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Globalization and Health
Globalization is a critical component in international public health. It is impacted by various patterns of migration, extensive trade, altering dietary practices, and ecological catastrophes; all of which affect the health of populations and contribute to the spreading of disease.
Globalization has emerged concurrently with urbanization, which offers a variety of public health benefits. A planned urban society has access to safe and clean drinking water with appropriate sanitation and waste removal mechanisms. Electricity provides an opportunity to create safe living conditions. Furthermore, modern urban societies have access to adequate and varied nutrition.
All these aspects contribute to overcoming health challenges and the spread of a disease that has afflicted society for centuries based on detrimental living conditions. However, globalization also has adverse effects on public health. Emerging infectious diseases are more common with an increased potential for transmissibility due to the interconnected nature of trade and migration. Reemerging infections are becoming a problem as well. Urbanization has led to increased pollution which affects public health. Accessibility to nutrition is actively contributing to the possibility of foodborne outbreaks and health conditions such as obesity due to increased food consumption (Jacobsen, 2014).
In 2015-2016, the CDC has noted a multistate foodborne outbreak of Salmonella Poona. More than 907 people were infected with reports coming from 40 states. 204 people were hospitalized with six reported deaths. Approximately 11 large illness clusters were identified which helped identify the source. Epidemiologic analysis showed that cucumbers were the origin of the infection, with 7% of the outbreak strains being drug-resistant.
They were distributed in retail and restaurant locations. They were imported into the United States from Mexico and distributed by Andrew & Williamson Fresh Produce. Two separate recalls of potentially dangerous batches of cucumbers were announced as the outcome of the investigation. The cause of the illness was undetermined. Some suggestions include potential cross-contamination in the shipping distribution chain (Centers for Disease Control and Prevention, 2016).
Global trade was a significant factor in the outbreak. Large food shipment and distribution chains open possibilities for foodborne illnesses. This occurs due to poor quality control, lack of standards on agricultural practices, and possibilities of cross-contamination as happened in this case. Therefore, more standards and regulations should be implemented for global trade and import of food products to avoid such occurrences.
Florida as a state adheres to national guidelines provided by CDC and other agencies on the emergency preparedness response to bioterrorism. It has become a relevant issue in the modern world post-September 11 and anthrax attacks that shook the nation in the early 2000s. Awareness and preparedness for bioterrorism attacks, not just from government agencies but the population as well, ensure that everyone is protected. State guidelines suggest that each family has an emergency plan that is practiced as well as knowing emergency plans at places of employment and education. Preparation can be ensured by having a disaster kit. Everyone should understand the realistic possibilities of a bioterrorism attack and learn information about various biological agents (Florida Health, n.d.).
Miami-Dade County does not seem to have a specific preparedness for terrorist attacks. It is recommended to follow state guidelines or a general emergency and disaster preparedness plan. However, there is documentation teaching about the dangerous biological agents and how to identify potential bioterrorist attacks as well as which agencies to contact (Florida Health Miami Dade County, n.d.). This could be helpful for the survival of the population in case of an attack.
I have not taken any steps to prepare for such events as a bioterrorism attack. I have a general awareness of emergency preparedness for events such as hurricanes. However, like most people, I am not actively seeking to prepare against biological attacks due to the seemingly inconceivable chance of such an occurrence. Such preparation requires time and resources for adequate knowledge and protection, which I feel will never be useful.
Centers for Disease Control and Prevention. (2016). Multistate outbreak of Salmonella poona infections linked to imported cucumbers .
Jacobsen, K. H. (2014). Introduction to global health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.
Florida Health. (n.d.). Emergency preparedness response and bioterrorism .
Florida Health Miami Dade County. (2013). Bioterrorism guide: Category A agents. Web.
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Home — Essay Samples — Sociology — Globalization — The Effects of Globalization on Health and Medicine
The Effects of Globalization on Health and Medicine
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The health impacts of globalisation: a conceptual framework
- Maud MTE Huynen 1 ,
- Pim Martens 1 , 2 , 3 &
- Henk BM Hilderink 4
Globalization and Health volume 1 , Article number: 14 ( 2005 ) Cite this article
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This paper describes a conceptual framework for the health implications of globalisation. The framework is developed by first identifying the main determinants of population health and the main features of the globalisation process. The resulting conceptual model explicitly visualises that globalisation affects the institutional, economic, social-cultural and ecological determinants of population health, and that the globalisation process mainly operates at the contextual level, while influencing health through its more distal and proximal determinants. The developed framework provides valuable insights in how to organise the complexity involved in studying the health effects resulting from globalisation. It could, therefore, give a meaningful contribution to further empirical research by serving as a 'think-model' and provides a basis for the development of future scenarios on health.
Introduction
Good health for all populations has become an accepted international goal and we can state that there have been broad gains in life expectancy over the past century. But health inequalities between rich and poor persist, while the prospects for future health depend increasingly on the relative new processes of globalisation. In the past globalisation has often been seen as a more or less economic process. Nowadays it is increasingly perceived as a more comprehensive phenomenon, which is shaped by a multitude of factors and events that are reshaping our society rapidly. This paper describes a conceptual framework for the effects of globalisation on population health. The framework has two functions: serving as 'think-model', and providing a basis for the development of future scenarios on health.
Two recent and comprehensive frameworks concerning globalisation and health are the ones developed by Woodward et al. [ 1 ], and by Labonte and Togerson [ 2 ]. The effects that are identified by Woodward et al. [ 1 ] as most critical for health are mainly mediated by economic factors. Labonte and Torgerson [ 2 ] primarily focus on the effects of economic globalisation and international governance. In our view, however, the pathways from globalisation to health are more complex. Therefore, a conceptual framework for the health effects of the globalisation process requires a more holistic approach and should be rooted in a broad conception of both population health and globalisation. The presented framework is developed in the following three steps: 1) defining the concept of population health and identifying its main determinants, 2) defining the concept of globalisation and identifying its main features and 3) constructing the conceptual model for globalisation and population health.
Population health
As the world around us is becoming progressively interconnected and complex, human health is increasingly perceived as the integrated outcome of its ecological, social-cultural, economic and institutional determinants. Therefore, it can be seen as an important high-level integrating index that reflects the state-and, in the long term, the sustainability-of our natural and socio-economic environments [ 3 ]. This paper primarily focuses on the physical aspects of population health like mortality and physical morbidity.
