impact of globalization on healthcare
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This is a presentation on the future of Healthcare and its transformation during Globalization eraTRANSCRIPT
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Dr. Abdulaziz Saddique Pharm.D., CPHQ,CSSMBB
7th Arab Conference “New Trends in Hospital Administration”“Performance improvement and cost containment in light of current national &
International Changes”
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Growing liberalization of trade (in goods and services and in
money), and accelerated integration into a global economy
Growing dominance of Western forms of political, economic,
and cultural life
Proliferation of new information technologies, intensification
of and acceleration of global communication
Weakening of local and national boundaries in many areas of
human endeavour
Weakening of the role of the State relative to the role of the
Market
“The State has become too small for the big problems and
too big for the small problems” (Wade Davis)2Dr. Saddique
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1500-1840
1850-1930
1950s
1960s
Best average speed of horse-drawn coaches and
sailing ships, 10mph.
Steam locomotives average 65mph. Steamships
average 36mph.
Propeller aircraft 300-
400 mph.Jet passenger aircraft 500-
700mph.
The Shrinking Globe The Shrinking Globe
Is Distance Dead? Is Distance Dead?
The cost of information transfer decreased by 98% in the last 40 years.
The cost of Goods transport is reduced by 50 %in the last 40 years.
Globalization is associated with “time and space contracting”:
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Bretton Woods Institutions: World Bank, IMF and World Trade Organization. “Washington consensus”: Rules imposed by
World Bank, the IMF, in consultation with US to encourage deregulation, privatisation, free trade, export oriented growth
Transnational corporations (TNCs/MNCs)
Leaders of the G-7, now G-8 Canada, France, Germany, Italy, Japan,
Russia, UK, US
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Drive for Change
Globalization
Governance
Local Governance
Citizens / Industry
•WTO•IMF•WHO•World Bank
•WTO•IMF•WHO•World Bank
•Laws•Rules•Regulations•Guidelines
•Laws•Rules•Regulations•Guidelines
•Implementation•Performing•Execution
•Implementation•Performing•Execution
•Economic developments effects all
•Economic developments effects all
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“We have global governance without global government, one in which a few institutions – the
World Bank, the IMF, the WTO, and a few players – finance and trade ministries, closely linked to certain financial and commercial interests –
dominate the scene, but in which many of those affected by their decisions are left almost
voiceless” Joseph Stiglitz, 2002
(author of “Making Globalization Work” and
“Globalization and its Discontents”)
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South-South linkages to reduce dependency on Northern markets: Brazil, India, China, South Africa (BRICs) Shanghai Cooperation Organisation: China, Russia,
Kazakhstan and other former Soviet territories Rise of social movements in the Civil Society
sector to protest unequal benefits and promote “alter-globalism” World Social Forum, 2001 Porto Allegre, calling for a
fair system of trade, full employment, guaranteed basic goods such as education and health, local prosperity, sustainable growth
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Globalization and the Globalization and the World’s PoorWorld’s Poor
Critics argue that globalization has not helped poor 1870: per capita income of 17 richest nations was 2.4x that of all
other countries. 1990: it was 4.5x larger.
Other factors may have influenced the gap Totalitarian governments. Economic policies that destroyed wealth creation. Little protection of property rights. Expanding populations. War.
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Internationalization-interaction & interdependence of people in different countries
Globalization-worldwide, universal
Universalization-spread of people & cultures worldwide
Westernization-values, behaviors of Western societies
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• Inevitable
• Universal
• Pro-active pays
• Uncertainties
• Stressful
What are the pros and cons of globalization on health care?
(Herhock et al., 2007)
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Globalization is: The product of the emergence of a
global economy, expansion of transnational linkages between
economic units creating new forms of collective decision making,
development of intergovernmental and quasi-supranational institutions, intensification of transnational
communications, and the creation of new regional and military orders
(Hershock, Mason & Hawkins, 2007, p. 30).
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Liberal arts Language Flexibility Attitude Acceptance Communication
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Steps to CCC Attitudes for CCC Self awareness Individual respect & Knowledge acceptance of differences Communication Inclusive
Q What is the stand of the JCAHO re: client centered & cultural competent care?
Client centered (CC): Treating person as a whole. CC entails: advocacy, empowerment, respect, self-determination & participation.
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….. "health problems that transcend national boundaries, that may be influenced by circumstances or experiences in other countries, and that are best addressed by cooperative actions, and solutions; whether they occur in developing countries, countries in advanced transition, or industrialized countries" (UNC-CH, 2007, p.3).
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Access: Sheer numbersWho pays? Use of ER/hospital careCommunication-interpretersNeed for client centered careUse of CAMSAdherence/compliance
Q What is the impact of immigration globally?
(Brush, 2008, 40(1):20-25; www.ilo.org;public/english/dialogue/sector/papers/health/wp209.pdf)
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2000 2050
% ofpop
Q What demographic shifts are occurring globally? 16Dr. Saddique
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Mass communication Sharing media Global traveling Advancements
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Caring Economics: A Global Agenda
CARING is big business!Caring is marketing.Caring & outcomesCaring takes time.Caring is a basic human need.
