The health impacts of globalisation: a conceptual framework

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

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] [13] [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 Multi-nature and multi-level framework for population health Figure 1 Multi-nature and multi-level framework for population health. New global governance structure Globalisation influences the interdependence among nations as well as the nation state's sovereignty leading to (a need for) new global governance structures. Global markets Globalisation is characterised by worldwide changes in economic infrastructures and the emergence of global markets and a global trading system.