Our identification of the most important factors influencing health is primarily based on a comprehensive analysis of a diverse selection of existing health models (see Huynen et al [ 4 ] for more details). We argue that the nature of the determinants and their level of causality can be combined into a basic framework that conceptualises the complex multi-causality of population health. In order to differentiate between health determinants of different nature, we will make the traditional distinction between social-cultural, economic, environmental and institutional factors. These factors operate at different hierarchical levels of causality, because they have different positions in the causal chain. The chain of events leading to a certain health outcome includes both proximal and distal causes; proximal factors act directly to cause disease or health gains, and distal determinants are further back in the causal chain and act via (a number of) intermediary causes [ 5 ]. In addition, we also distinguish contextual determinants. These can be seen as the macro-level conditions shaping the distal and proximal health determinants; they form the context in which the distal and proximal factors operate and develop.
Subsequently, a further analysis of the selected health models and an intensive literature study resulted in a wide-ranging overview of the health determinants that can be fitted within this framework (Figure 1 and Table 1 ). We must keep in mind, however, that determinants within and between different domains and levels interact along complex and dynamic pathways to 'produce' health at the population level. Additionally, health in itself can also influence its multi-level, multi-nature determinants; for example, ill health can have a negative impact on economic development.
Multi-nature and multi-level framework for population health.
Globalisation
There is more and more agreement on the fact that globalisation is an extremely complex phenomenon; it is the interactive co-evolution of multiple technological, cultural, economic, institutional, social and environmental trends at all conceivable spatiotemporal scales. Hence, Rennen and Martens [ 6 ] define contemporary globalisation as an intensification of cross-national cultural, economic, political, social and technological interactions that lead to the establishment of transnational structures and the global integration of cultural, economic, environmental, political and social processes on global, supranational, national, regional and local levels. Although somewhat complex, this definition is in line with the view on globalisation in terms of deterritorialisation and explicitly acknowledges the multiple dimensions involved.
However, the identification of all possible health effects of the globalisation process goes far beyond the current capacity of our mental ability to capture the dynamics of our global system; due to our ignorance and interdeterminacy of the global system that may be out of reach forever [ 7 ]. In order to focus our conceptual framework, we distinguish-with the broader definition of globalisation in mind-the following important features of the globalisation process: (the need for) new global governance structures, global markets, global communication and diffusion of information, global mobility, cross-cultural interaction, and global environmental changes (Table 2 ) (see Huynen et al. [ 4 ] for more details).
Conceptual model for globalisation and health
We have identified (the need for) global governance structures, global markets, global communication and the diffusion of information, global mobility, cross-cultural interaction, and global environmental changes as important features of globalisation. Based on Figure 1 and Table 1 , it can be concluded that these features all operate at the contextual level of health determination and influence distal factors such as health(-related) policies, economic development, trade, social interactions, knowledge, and the provision of ecosystem goods and services. In turn, these changes in distal factors have the potential to affect the proximal health determinants and, consequently, health. Our conceptual framework for globalisation and health links the above-mentioned features of the globalisation process with the identified health determinants. This exercise results in Figure 2 .
Conceptual framework for globalisation and population health.
Figure 3 , subsequently, shows that within the developed framework, several links between the specific features of globalisation and health can be derived. These important links between globalisation and health are discussed in the following sections. It is important to note that Figure 3 primarily focuses on the relationships in the direction from globalisation to health. This does not mean, however, that globalisation is an autonomous process: globalisation is influenced by many developments at the other levels, although these associations are not included in the Figure for reasons of simplification. In addition, the only feedback that is included in Figure 3 concerns the institutional response. One also has to keep in mind that determinants within the distal level and within the proximal level also interact with each other, adding complexity to our model (see Huynen et al. 4 for more details and examples of important intralevel relationships).
Conceptual model for globalisation and population health.
Globalisation and distal health determinants
Figure 3 shows that the processes of globalisation can have an impact on all identified distal determinants (Figure 3 ; arrows 1–4). Below, the implications of the globalisation process on these distal determinants will be discussed in more detail.
Health(-related) policies
Global governance structures are gaining more and more importance in formulating health(-related) policies (Figure 3 ; arrow 1). According to Dodgson et al. [ 8 ], the most important organisations in global health governance are the World Health Organization (WHO) and the World Bank (WB). The latter plays an important role in the field of global health governance as it acknowledges the importance of good health for economic development and focuses on reaching the Millennium Development Goals [ 9 ]. The WB also influenced health(-related) policies together with the International Monetary Funds (IMF) through the Structural Adjustment Programmes (SAPs) (e.g. see Hong [ 10 ]). In order to give a more central role to pro-poor growth considerations in providing assistance to low-income countries, the IMF and WB introduced the Poverty Reduction Strategy approach in 1999 [ 11 ]. In addition, the policies of the World Trade Organization (WTO) are also increasingly influencing population health [ 10 , 12 – 14 ]. Fidler [ 15 ] argues that 'from the international legal perspective, the centre of power for global health governance has shifted from WHO to the WTO'. Opinions differ with regard to whether the WTO agreements provide sufficient possibilities to protect the population from the adverse (health) effects of free trade or not [ 16 ]. In 2002, the WTO ruled that the French ban on the import of all products containing asbestos was legal on health grounds, despite protests from Canada [ 17 , 18 ]. However, protecting citizens against health risks remains difficult, as health standards often need to be supported by sound scientific evidence before trade can be restricted (see e.g. the WTO ruling against the European trade barrier concerning hormone-treated meat [ 19 , 20 ]).
Another important development is the growing number of public-private partnerships for health, as governments increasingly attract private sector companies to undertake tasks that were formerly the responsibility of the public sector. At the global level, public-private partnerships are more and more perceived as a possible new form of global governance [ 12 ] and could have important implications for health polices, but also for health-related policies.
Economic development
Opinions differ with regard to the economic benefits of economic globalisation (Figure 3 ; arrow 2). On the one side, 'optimists' argue that global markets facilitate economic growth and economic security, which would benefit health. They base themselves on the results of several studies that argue that inequities between and within countries have decreased due to globalisation (e.g. see Frankel [ 21 ], Ben David [ 22 ], Dollar and Kraay [ 23 ]). Additionally, it is argued that although other nations or households might become richer, absolute poverty is reduced and that this is beneficial for the health of the poor [ 24 ]. On the other side, 'pessimists' are worried about the health effects of the exclusion of nations and persons from the global market. They argue that the risk of exclusion from the growth dynamics of economic globalisation is significant in the developing world [ 25 ]. In fact, notwithstanding some spectacular growth rates in the 1980's, especially in east Asia, incomes per capita declined in almost 70 countries during the same period [ 26 ]. Many worry about what will happen to the countries that cannot participate in the global market as successful as others.