Q Is caring a business commodity?
(Eisler, R., 2007, Creating a Caring Economics: The Real Wealth of Nations)
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Health Disparities: mortality & morbidity of poor
Infectious Diseases More effective health care Systems Tobacco addiction
Q What other issues can you identify?
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#1 France #6 Singapore #10. Japan #15. Iceland #20. Switzerland #25. Germany #30. Canada #37. USA #61. Mexico #144. China
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Access to health care Individual profile Social:
education/economics Environment Infant mortality Life expectancy
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USA 7.09 male deaths/1000 births UK 5.67 Canada 5.15 Australia 5.02 Switzerland 4.84 Spain 4.76 Germany 4.56 Japan 3.58 Iceland 3.43 Sweden 2.92
(Retrieved from www. Who.org , 2007) 22Dr. Saddique
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Male FemaleUK 78.8 83.1Australia 78.5 83.3Japan 78.5 85.5Iceland 78.5Germany 77.4 84.4Malta 77.0 81.9 France 75.9 83.1Spain 74.5 82.0USA 74.8 80.1 (17th.
in world)Sweden 70.4 78.4(www.INED.fr/en/pop_figures, 2006; Holtz, 2008, p. 5) 23Dr. Saddique
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Cardiovascular/hypertensionDiabetesCancerObesity & nutritionHIV/AIDSTobacco/alcohol addictionSubstance abuseInjury/violenceImmunizations
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Universal INFECTION CONTROL
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Cultural competency
Diversity & Workforce
Diversity management
Equity/social justice
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System Outcomes
Quality Improveme
nt
Evidence-based
Practices
Performance MeasurementQ What are the expected outcomes of globalization and health care? 27Dr. Saddique
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•Advocates for health are imperative•Society continues to change•Gatekeepers are necessary•Learning to cope is essential Q What do you predict for the globalization of
health care?
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Global partnerships Government’s role Philanthropy Engagement/participation Transformational leadership
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Health People 2015 in various countries Eight Millennium Development Goals 1990-2015 United Nations/World Health Organization shifts Ministries of health Non-Government Organizations, consumer/
professional/environmental groups Public/private partnerships & alliances
Q What needs to be done to activate clients in health care?
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•Cultural diversity
•HCP migration
•Nursing & Medicine shortages
•Service learning
•Health careers
Q What significant impact will globalization have on the role of the HCP? 31Dr. Saddique
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Health care systems are in reform globally.
Globalization affects every system.
Inter-professional efforts are needed to improve health care globally.
Health care providers need to prepare, be
proactive and collaborate.
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In 2001, trade in goods accounted for 40% of the world’s GDP compared with 33% in 1990 19% for US but over 100% for many
developing countries In 2001, foreign direct investment
totaled 746 billion dollars compared with 203 billion dollars in 1990
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Foreign trade volume increased from 48 billion dollars in 1960 to 3.6 trillion dollars in 2006
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US-owned assets abroad 457 billion dollars in 1976 13.8 trillion dollars in 2006
Foreign-owned assets in the US 292 billion dollars in 1976 16.3 trillion dollars in 2006
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Normative theory What ought to be e.g.: “Globalization is ultimately good for poor
developing countries.” Positive theory
What is e.g.: “Globalization increases economic
inequality between rich and poor countries.”
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The impact of globalization on income inequality unemployment education health care women and children the environment homeland security, etc.
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Does globalization decrease levels of government spending on social services such as health care and education?
Yes: “race to efficiency” or “race to the bottom”
No: “race to the top” of human capital formation
How to empirically test these theories?
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Social ImplicationsSocial Implications
Large technological transfer + cheap information technology: knowledge diffusion
Increase of skilled labor
Leapfrog development steps: high-speed transition towards a service economy
Economic efficiency economic growth poverty reduction
“Westernization” of governance: gender issues / democracy
Convergence of income / labor standards
Efficient allocation of labor between i) economic sectors ii) rural-urban areas
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Important NoteImportant NoteThe move from Agricultural Society The move from Agricultural Society into Industrial Society was a move into Industrial Society was a move
in the type of products and in the type of products and production process.production process.
The move from Industrial Society The move from Industrial Society into Information Society into Information Society
(Globalization) is not limited to the (Globalization) is not limited to the type of products or the process of type of products or the process of production but it affects people in production but it affects people in
all their life aspects.all their life aspects.40Dr. Saddique
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Globalization & Culture: The Globalization & Culture: The Story So FarStory So Far
Cultural HomogenizationCultural Homogenization
Cultural ImperialismCultural Imperialism
McdonaldizationMcdonaldization
Coca-ColonizationCoca-Colonization
AmericanizationAmericanization
WesternizationWesternization
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Thanks you for your Participation