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Ronald Labonte, Ted Schrecker u.a. (Hrsg.): Globalization and Health

Cover Ronald Labonte, Ted Schrecker, Corinne Packer, Vivien Runnels (Hrsg.): Globalization and Health. Routledge (New York) 2012. 378 Seiten. ISBN 978-0-415-64805-9. 42,35 EUR.
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The book desribes some of the findings of a research network that examined the relation between contemporary globalization and social determinants of health, with particularly attention to health equity.


All editors work at the Institute of Population Health, Faculty of Medicine, University of Ottawa, Canada.


The content of the book is largely founded on the work undertaken by the members of the Globalization Network established by the WHO Commission on Social Determinants of Health (SDH). The work was made possible by the funding provided by the International Affairs Directorate of Health Canada (Canada´s National Ministry of Health).


  1. Ronald Labonté and Ted Schrecker: Introduction: Globalization´s Challenges to People´s Health
  2. Giovanni Andrea Cornia et al.: An empirical Investigation of the Relation between Globalization and Health
  3. Patrick Bond: Global Political-Economic and Geopolitical Processes, Structures, and Trends
  4. Ted Schrecker: Labour Markets, Equity, and Social Determinants of Health
  5. Meri Koivusalo et al.: Globalization and Policy Space for Health and Social Determinants of Health
  6. Aniket Bhushan and Chantal Blouin: Leberalization „Shocks“ and Social Protection Policies: Lessons from the Asian Financial Crises
  7. Sebastian Taylor and Michael Rowson: Global Financing for Health: Aid and Debt Relief
  8. John Listerand Ronald Labonté: Globalization and Health System Change
  9. Corinne Packer et al.: Globalization and the Cross-Border Flow of Health Workers
  10. Corinna Hawkes et al.: Globalization, Trade, and the Nutritional Transition
  11. Carlos Correa: Intellectual Property Rights and Inequalities in Health Outcomes
  12. Kelley Lee et al.: Global Governance and Health
  13. Ronald Labonté and Ted Schrecker: Rights, Redistribution and Regulation
  14. Ted Schrecker: Globalization, Social Determinants and the Struggle for Health


Chapter 2 presents an empirical study of how globalization-related policies have affected health outcomes. Although 1980-2005 was characterized by a series of favorable political and economic „dividends“ that should have led to faster improvement in health status and declines in health inequality within and across countries and regions, the period recorded a slowdown in health improvements and an increase in health inequality worldwide. The chapters explore the reasons for this phenomenon using an econometric regression model comparing global and regionl trends in life expectancy at birth since 1980 attributable to globalization-related policies, against a counterfactual continuation of trends in the preglobalization decades of 1960-1980.

Chapter 3 adds depth to understanding how these globalization-related policies reflected major shifts in global political economy and geopolitics since the 1970s. These shifts brought together processes of governance and liberalization in often uncomfortable ways and with profound implications for health and SDH policies. Geopolitical realignments and neoliberal policy ascendancy are observed in a series of „moments“ in key events reflected important power shifts. The broader global context has been a series of durable economic problems: stagnation, financial volatility, and uneven development. One reaction to these persisting problems has been the turn to what the chapter describes as „extra-economic“ relationships between markets and nonmarket social and ecological values; an unhealthy development when global political discourses are dominated by neoliberal and neoconservative forces.

Chapter 4 focuses on one of globalization´s main health-determining pathways: the substantial and dramatic changes that have occurred in global labor markets. The author examines the relationship between labor-market outcomes and poverty; the global reorganization of production and the associated emergence of a genuinely global labor market; the tendency of globalization to increase economic inequality and demands for labor-market flexibility; and the impact of financial crises on employment and labor income.

Chapter 5 discusses a more subtle and complex way by which globalization is affecting health and SDH: the contraction of polity space available to national governments for puposes of regulation. One of the means of doing so (trade agreements) is already well known, since the purpose of such treaties is precisely to reduce the policy flexibilities governments can use with respect to international economic transactions in order to maximize the free movement of goods, services, and capital. While noting that not all international constraints on policy space are potentially health-negative (human right treaties and environmental agreements are cited as health-positive), the authors argue the importance of protecting policy flexibilities for health and SDH.

Chapter 6 focuses on one set of policies that government can use to buffer the inherently „disequalizing“ outcomes of global market liberalization: the use and expansion of social protetion policies. Globalization generally and trade liberalization specifically create winners und losers in domestic economies as well as among countries. The negative impacts are not limited to one-time adjustments to trade reforms but more generally to the greater frequency and scope of economic restructuring in an open economy. Using the experience of East Asia country responses to the financial crisis of the late 1990s, the authors assess the impact of differing national policies aimed at reducing economic vulnerability arisung from trade or financial-market liberalization. The evidence underscores the importance of improving general social safety nets prior to or alongside ongoing global market integration.