Due to the establishment of global markets and a global trading system, there has been a continuing increase in world trade (Figure 3 ; arrow 2). According to the WTO, total trade multiplied by a factor 14 between 1950 and 1997 [ 27 ]. Today all countries trade internationally and they trade significant proportions of their national income; around 20 percent of world output is being traded. The array of products being traded is wide-ranging; from primary commodities to manufactured goods. Besides goods, services are increasingly being traded as well [ 28 ]. In addition to legal trade transactions, illegal drug trade is also globalising, as it circumvents national and international authority and takes advantage of the global finance systems, new information technologies and transportation.
Social interactions: migration
Due to the changes in the infrastructures of transportation and communication, human migration has increased at unprecedented rates (Figure 3 ; arrow 3) [ 28 ]. According to Held et al. [ 28 ] tourism is one of the most obvious forms of cultural globalisation and it illustrates the increasing time-space compression of current societies. However, travel for business and pleasure constitutes only a fraction of total human movement. Other examples of people migrating are missionaries, merchant marines, students, pilgrims, militaries, migrant workers and Peace Corps workers [ 28 , 29 ]. Besides these forms of voluntary migration, resettlement by refugees is also an important issue. However, since the late 1970s, the concerns regarding the economic, political, social and environmental consequences of migration has been growing and many governments are moving towards more restrictive immigration policies [ 30 ].
Social interactions: conflicts
The tragic terrorist attacks in New York and Washington D.C. in September 2001 fuelled the already ongoing discussions on the link between globalisation and conflicts. Globalisation can decrease the risk on tensions and conflicts, as societies become more and more dependent on each other due the worldwide increase in global communication, global mobility and cross-cultural interactions (Figure 3 ; arrow 3). Others argue that the resistance to globalisation has resulted in religious fundamentalism and to worldwide tensions and intolerance [ 31 ]. In addition, the intralevel relationships at the distal level play a very important role, because many developments in other distal factors that have been associated with the globalisation process are also believed to increase the risk on conflicts. In other words, the globalisation-induced risk on conflict is often mediated by changes in other factors at the distal level [ 4 ].
Social interactions: social equity and social networks
Cultural globalisation (global communication, global mobility, cross-cultural interaction) can also influence cultural norms and values about social solidarity and social equity (Figure 3 ; arrow 3). It is feared that the self-interested individualism of the marketplace spills over into cultural norms and values resulting in increasing social exclusion and social inequity. Exclusion involves disintegration from common cultural processes, lack of participation in social activities, alienation from decision-making and civic participation and barriers to employment and material sources [ 32 ]. Alternatively, a socially integrated individual has many social connections, in the form of both intimate social contacts as well as more distal connections [ 33 ]. On the other hand, however, the geographical scale of social networks is increasing due to global communications and global media. The women's movement, the peace movement, organized religion and the environmental movement are good examples of such transnational social networks. Besides these more formal networks, informal social networks are also gaining importance, as like-minded people are now able to interact at distance through, for example, the Internet. In addition, the global diffusion of radio and television plays an important role in establishing such global networks [ 28 ]. The digital divide between poor and rich, however, can result in social exclusion from the global civil society.
The knowledge capital within a population is increasingly affected by developments in global communication and global mobility (Figure 3 : arrow 3). The term 'globalisation of education' suggests getting education into every nook and cranny of the globe. Millions of people now acquire part of their knowledge from transworld textbooks, due to the supraterritoriality in publishing. Because of new technologies, most colleges and universities are able to work together with academics from different countries, students have ample opportunities to study abroad and 'virtual campuses' have been developed. The diffusion of new technologies has enabled researchers to gather and process data in no time resulting in increased amounts of empirical data [ 34 ]. New technologies have even broadened the character of literacy. Scholte [ 34 ] argues that 'in many line of work the ability to use computer applications has become as important as the ability to read and write with pen and paper. In addition, television, film and computer graphics have greatly enlarged the visual dimensions of communication. Many people today 'read' the globalised world without a book'. Overall, it is expected that the above-discussed developments will also improve health training and health education (e.g. see Feachem [ 24 ] and Lee [ 35 ]).
Ecosystem goods and services
Global environmental changes can have profound effects on the provision of ecosystem goods and services to mankind (Figure 3 ; arrow 4). The Intergovernmental Panel on Climate Change (IPCC) [ 36 ] concludes that it is expected that climate change can result in significant ecosystem disruptions and threatens substantial damage to the earth's natural systems. In addition, several authors have addressed the link between biodiversity and ecosystem functioning and it is agued that maintaining a certain level of biodiversity is necessary for the proper provision of ecosystem goods and services [ 37 – 40 ]. However, it is still unclear which ecosystem functions are primarily important to sustain our physical health. Basically, the following types of 'health functions' can be distinguished. First, ecosystems provide us with basic human needs like food, clean air, clean water and clean soils. Second, they prevent the spread of diseases through biological control. Finally, ecosystems provide us with medical and genetic resources, which are necessary to prevent or cure diseases [ 41 ].
Globalisation and proximal health determinants
Figure 3 shows that the impact of globalisation on each proximal health determinant is mediated by changes in several distal factors (Figure 3 ; arrows 5–12). The most important relationships will be discussed in more detail below. It is important to note that health policies and health-related policies can have an influence on all proximal factors (Figure 3 ; arrow 5).
Health services
Health services are increasingly influenced by globalisation-induced changes in health care policy (Figure 3 ; arrow 5), economic development and trade (Figure 3 : arrow 6), and knowledge (Figure 3 ; arrow 7), but also by migration (3: arrow 7). Although the WHO aims to assist governments to strengthen health services, government involvement in health care policies has been decreasing and, subsequently, medical institutions are more and more confronted with the neoliberal economic model. Health is increasingly perceived as a private good leaving the law of the market to determine whose health is profitable for investment and whose health is not [ 10 ]. According to Collins [ 42 ] populations of transitional economies are no longer protected by a centralized health sector that provides universal access to everyone and some groups are even denied the most basic medical services. The U.S. and several Latin American countries have witnessed a decline in the accessibility of health care following the privatisation of health services [ 43 ].
