The past has already been written and the accolades distributed. We now need to decide whether the next century is going to be good or bad for our health, and the role of globalisation in helping us to determine our destiny. People living in failed states do not enjoy utopian, anarchic freedom. They die young. Healthy populations need the goods and services of society to be shared in a broadly inclusive fashion. They need health systems that can respond rapidly and flexibly to emerging disease. They need environments that support human life.
70,000 years ago our ancestors took their first steps out of Africa. With those steps they initiated the binding link between globalisation and health. The difference between then and now is a matter of temporal and geographical scale. Then, nothing moved faster than a walking pace. Now, a person can traverse the globe in 24 hours. A city thousands of kilometres away can be destroyed in 30 minutes. An idea can be everywhere in seconds.
The technological advances of the last century have been kept pace by extraordinary improvements in human health. Average life expectancy barely moved until the beginning of the last century, and over the next hundred years, it doubled. In 2016, the global average life expectancy was 71.4 years of age. We had achieved the biblical entitlement of three score and ten years promised in Psalm 90. The improvements in health were achieved because of globalisation. Reductions in poverty. Improvements in food supply. Advances in healthcare. Sophisticated infrastructure was delivering clean water and carrying away waste. Those advances have also been accompanied by large inequalities in health outcomes and significant environmental degradation.
I suggest there are three broad intersections between globalisation and health. First, there is the real (and sometimes imagined) disease outbreaks: Ebola or the Zombie apocalypse. Infectious disease, however, is only one part of the health and globalisation relationship. The second, very modern concern is the interconnection between our global activities and environmental change, and by extension the impact on human health. The final idea is our relationships with each other, and how these relationships can shift, and the effect the changes may have on the availability of health supporting resources.
I sketched these ideas out in a 3,000 word essay in early 2017 at the invitation of the Editors of “Vaguardia dossier” a Spanish language, Catalan magazine. Many people (including myself) cannot read the published, Spanish version, but you can get the slightly rough, English language preprint here.
Reidpath DD, Globalización y salud [Globalisation and health]. Vanguardia dossier. 2017; 65:76-81