The health impacts of globalisation: a conceptual framework

Huynen, Maud MTE; Martens, Pim; Hilderink, Henk BM

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 . 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 [1] [2] [3] [4] . Below, the implications of the globalisation process on these distal determinants will be discussed in more detail.