The increasing trade in health services can have profound implications for provision of proper health care. Although it is perceived as to improve the consumer's choice, some developments are believed to have long-term dangers, such as establishing a two-tier health system, movement of health professionals from the public sector to the private sector, inequitable access to health care and the undermining of national health systems [ 10 , 12 ]. The illegal trading of drugs and the provision of access to controlled drugs via the Internet are potential health risks [ 44 ]. In addition, the globalisation process can also result in a 'brain-drain' in the health sector as a result of labour migration from developing to developed regions.
However, increased economic growth is generally believed to enhance improvements in health care. Increased (technological) knowledge resulting from the diffusion of information can further improve the treatment and prevention of all kinds of illnesses and diseases.
Social environment
The central mechanism that links personal affiliations to health is 'social support,' the transfer from one person to another of instrumental, emotional and informational assistance [ 45 ]. Social networks and social integration are closely related to social support [ 46 ] and, as a result, globalisation-induced changes in social cohesion, integration and interaction can influence the degree of social support in a population (Figure 3 ; arrow 9). This link is, for example, demonstrated by Reeves [ 47 ], who discussed that social interactions through the Internet influenced the coping ability of HIV-positive individuals through promoting empowerment, augmenting social support and facilitating helping others. Alternatively, social exclusion is negatively associated with social support.
Another important factor in the social environment is violence, which often is the result of the complex interplay of many factors (Figure 3 ; arrows 5, 8 and 9). The WHO [ 48 ] argues that globalisation gives rise to obstacles as well as benefits for violence prevention. It induces changes in protective factors like social cohesion and solidarity, knowledge and education levels, and global violence prevention activities such as the implementation of international law and treaties designed to reduce violence (e.g. social protection). On the other hand, it also influences important risk factors associated with violence such as social exclusion, income inequality, collective conflict, and trade in alcohol, drugs or firearms.
Due to the widespread flow of people, information and ideas, lifestyles also spread throughout the world. It is already widely acknowledged and demonstrated that several modern behavioural factors such as an unhealthy diet, physical inactivity, smoking, alcohol misuse and the use of illicit drugs are having a profound impact on human health [ 49 – 52 ] (Table 3 ). Individuals respond to the range of healthy as well as unhealthy lifestyle options and choices available in a community [ 53 ], which are in turn determined by global trade (Figure 3 ; arrow 8), economic development (Figure 3 ; arrow 8) and social interactions (Figure 3 ; arrow 9).
Although the major chronic diseases are not transmittable via an infectious agent, the behaviours that predispose to these diseases can be communicated by advertising, product marketing and social interactions [ 54 ]. Global trade and marketing developments drive, for example, the nutrition transition towards diets with high proportions of salt, saturated fat and sugars [ 51 , 53 ]. Another example is the worldwide spread of tobacco consumption as transnational tobacco companies take advantage of the potential for growth in developing countries [ 51 , 55 ]. Additionally, the scale of cigarette smuggling poses a considerable global threat to the efforts to control tobacco consumption [ 44 ]. Illegal trade in illicit drugs poses similar problems. At the same time, the alcohol industry is almost as globalised as the tobacco industry [ 56 ].
However, health education can play a role in promoting healthy lifestyles by improving an individual's knowledge about the health effects of different lifestyle options (Figure 3 ; arrow 9). Besides health education, (global) policies can also directly discourage unhealthy behaviour by means of economic incentives (e.g. charging excise on tobacco) or other legislation (Figure 3 ; arrow 5).
Physical environment: infectious diseases pathogens
The spread of infectious diseases is probably one of the most mentioned health effects of globalisation and past disease outbreaks have been linked to factors that are related to the globalisation process (see e.g. Newcomb [ 57 ]). The recent outbreak of the Severe Acute Respiratory Syndrome (SARS) demonstrates the potential of new infectious diseases to spread rapidly in today's world, increasing the risk of a global pandemic. The combination of movement of goods (Figure 3 ; arrow 10) and people (Figure 3 ; arrow 11), and profound changes affecting ecosystem goods and services (Figure 3 ; arrow 12) all contribute to increased risk of disease spread [ 57 ]. For example, the globalisation of food production, trade and consumption has been associated with the increased spread and transmission of food born diseases [ 57 , 58 ]. Diseases like HIV/AIDS or hepatitis B can also spread through trade in infected biological products (e.g. blood) [ 44 ].
Enhanced knowledge and new technologies will improve the surveillance of infectious diseases and monitoring of antibiotic resistance [ 24 , 35 ] (Figure 3 ; arrow 11). Globalisation potentially increases the speed of responses in some cases. Wilson [ 29 ] states that responding to disease emergence requires a global perspective-both conceptually and geographically-as the current global situation favours the outbreak and rapid spread of infectious disease. As a result, the policies and actions undertaking by the WHO are becoming increasingly important in controlling infectious diseases at a global level (Figure 3 ; arrow 5). For instance, the WHO played a critical role in controlling SARS by means of global alerts, geographically specific travel advisories and monitoring [ 59 ].
Food trade has become an increasingly important factor with regard to food security worldwide (Figure 3 ; arrow 10). At present, however, the developed countries usually subsidise their agricultural sectors. Current liberalisation policies are expected to have profound implications on food trade and, subsequently food security [ 60 ]. Some argue that the resulting free trade will create access to better and cheaper food supplies via food imports and can stimulate more efficient use of the world's resources as well as the production of food in regions that are more suitable to do so [ 60 , 61 ]. Free trade permits food consumption to grow faster than domestic food production in countries where there are constraints on increasing the latter. Accelerated economic growth can also contribute to food security (Figure 3 ; arrow 10) [ 60 ]. Others, however, argue that the forces of globalisation in fact endanger food security (e.g. see Lang [ 62 ]) and that countries should strive to become more self-sufficient [ 60 ]. For many countries the increasing dependence on food imports goes hand in hand with a higher vulnerability to shocks arising in global markets, which can affect import capacity and access to food imports [ 60 ]. Many food insecure countries are not able to earn enough with exporting goods in order to pay for the needed food imports [ 63 ].
At the global level, there are increasing international efforts to achieve widespread food security (Figure 3 ; arrow 5). For instance, the right to adequate food is directly addressed in the 1966 International Covenant on Economic, Social and Cultural Rights. In 1996, the World Food Summit reaffirmed the right of everyone to have access to safe and nutritious food. In case of extreme food-insecurity and insufficient import capacity, food aid may be provided in order to supplement the scarce food imports. Globalisation can affect food security by enhancing the knowledge of foreign nations about the usefulness of food aid (Figure 3 ; arrow 11) [ 60 ].
