By Rebecca Denver, Lancaster Royal Grammar School

Citation

Denver, R. (2020) Does globalisation lead to good health outcomes?. Routes 1(2): 171-181.

Abstract

This essay focuses on the impact that globalisation has on health, questioning whether the health outcomes of globalisation are positive or negative using a range of examples. It is difficult to conclusively claim that globalisation leads to good health outcomes, after discussing various scenarios where globalisation has had varying impacts on health, I conclude that while globalisation can have positive and negative health outcomes, it appears to cause more negative health outcomes in the examples discussed.

1. Introduction

Globalisation is defined by the World Health Organisation (WHO) as ‘… the increased interconnectedness and interdependence of peoples and countries, is generally understood to include two inter-related elements: the opening of international borders to increasingly fast flows of goods, services, finance, people and ideas; and the changes in institutions and policies at national and international levels that facilitate or promote such flows. Globalization has the potential for both positive and negative effects on development and health’– (WHO, 2020a).

This definition recognises the idea that globalisation can have both positive and negative health outcomes, often dependant on wealth of individuals and the location on the globe.  

Health is defined as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ – (WHO, 2020b). 

The WHO definition of health recognises there are many dimensions to good health, not simply the absence of disease. In this essay I will discuss the differing impacts that globalisation has on health, looking at different locations and how globalisation could be viewed as a cause and a solution to many health issues. With regard to the current Covid-19 pandemic, the movement of people that globalisation has accommodated is a cause of the pandemic because widespread travel allowed the virus to spread globally. However, globalisation can also be viewed as a solution to the pandemic because the interconnectedness of the world makes it easier for world leaders and multi-government organisations (MGOs) to work together to end the pandemic.

2. Health impacts of globalisation in daily life

Globalisation is evident in daily life, due to the abundance of products available to us in the UK such as food. Much of the food we regularly eat is not produced in Britain due to the unfavourable climate, instead globalisation allows for foods to be imported into the UK. Avocados are an example of a fruit which is not native to Britain, however they can be found in most mainstream supermarkets. Mexico is the leading exporter of avocados; they are also grown in Peru and South Africa. Purchasing these goods in the UK helps to fund farms and provide income for farm workers in less economically stable countries like Mexico. Some avocados are part of Fairtrade schemes which ensure farmers get a fair wage for their produce, giving agriculture workers a fair income and reducing poverty. This trade is possible because of globalisation and the income generated by imports and exports improves the health of agricultural workers as they can afford to have better housing, nutrition and healthcare. These factors can improve quality of life for agriculture workers, leading to good health outcomes. In addition, avocados are a healthy source of vitamins and unsaturated fat, which can reduce the risk of a person developing cardiovascular disease (CVD), a disease that can be fatal. Globalisation has enabled avocados to be exported globally, allowing people across the world to enjoy the health benefits that avocados can provide. The unsaturated fat that avocados contain can improve a person’s overall health if eaten as part of a balanced diet, highlighting a link between good health and globalisation. 

Despite the potential benefits, there are also issues with the rising demand for exotic produce such as avocados. The Avocado trade in Mexico has become very prominent, with avocados being referred to as ‘green gold’ by some Mexican cartels due to their high value and high demand, consequently, some gangs are competing to gain more control over the market. In recent years, the avocado trade has been a source of conflict, with rival cartels competing to seize control of the local avocado trade. Unfortunately, this gang rivalry has resulted in violence, which has negative impacts on health as people are injured and displaced by the conflict. Avocados are in such high demand in high income countries (HICs) due to rising popularity of healthier diets and vegetarianism and veganism. This high demand can be exploited by rival cartels and gangs who see that there is substantial money to be made in this business. 

In addition, it is not always the farmers who benefit from avocados and other popular crops being purchased. Not all produce that globalisation has accommodated the sale of is Fairtrade. If products such as avocados are not Fairtrade, agricultural workers are not guaranteed to be paid a ‘fair’ wage – meaning many do not have sufficient income to buy basic necessities such as food and cleaning products. In turn, if workers cannot afford essentials, they are more vulnerable to disease due to lack of sanitation and poor diet. This is an example of how globalisation can cause negative health outcomes.

3. The impacts of globalisation on a wider scale

Crops are not the only food products more widely available due to globalisation, ‘junk food’ is also rising in popularity around the world. Transnational corporations (TNCs) such as McDonalds have gained global influence, with ‘over 34,000 restaurants around the world’ – (BBC, 2013).

The fact that McDonald’s has over 34,000 restaurants all over the globe shows how globalisation can open doors and allow companies to expand their empire throughout many countries. With increasing popularity of fast food, comes increasing instances of obesity due to more consumption of high calorific ‘junk food’.  Adult obesity is classified by the WHO as ‘… a BMI greater than or equal to 30 …’ (WHO 2020 c) where BMI stands for Body Mass Index. Obesity causes or worsens other heath conditions such as diabetes and CVD.  According to Public Health England (2020) ‘CVD is the leading cause of death worldwide, accounting for 17.9 million deaths each year, 31% of all global deaths.’.