Chapter 7 examines two critical and enjoined issues related to improving their financing capacities: aid and debt relief. The authors confront the heated debate regarding aid effectiveness, suggesting that new evidence shows that aid is not only essential for the health and welfare of poorer countries, but that, despite its many well-documented problems associated in the first instance with donor countries practices, it has been effective in promoting economic development and in improving health outcomes. Aid effectiveness, however, has been hampered by countries´ continued servicing of foreign debt. Debt relief for a group of nations known as the Heavily Indebted Poor Countries has been compromised by a lack of speed and creditor dominance.

Chapter 8 narrows the examination of globalization´s health impact focusing on one critical sector: health systems. The authors argue that, since the 1980s health system reform globally has followed a marketization model, emphazising cost recovery. The results of the imposition of these reforms have been largely health-negative, leading to a recent recall for a return to broader and more integrated models of health care delivery.

Chapter 9 highligts another facet of globalization´s effect on health systems: the crisis in global workforce migration. Deteriorating economic and broader social and environmental conditions at least partly attributable to liberalization of global market integration are pushing out health workers in many developing countries. At the same time, the main destination countries of health migrants suffer their own health worker shortages and increasingly rely on immigration of foreign-trained health workers relieve them. These countries are able to offer higher pay, better working conditions, and greater oppurtunities to save money, effectively pulling in foreign health workers.

Chapter 10 introduces the concept of „nutritional transition“, a term referring to the globalization of poor quality energy-dense diets leading to obesity.and diet-related chronic diseases. The authors explore, how globalization is affecting the development of overnutrtion in a world still plagued by undernutrtion. They identify the supply-side globalization process to the increase of poor quality diets, focusing on three processes: the growth of transnational food companies, international food trade, and global food advertising and promotion. The evidence finds that these processes are affecting the availibility, price and desirability of different foods, driving uneven dietary develoment between different socioeconomic groups.

Chapter 11 explores inequalities in health outcomes emerging from the existing intellectual property-rights regime, one of the most visible and contentious of globalization´s policies having direct health-related effects. The author examines the impact of the internationalization of the Intellectual Property-Rights system and the adoption of minimum standards of protection in the WTO Agreement on Trade-Related Intellectual Property-Rights. The chapter concludes by assessing how policy interventions improve such access through strengthened flexibilities in trade treaties and various models for financing drug research outside of patent regimes.

Chapter 12 extends the discussion of alternatives to the current system of globalization´s various trade and investment rules to the broader terrain of global governance for health. The authors document the transition taking place towards global governance related to SDH in terms of institutional actors and their relative roles, power, and authority. The chapter than assesses how emerging forms of global governance may be influencing the SDH, posing the question: How might various institutions affect the SDH? The authors answer this question, in part, by assessing the quality of emerging forms of global governance against recognized „good governance“ criteria.

Chapter 13 discribes the new forms of coordinated action on an international scale by national governments and multilateral institutions that the „three Rs“ (redistribution, regulation, and rights) demand, highlighting a number of productive areas for policy innovation while warning that their potential is unlikely realized in the abscence of decisive leadership and political action.

Chapter 14 offers an invited, reflective commentary by David Sanders, one of the founders of People´s Health Movement and a longtime African-based activist public health physician. He focuses on the evidence for how power inequalities lie at the heart of both the health inequalities associated with contemporary globalization, and in the historically rooted necessity of civil society struggles and alter these toxic inequalities.


A specific chapter about gender issues is missing in the book, because the consequences of globalization processes differ between males and females.

Target Groups

Target groups for the book are public health scientists, economists and acteurs in international organizations in the field of promoting global health.


The book desribes some of the findings of a WHO Research Network of scientists that examined the relation between contemporary globalization and social determinants of health, with particularly attention to health equity. In the 14 chapters a variety of aspects, such as international labor market, aid and debt relief, cross border flow of health workers, nutritional transition, global governance for health are described and discussed.

Rezension von
Prof. Dr. Uwe Helmert

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Uwe Helmert. Rezension vom 30.09.2015 zu: Ronald Labonte, Ted Schrecker, Corinne Packer, Vivien Runnels (Hrsg.): Globalization and Health. Routledge (New York) 2012. ISBN 978-0-415-64805-9. In: socialnet Rezensionen, ISSN 2190-9245,, Datum des Zugriffs 20.10.2021.

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