Besides food trade, one can also deal with the mismatch between demand and supply by increasing food production in food-short regions. The globalisation process can increase food security by facilitating the worldwide implementation of better technologies and improved knowledge (e.g. irrigation technologies, research on genetically modified food) (Figure 3 ; arrow 11). At the same time, the natural resource base for food production is increasingly threatened (Figure 3 ; arrow 12). Finally conflicts are, of course, a threat to food security and it is expected that food security in sub-Saharan Africa, for example, will not increase without the establishment of political instability (Figure 3 ; arrow 11) [ 64 ].
The effects of globalisation are also raising concerns over water security. The current globalisation process is accompanied by privatisation policies affecting the provision of water [ 65 ] (Figure 3 ; arrow 5). Governments and international financial institutions promote privatisation, as they believe it will promote market competition and efficiency. However, others are less optimistic about the effects of privatisation. In fact, some cases show that prices and inequalities in access even rise [ 66 ]. It is also argued that water, with vital importance socially, culturally, and ecologically, 'cannot be protected by purely market forces' [ 65 ]. On a global scale, there are increasing efforts to set up global guidelines or policies with regard to fresh water (Figure 3 ; arrow 5), however none of the international declarations and conference statements requires states to actual meet individual's water requirements [ 67 ].
The virtual trade of water is also believed to be of increasing importance (Figure 3 ; arrow 10). The water that is used in the production process of a commodity is called the 'virtual water' contained in that commodity. Therefore, the increasing global trade of commodities is accompanied by an increasing global trade in virtual water. The global volume of virtual water embedded in crop and livestock products traded between nations is estimated to be 1400 billion cubic metres per year [ 68 ].
In addition, the globalisation process can increase water security by facilitating the worldwide implementation of better technologies and improved knowledge (Figure 3 ; arrow 11). At the same time, the natural resource base is increasingly threatened as, for example, global climate change and deforestation profoundly affect our ecosystems ability to provide us with sufficient and adequate fresh water (Figure 3 ; arrow 12).
Globalisation is causing profound and complex changes in the very nature of our society, bringing new opportunities as well as risks. In addition, the effects of globalisation are causing a growing concern for our health, and the intergenerational equity implied by 'sustainable development' forces us to think about the right of future generations to a healthy environment and a healthy life.
Despite some empirical research efforts indicating the links between the globalisation process and specific health impacts, the present weakness in empirical evidence on the multiple links between globalisation and health is still a problem [ 44 ]. The described conceptual framework could give a meaningful contribution to further empirical research by serving as a well-structured 'think-model' or 'concept map'. It clearly demonstrates that an interdisciplinary approach towards globalisation and health is required, which draws upon the knowledge from relevant fields such as, for example, medicine, epidemiology, sociology, political sciences, (health) education, environmental sciences and economics.
In addition, the exploration of possible future health impacts of different globalisation pathways by means of scenarios analysis could provide a useful contribution to the ongoing discussions on globalisation and health [ 4 ]. Scenarios can be described as 'plausible but simplified descriptions of how the future may develop, according to a coherent and internally consistent set of assumptions about key driving forces and relationships' [ 69 ]. Recent research showed, however, that the health dimension is largely missing in existing global scenarios [ 70 ]. The developed framework for globalisation and population health has contributed to the understanding of future health implications and the model is, therefore, considered to be a useful tool to structure future scenario studies on the health implications of the globalisation process.
To conclude, the framework provides valuable insights in how to organise the complexity involved in studying the health effects resulting from globalisation. We claim that our approach has several beneficial characteristics. First, it is embedded in a holistic approach towards globalisation; in this paper we perceive globalisation as an overarching process in which simultaneously many different processes take place in many societal domains. In addition, the conceptual framework is embedded in a holistic approach towards population health. As a result, our model explicitly visualises that globalisation affects the institutional, economic, social-cultural and ecological determinants of population health and that the globalisation process mainly operates at the contextual level, while influencing health through the more distal and proximal determinants.
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Acknowledgements
We would like to thank all colleagues at the International Centre for Integrative Studies (ICIS) and the Netherlands Environmental Assessment Agency (MNP-RIVM) for the fruitful discussions leading to this paper. This work is financially supported by MNP-RIVM within the project 'Population & Health'.
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Huynen, M.M., Martens, P. & Hilderink, H.B. The health impacts of globalisation: a conceptual framework. Global Health 1 , 14 (2005). https://doi.org/10.1186/1744-8603-1-14
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Globalization and Its Impact on Healthcare Essay
The medical system in Canada is governed by political aspects related to economic globalization. The situation is compounded by growing inequality, which is shifting responsibility towards the provinces. If the direction is not changed, there will be a continued increase in discrimination by social class, gender, and ethnic group. However, some argue that the crisis in allopathic care can have a positive impact on public health. The topic is controversial since there are considerable differences in life expectancy at birth, which are affected by globalization, and they can be corrected by revising health care policies.
Differences in life expectancy around the world happen because of environmental influences. It includes social, economic, ethnic, and geographic factors that are seen in Africans. OECD countries have the highest life expectancy, while Africa has the lowest (Clarke, 2016). It affects residents’ overall life expectancy, especially children; their immunity is not yet strong. Many factors affect life expectancy; therefore, the government’s policy and medical management in developing countries must be revised.
Globalization occurs because of migration, which brings with it the spread of various diseases. For example, tourists in Africa can bring diseases there that cannot be cured locally. In this region, unsanitary conditions prevail; therefore, there is a high probability of infection during surgery. The free movement of people around the world opens up not only opportunities to get acquainted with a foreign culture but can bring negative consequences to the health of residents.
The solution to the problem is to rethink health service delivery policies and funding sectors. For example, introducing insurance like in the UK will allow people to receive decent help from the state (Clarke, 2016). The alternative is to disseminate a health plan, a nationalized, government-run system that provides universal coverage. Such a policy will cover medical needs, excluding cosmetic surgeries. Global changes should begin with analytics and the search for opportunities for improvement on the part of the state.
Globalization affects life expectancy; therefore, the healthcare system needs to be revised. The environment, growing discrimination, and shifting responsibility to provincial health facilities drive fragmented survival rates. In developing countries, it is impossible to cure several diseases that affect children and lead to death. The solution to the problem is to revise health policy at the state level, taking the experience of the UK as an example.
Clarke, J. N. (2016). Health, illness, and medicine in Canada (7th ed.). England, UK: Oxford University Press.
