Towards health-equitable globalisation : rights, regulation and redistribution : final report to the Commission on Social Determinants of Health.

Globalisation, in a broad sense, holds considerable potential for improving human health, while presenting many challenges. At base, the key challenge for the Commission is to understand how globalisation affects people’s access to social determinants of health (SDH) and, given an explicit concern with equity, how that access is distributed. The approach taken by the Globalisation Knowledge Network (GKN) to assist with this task emphasized the economic aspects of globalisation since the 1970s on the basis that the policies driving global market integration are the most important with respect to SDH. There is some evidence of positive global responses to this challenge. Efforts have been made to cut across existing national, international and institutional boundaries to address issues of transnational reach, whether articulated as goals (e.g. the Millennium Development Goals), broadly stated themes (e.g. poverty alleviation, social exclusion, gender empowerment) or control of such health-damaging products as tobacco (e.g. the Framework Convention on Tobacco Control). Even disease-specific global initiatives are increasing their response to the challenge of contemporary globalisation. Efforts to tackle the HIV/AIDS pandemic, as one example, have broadened from an initial biomedical focus to issues concerning human rights, poverty and gender. Yet much more needs to done to manage the multiple ways in which globalisation affects SDH. Globalisation affects health and SDH through changes in social stratification, differential exposure or vulnerability, health system characteristics and differential consequences. These changes arise through globalisation’s effects on power, resources, labour markets, policy space, trade, financial flows (including aid and debt servicing/cancellation), health systems (including health human resources and health services), water and sanitation, food security and access to essential medicines. While not exhaustive, this list covers the principle pathways linking globalisation to health that were examined by the GKN