The health impacts of globalisation: a conceptual framework

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

Global environmental changes can have profound effects on the provision of ecosystem goods and services to mankind ( Figure 3; arrow 4) . The Intergovernmental Panel on Climate Change (IPCC) [36] concludes that it is expected that climate change can result in significant ecosystem disruptions and threatens substantial damage to the earth's natural systems. In addition, several authors have addressed the link between biodiversity and ecosystem functioning and it is agued that maintaining a certain level of biodiversity is necessary for the proper provision of ecosystem goods and services [37] [38] [39] [40] . However, it is still unclear which ecosystem functions are primarily important to sustain our physical health. Basically, the following types of 'health functions' can be distinguished. First, ecosystems provide us with basic human needs like food, clean air, clean water and clean soils. Second, they prevent the spread of diseases through biological control. Finally, ecosystems provide us with medical and genetic resources, which are necessary to prevent or cure diseases [41] . Figure 3 shows that the impact of globalisation on each proximal health determinant is mediated by changes in several distal factors (Figure 3 ; arrows 5-12). The most important relationships will be discussed in more detail below. It is important to note that health policies and health-related policies can have an influence on all proximal factors (Figure 3 ; arrow 5).