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Does globalisation lead to good health outcomes?
By Rebecca Denver, Lancaster Royal Grammar School
Denver, R. (2020) Does globalisation lead to good health outcomes?. Routes 1(2): 171-181.
This essay focuses on the impact that globalisation has on health, questioning whether the health outcomes of globalisation are positive or negative using a range of examples. It is difficult to conclusively claim that globalisation leads to good health outcomes, after discussing various scenarios where globalisation has had varying impacts on health, I conclude that while globalisation can have positive and negative health outcomes, it appears to cause more negative health outcomes in the examples discussed.
1. Introduction
Globalisation is defined by the World Health Organisation (WHO) as ‘… the increased interconnectedness and interdependence of peoples and countries, is generally understood to include two inter-related elements: the opening of international borders to increasingly fast flows of goods, services, finance, people and ideas; and the changes in institutions and policies at national and international levels that facilitate or promote such flows. Globalization has the potential for both positive and negative effects on development and health’ – (WHO, 2020a).
This definition recognises the idea that globalisation can have both positive and negative health outcomes, often dependant on wealth of individuals and the location on the globe.
Health is defined as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ – (WHO, 2020b).
The WHO definition of health recognises there are many dimensions to good health, not simply the absence of disease. In this essay I will discuss the differing impacts that globalisation has on health, looking at different locations and how globalisation could be viewed as a cause and a solution to many health issues. With regard to the current Covid-19 pandemic, the movement of people that globalisation has accommodated is a cause of the pandemic because widespread travel allowed the virus to spread globally. However, globalisation can also be viewed as a solution to the pandemic because the interconnectedness of the world makes it easier for world leaders and multi-government organisations (MGOs) to work together to end the pandemic.
2. Health impacts of globalisation in daily life
Globalisation is evident in daily life, due to the abundance of products available to us in the UK such as food. Much of the food we regularly eat is not produced in Britain due to the unfavourable climate, instead globalisation allows for foods to be imported into the UK. Avocados are an example of a fruit which is not native to Britain, however they can be found in most mainstream supermarkets. Mexico is the leading exporter of avocados; they are also grown in Peru and South Africa. Purchasing these goods in the UK helps to fund farms and provide income for farm workers in less economically stable countries like Mexico. Some avocados are part of Fairtrade schemes which ensure farmers get a fair wage for their produce, giving agriculture workers a fair income and reducing poverty. This trade is possible because of globalisation and the income generated by imports and exports improves the health of agricultural workers as they can afford to have better housing, nutrition and healthcare. These factors can improve quality of life for agriculture workers, leading to good health outcomes. In addition, avocados are a healthy source of vitamins and unsaturated fat, which can reduce the risk of a person developing cardiovascular disease (CVD), a disease that can be fatal. Globalisation has enabled avocados to be exported globally, allowing people across the world to enjoy the health benefits that avocados can provide. The unsaturated fat that avocados contain can improve a person’s overall health if eaten as part of a balanced diet, highlighting a link between good health and globalisation.
Despite the potential benefits, there are also issues with the rising demand for exotic produce such as avocados. The Avocado trade in Mexico has become very prominent, with avocados being referred to as ‘green gold’ by some Mexican cartels due to their high value and high demand, consequently, some gangs are competing to gain more control over the market. In recent years, the avocado trade has been a source of conflict, with rival cartels competing to seize control of the local avocado trade. Unfortunately, this gang rivalry has resulted in violence, which has negative impacts on health as people are injured and displaced by the conflict. Avocados are in such high demand in high income countries (HICs) due to rising popularity of healthier diets and vegetarianism and veganism. This high demand can be exploited by rival cartels and gangs who see that there is substantial money to be made in this business.
In addition, it is not always the farmers who benefit from avocados and other popular crops being purchased. Not all produce that globalisation has accommodated the sale of is Fairtrade. If products such as avocados are not Fairtrade, agricultural workers are not guaranteed to be paid a ‘fair’ wage – meaning many do not have sufficient income to buy basic necessities such as food and cleaning products. In turn, if workers cannot afford essentials, they are more vulnerable to disease due to lack of sanitation and poor diet. This is an example of how globalisation can cause negative health outcomes.
3. The impacts of globalisation on a wider scale
Crops are not the only food products more widely available due to globalisation, ‘junk food’ is also rising in popularity around the world. Transnational corporations (TNCs) such as McDonalds have gained global influence, with ‘over 34,000 restaurants around the world’ – (BBC, 2013).
The fact that McDonald’s has over 34,000 restaurants all over the globe shows how globalisation can open doors and allow companies to expand their empire throughout many countries. With increasing popularity of fast food, comes increasing instances of obesity due to more consumption of high calorific ‘junk food’. Adult obesity is classified by the WHO as ‘… a BMI greater than or equal to 30 …’ (WHO 2020 c) where BMI stands for Body Mass Index. Obesity causes or worsens other heath conditions such as diabetes and CVD. According to Public Health England (2020) ‘CVD is the leading cause of death worldwide, accounting for 17.9 million deaths each year, 31% of all global deaths.’.
The presence of multinationals in low income countries (LICs) and middle income countries (MICs) could correlate directly with obesity and obesity related conditions. According to the World Health Organisation (2020 c) worldwide obesity has nearly tripled since 1975, corresponding with the rising popularity of fast food since the 1970s. The increasing availability of fast food chains in LICs and MICs could be responsible for this trend because in countries such as Ghana, a westernised diet has only recently been introduced, before this, traditional, native and healthier foods were all that was available. Due to globalisation, TNCs have the ability to infiltrate the food market in poorer countries as well as wealthy regions. Although many people living in LICs and MICs live in poverty, fast food franchises are increasingly popular. This could be due to the nature of the food, being ‘fast food’, it can be made in a matter of minutes and gives instant gratification to the consumer. Another contributing factor to the rising popularity of fast food in poorer countries is lack of education and cookery skills. In Ghana, the fast food franchise KFC is becoming commonplace and its rising popularity amongst local people coincides with increased instances of obesity. Despite this, 28 million people living in Ghana are living in extreme poverty, this is classified by the World Bank as ‘living on less than $1.90 per day per person’ (World Bank, 2020). This highlights how even in countries such as Ghana where millions live in extreme poverty, there is rising demand for junk food because of globalisation. Poverty and poor health often occur simultaneously because poor health is often a result of poverty; those living in poverty may have a low level of education so are not aware of the health consequences of a poor diet. Poorer people also find it difficult to access and afford sanitation products, leading to disease.
