17/01/2022)

Universal attainment of health, defined as a “complete physical, mental and social well-being”, goes well beyond healthcare and disease control. It concerns the common “planetary destiny” that all living beings share [15]. Emphasis on “one health” (see Chap. 76) and “planetary health” (see Chap. 77) contribute to reaffirm the health determinants and human rights approach which inspire GH. Nevertheless, global health studies and policymaking must abandon the top-down, colonial, market-based development perspective. Aware of global interconnectedness and power dynamics, “g-local” counter-hegemonic processes are needed in defence of the sovereignty of local communities with human and ecosystem’s health as the new indicator of “development”.