In 2001, Richard Feachem argued that ‘globalisation is good for your health, mostly’. The claim was that the economic growth stimulated by globalization – specifically, increased volumes of trade as a share of a country’s economic output – reduced poverty and increased resources available for providing health care. His position has since been called into question both because of the World Bank data on trade flows and growth on which Feachem relied and because of the problematic connection between economic growth, poverty reduction and better health. The work of historian Simon Szreter is especially noteworthy on this latter point.
More than 20 years on, an Economist leader ignored much of the accumulated evidence about the questionable human benefits of globalization. Instead, it called (in the weekly’s January 14 issue) for renewed efforts to support the global reorganization of production that has occurred over the last four decades or so, in the name of economic efficiency, in order to continue past progress in reducing poverty and render affordable the costs of decarbonizing the world economy. Yet further globalization in anything like its pre-pandemic form is likely to harm the health of many people worldwide.
Let’s take the decarbonization claim first. In 2020, the United Kingdom’s National Audit Office (NAO) produced a remarkably detailed examination of the economic and societal changes that will be needed if the UK is to reach its stated goal of ‘net zero’ emissions by 2050. So-called free markets will not do the job. Creative, thoughtful dirigisme and policy innovation across a range of sectors will be necessary, although not sufficient. The same is true of any other complex economy one can think of (innovation scholar Mariana Mazzucato is especially persuasive on this point).
What about globalization and poverty reduction? Based on the World Bank’s contentious definition of extreme poverty, hundreds of millions of people have been lifted out of poverty since the start of the era of contemporary globalization. Even leaving aside the problematic nature of the definition, until early in the new millennium global extreme poverty reduction was entirely a China story. In other words, everywhere outside China as someone escaped poverty based on the World Bank’s definition, someone else fell into it. According to the Food and Agriculture Organization and other United Nations agencies, before the pandemic healthy diets were unaffordable to three billion people on ‘the most conservative estimate’ and ‘[t]wo billion people, or 25.9 percent of the global population, experienced hunger or did not have regular access to nutritious and sufficient food in 2019’.
The Economist’s encomium to globalization is indifferent to inequality. In 2013 Serge Halimi, the editor of Le Monde Diplomatique, described globalization as ‘[t]he inequality machine [that] is reshaping the planet’. The effects have now become too conspicuous to ignore within national borders (Figures 1 and 2); overall, the pandemic amplified the reshaping process. For example, a 2022 annual report on the world economic situation observed: ‘According to preliminary estimates, the top 1 per cent of income earners in the United States registered net wealth gains of about $3.5 million per person between the first quarter of 2020 and the second quarter of 2021. The bottom 20 percent recorded an increase of only about $5,300 per person’. Even as pre-pandemic globalization eased extreme poverty in China, and more recently in other jurisdictions outside the high-income world, it devastated the economic futures of many working families in countries like the United States – contributing to what Anne Case and Angus Deaton eloquently describe as ‘deaths of despair’ among the left-behind.
Much more can and should be said about all these matters. Global health researchers and practitioners must rely on data and analysis from various areas of social science and law that are not necessarily connected to health in obvious ways – at least, not in ways that are apparent to the biomedical gaze. This is where multidisciplinarity comes in: the ability to engage with a range of disciplines and assess the implications of their findings for global health is indispensable for critical assessment of claims like those about the benefits of globalization.
Before I retired, some of my postgraduate students wondered why the learning objectives in my global health courses included the ability to read articles in the business press and explicate their implications for global health. This is why.
Acknowledgements and disclosures
Parts of this analysis are based on the author’s chapter on globalization in L. Bharadwaj and C. Schuster-Wallace, eds., Handbook on Global Health and Sustainable Development (Edward Elgar, forthcoming). A longer version appears on his Newcastle University site ‘Health as if Everybody counted’. The author owns shares in firms that will benefit from US technology subsidy programmes critiqued in the Economist leader cited here. Unfortunately, some of the links are protected by paywalls. The author will endeavour to provide copies of the cited materials for the personal use of readers without access.