In a place like Ghana, those living in extreme poverty do not have the luxury of being selective when it comes to their diet, they simply eat what they can afford. The presence of KFC in Ghana has made relatively cheap food accessible for poorer consumers. Unfortunately, this food is high in calories and saturated fats, so if eaten regularly, will cause obesity and other health conditions. In Ghana, obesity is becoming an increasing issue; Ghana is ‘one of 73 countries where obesity has at least doubled since 1980. In that period, Ghana’s obesity rates have surged more than 650 percent, from less than 2 percent of the population to 13.6 percent, according to the Institute for Health Metrics and Evaluation, an independent research centre at the University of Washington’ (Searcy and Richtel, 2017). The dramatic increase in obesity cases in Ghana shows how globalisation and the rise of TNCs in LICs has negative health outcomes, causing obesity and leading to other severe health conditions such as CVD. Globalisation has allowed for multinational ‘fast food’ companies to gain market share overseas, as these ‘fast food’ multinationals increase their popularity in LICs and MICs, obesity related health conditions also appear to rise proportionally in areas such as Ghana. This suggests that globalisation could have negative health outcomes in relation to diet and diet-related health conditions because it has enabled the global spread of unhealthy foods.
4. Transnational corporations and globalisation
Globalisation stimulates economic growth as goods and services are imported and exported between countries. TNCs are a prime example of globalisation stimulating economic growth due to trade, as TNCs are companies which trade internationally and create trade links between countries at different levels of development. These trade links established by TNCs bring goods and income into a country, which can be used to improve infrastructure. In turn, improvement of infrastructure like healthcare usually leads to good health outcomes.
Apple is an example of a well-known TNC, which sells its products in most of the world. Apple is based in California; however, Apple iPhones are manufactured in China. Apple creates 2 million jobs, many in the manufacturing sector in China, giving many people a source of income. This income can be used to access better healthcare, as well as purchase higher quality foods. Better healthcare and nutrition are crucial for good health as nutritious foods ensure people have a well-balanced diet with the essential vitamins. Those in China who have a stable income due to their job at Apple will also be able to access better healthcare and transport to healthcare facilities, leading to good health outcomes for individuals.
5. Environmental impacts of globalisation
Unfortunately, TNCs can also have negative health outcomes, particularly due to their impacts on the environment. Apple products are manufactured in China and are then shipped and transported globally. This process is highly polluting, as shipping and air transport release greenhouse gases, such as carbon dioxide and carbon monoxide, into the atmosphere. These gases can irritate the lungs and lead to breathing problems such as asthma, a negative health outcome.
Gases such as carbon dioxide are also known to cause a ‘greenhouse effect’ as the layer of greenhouse gases cause more heat to be trapped between the Earth’s surface and our atmosphere rather than being able to dissipate into space. The ‘greenhouse effect’ is crucial to maintain a relatively stable environment on Earth, as some heat needs to be trapped between Earth’s surface and Earth’s atmosphere to prevent the temperature from becoming dangerously low. However, extensive burning of fossil fuels and transportation of goods due to globalisation causes gases such as carbon dioxide and carbon monoxide to occur in excess. High levels of these gases are known to increase the rate of climate change and global warming, which causes more natural disasters and extreme weather.
Figure 1 shows the increasing severity of North Atlantic tropical cyclone activity over the last 70 years alongside the rising sea surface temperature. Although there are anomalies, such as the very low power dissipation Index between 2010-2020 despite the high sea surface temperature of around 83°F. Generally, the power of cyclones is shown to increase as the sea surface temperature rises, showing that as global warming occurs, the warmer sea can cause more destructive storms. These storms have greater impacts, damaging buildings and causing injury. If homes are destroyed, people may become homeless which could make them more vulnerable to disease and poor health as they have little access to sanitation. Suggesting that the impacts of globalisation on health are not always good.
Additionally, globalisation can lead to deforestation in order to make space for large scale activities. Trees act as carbon sinks, taking in greenhouse gas carbon dioxide and releasing oxygen, therefore, largescale removal of forest cover releases carbon back into the environment which could contribute to greenhouse gases. Deforestation also limits the amount of oxygen in the atmosphere as if there are fewer trees, less oxygen is released into the atmosphere. In terms of health, if there are more greenhouse gases in the air due to deforestation, this could cause lung and breathing issues such as asthma. This is a negative environmental impact of globalisation that has poor health outcomes.
6. Links between globalisation and climate change
Interestingly, the sea surface temperature and power of tropical storms appears to coincide with globalisation. Between 1949 and 2015 the world has become increasingly interconnected due to new technology that allows people all over the world to communicate with ease, as well as large amounts of trade and the popularisation of air travel. With this globalisation comes wider transport of goods and movement of people, producing larger amounts of greenhouse gas. The graph suggests that generally, the sea surface temperature has been increasing since 1980, this roughly coincides with the increased globalisation seen in the last 40 years. In my view, this suggests a relationship between globalisation and the amount of greenhouse gas in the atmosphere, as more globalisation occurs, more fossil fuels are burnt producing more greenhouse gases. In turn, this contributes to global warming and causes an increase in sea surface temperature, which can cause more powerful tropical storms, as shown in Figure 1. More powerful storms result in greater devastation and can cause homelessness, loss of life and injury, supporting the idea that globalisation does not always have good health outcomes.
TNCs also often manufacture products in LICs or newly emerging economies (NEEs) due to cheaper labour. This lowers manufacture costs but also takes away jobs in manufacturing in high income countries (HICs). This is a common issue in the clothing industry, many retailers on the UK highstreets such as New Look manufacture their clothes in NEEs and LICs. New Look is a popular ‘fast fashion’ clothing retailer, producing its relatively cheaply made clothes in Bangladesh, Cambodia and Turkey. These countries are at low levels of development compared to the UK, so labour costs are much lower. As a result, there are fewer jobs in textiles and manufacturing in the UK compared to NEEs and LICs, leaving people in the UK unemployed. Unemployment plunges families into poverty, they cannot afford balanced diets or high standard education, leading to poor health outcomes such as diabetes from a poor diet and lack of education on health.
Although clothing retailers such as New Look create jobs for people in less developed countries, which improves their health as they can afford healthier nutrition and better housing, the ethics of a company may cause negative health impacts. Workers have few rights, so may be exploited – this has a negative impact on health if employees are overworked and under-paid, as this may contribute to poverty as well as lack of job satisfaction.
Another way in which globalisation can negatively impact health is the lack of safety of factories in developing countries. Globalisation can create large inequalities across the world, with large TNCs sometimes cutting corners when it comes to safety due to the lack of safety policies in poorer countries. Often factories are built cheaply in LICs and NEEs, which do not have the same employee protection standards as HICs, these factories may be unsafe. The Rana Plaza disaster is a tragic example of the lack of building safety standards in lower income countries, shown in Figure 2.
The Rana Plaza was an eight-storey garment factory in Bangladesh which collapsed due to lack of maintenance. Burke (2014) suggests that the workers initially protested due to cracks in the walls and the obvious structural weakness, however, the owners ignored the warnings and ordered workers to return to the factory. The collapse occurred on the 24 th April 2013 and 1,129 workers were killed in the disaster. An additional 2,500 were injured, making this the worst garment factory incident in history. Injured workers were left devastated and unable to work due to their injuries, which may have rendered some unemployed and poor, leading to illnesses and poor health.
7. The Covid-19 pandemic in relation to globalisation
There are many instances where economic gains have been put above health and safety. The lack of disease screening combined with widespread travel of people rapidly amplifies disease spread. Covid-19 is a significant example of this, the disease originated in Wuhan, China and is now prevalent in the rest of the world due to the travel enabled by globalisation.
Figure 3 is a map taken from WHO, showing the global distribution of Covid-19 and highlights how widespread this disease is. The Covid-19 pandemic has left millions ill, unable to work and unemployed. More than 26.4 million people in the US have claimed unemployment benefit amid the pandemic. This staggeringly high figure indicates the severe economic and social impacts that the pandemic has caused. Globalisation has enabled people to easily travel around the world and is a major factor in the rapid spread of the virus. Unemployment and illness caused by the pandemic prevents people earning an income and limits their access to healthcare, particularly in the US where there is no state funded comprehensive national health service.
On the other hand, globalisation has helped to manage the current Covid-19 pandemic. Many countries around the world are following the WHO guidance and working in unison to tackle the pandemic. The WHO links countries together and provides crucial information to improve global health. Globalisation and technology have made this possible, as communities and countries can work together and have a greater positive impact on health. Wealthy developed countries like the UK can also contribute money to the LICs, which Covid-19 will have the worst impacts upon. LICs do not have the healthcare facilities or the expertise to deal with a pandemic like Covid-19, consequently, experts from HICs like Italy can help to advise those in LICs and NEEs to try to educate the public on the spread and the treatment strategies. This globalisation is helping world leaders to work towards good health outcomes in the Covid-19 pandemic.
8. Conclusion
Overall, globalisation has both positive and negative health outcomes, all of which have significant impacts on individuals and the health of a nation. It could be argued that there are equal numbers of positive and negative health outcomes created by globalisation. The current Covid-19 pandemic is an example of the way in which globalisation caused and could reduce the spread of Covid-19 as countries are well linked and can work collaboratively to lead to good health outcomes in the case of working conditions, disease spread and trade.
Globalisation has also accommodated the spread of TNCs into LICs and MICs as well as HICs. In recent years the popularity of fast food TNCs has contributed to obesity and CVD. As discussed, CVD is the leading cause of death globally; a negative health outcome caused by globalisation. Alternatively, as seen there are positive health outcomes associated with globalisation such as the creation of jobs in LICs and MICs, which give people a source of income and a better quality of life which can reduce their risk of developing some diseases such as cholera if they have the money to access sanitation products.
Globalisation is shown to contribute significantly to greenhouse gas emissions and also air pollution in industrial regions. The deforestation and pollution caused by globalisation can cause higher instances of greenhouse gases in the air. These contribute to climate change which, in turn, can cause higher instance of tropical storms which have negative health outcomes as they cause homelessness, poverty and injury. The polluting gases released by agriculture and factories can also cause chest irritations and contribute to conditions such as asthma. These conditions can be damaging to health, highlighting how globalisation can cause environmental impacts that also have negative health outcomes.
After consideration, I believe that in the examples examined, globalisation appears to have more negative health outcomes than positive. This is due to the detrimental impacts on health such as rising levels of obesity and pollution caused by globalisation. Travel associated with globalisation is also accelerating global warming and climate change contributing to natural disasters and loss of biodiversity. These consequences of globalisation can have negative health outcomes such as injury, chronic chest conditions and homelessness. This discussion is limited by the selection of cases and examples that have been analysed. In addition, the health outcomes of globalisation can be interpreted subjectively, therefore it is possible there are differing views as to whether it leads to good health outcomes.
9. Acknowledgements
I am a Lower Sixth Form student, my A-Level Geography teacher Mr Andrew Talks at Lancaster Royal Grammar School has encouraged me to submit my essay.
10. References
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https://www.bbc.co.uk/news/business-24692392
(Accessed 12.08.2020).
Burke, J. (2014). ‘Rana Plaza: one year on from the Bangladesh Factory disaster’. The Guardian. 19 April. Available at:
https://www.theguardian.com/world/2014/apr/19/rana-plaza-bangladesh-one-year-on
(Accessed 24.07.2020).
Dehghan, S.A. (2019). ‘Are Mexican avocados the world’s new conflict commodity?’. The Guardian . 30 December. Available at:
https://www.theguardian.com/global-development/2019/dec/30/are-mexican-avocados-the-worlds-new-conflict-commodity
(Accessed 10.08.2020).
Emanuel, K.A. (2016). ‘North Atlantic Tropical Cyclone Activity According to the Power Dissipation Index’. United States Environmental Protection Agency. August. Available at:
https://www.epa.gov/climate-indicators/climate-change-indicators-tropical-cyclone-activity
Oxford English Dictionary (2012). Oxford University Press.
Public Health England. (2020). ‘Health matters: preventing cardiovascular disease’. GOV.UK . Available at:
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(Accessed 22.08.2020).
Searcy.D and Richtel.M. (2017). ‘Obesity Was Rising as Ghana Embraced Fast Food. Then Came KFC.’. The New York Times. Available at:
https://www.nytimes.com/2017/10/02/health/ghana-kfc-obesity.html?referer
World Bank. (2020). ‘Understanding Poverty’. Available at:
http://www.worldbank.org/en/topic/poverty
(Accessed 12.08.2020).
World Health Organisation. (2020 a). ‘Frequently asked questions’. Available at:
https://www.who.int/about/who-we-are/frequently-asked-questions
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https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
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(Accessed 17.07.2020).
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