The presence of multinationals in low income countries (LICs) and middle income countries (MICs) could correlate directly with obesity and obesity related conditions. According to the World Health Organisation (2020 c) worldwide obesity has nearly tripled since 1975, corresponding with the rising popularity of fast food since the 1970s. The increasing availability of fast food chains in LICs and MICs could be responsible for this trend because in countries such as Ghana, a westernised diet has only recently been introduced, before this, traditional, native and healthier foods were all that was available. Due to globalisation, TNCs have the ability to infiltrate the food market in poorer countries as well as wealthy regions. Although many people living in LICs and MICs live in poverty, fast food franchises are increasingly popular. This could be due to the nature of the food, being ‘fast food’, it can be made in a matter of minutes and gives instant gratification to the consumer. Another contributing factor to the rising popularity of fast food in poorer countries is lack of education and cookery skills. In Ghana, the fast food franchise KFC is becoming commonplace and its rising popularity amongst local people coincides with increased instances of obesity. Despite this, 28 million people living in Ghana are living in extreme poverty, this is classified by the World Bank as ‘living on less than $1.90 per day per person’ (World Bank, 2020). This highlights how even in countries such as Ghana where millions live in extreme poverty, there is rising demand for junk food because of globalisation. Poverty and poor health often occur simultaneously because poor health is often a result of poverty; those living in poverty may have a low level of education so are not aware of the health consequences of a poor diet. Poorer people also find it difficult to access and afford sanitation products, leading to disease. 

In a place like Ghana, those living in extreme poverty do not have the luxury of being selective when it comes to their diet, they simply eat what they can afford. The presence of KFC in Ghana has made relatively cheap food accessible for poorer consumers. Unfortunately, this food is high in calories and saturated fats, so if eaten regularly, will cause obesity and other health conditions. In Ghana, obesity is becoming an increasing issue; Ghana is ‘one of 73 countries where obesity has at least doubled since 1980. In that period, Ghana’s obesity rates have surged more than 650 percent, from less than 2 percent of the population to 13.6 percent, according to the Institute for Health Metrics and Evaluation, an independent research centre at the University of Washington’ (Searcy and Richtel, 2017). The dramatic increase in obesity cases in Ghana shows how globalisation and the rise of TNCs in LICs has negative health outcomes, causing obesity and leading to other severe health conditions such as CVD. Globalisation has allowed for multinational ‘fast food’ companies to gain market share overseas, as these ‘fast food’ multinationals increase their popularity in LICs and MICs, obesity related health conditions also appear to rise proportionally in areas such as Ghana. This suggests that globalisation could have negative health outcomes in relation to diet and diet-related health conditions because it has enabled the global spread of unhealthy foods.

4. Transnational corporations and globalisation

Globalisation stimulates economic growth as goods and services are imported and exported between countries. TNCs are a prime example of globalisation stimulating economic growth due to trade, as TNCs are companies which trade internationally and create trade links between countries at different levels of development. These trade links established by TNCs bring goods and income into a country, which can be used to improve infrastructure. In turn, improvement of infrastructure like healthcare usually leads to good health outcomes. 

Apple is an example of a well-known TNC, which sells its products in most of the world. Apple is based in California; however, Apple iPhones are manufactured in China. Apple creates 2 million jobs, many in the manufacturing sector in China, giving many people a source of income. This income can be used to access better healthcare, as well as purchase higher quality foods. Better healthcare and nutrition are crucial for good health as nutritious foods ensure people have a well-balanced diet with the essential vitamins. Those in China who have a stable income due to their job at Apple will also be able to access better healthcare and transport to healthcare facilities, leading to good health outcomes for individuals. 

5. Environmental impacts of globalisation

Unfortunately, TNCs can also have negative health outcomes, particularly due to their impacts on the environment. Apple products are manufactured in China and are then shipped and transported globally. This process is highly polluting, as shipping and air transport release greenhouse gases, such as carbon dioxide and carbon monoxide, into the atmosphere. These gases can irritate the lungs and lead to breathing problems such as asthma, a negative health outcome. 

Gases such as carbon dioxide are also known to cause a ‘greenhouse effect’ as the layer of greenhouse gases cause more heat to be trapped between the Earth’s surface and our atmosphere rather than being able to dissipate into space. The ‘greenhouse effect’ is crucial to maintain a relatively stable environment on Earth, as some heat needs to be trapped between Earth’s surface and Earth’s atmosphere to prevent the temperature from becoming dangerously low. However, extensive burning of fossil fuels and transportation of goods due to globalisation causes gases such as carbon dioxide and carbon monoxide to occur in excess. High levels of these gases are known to increase the rate of climate change and global warming, which causes more natural disasters and extreme weather. 

Figure 1 shows the increasing severity of North Atlantic tropical cyclone activity over the last 70 years alongside the rising sea surface temperature. Although there are anomalies, such as the very low power dissipation Index between 2010-2020 despite the high sea surface temperature of around 83°F. Generally, the power of cyclones is shown to increase as the sea surface temperature rises, showing that as global warming occurs, the warmer sea can cause more destructive storms. These storms have greater impacts, damaging buildings and causing injury. If homes are destroyed, people may become homeless which could make them more vulnerable to disease and poor health as they have little access to sanitation. Suggesting that the impacts of globalisation on health are not always good. 

Additionally, globalisation can lead to deforestation in order to make space for large scale activities. Trees act as carbon sinks, taking in greenhouse gas carbon dioxide and releasing oxygen, therefore, largescale removal of forest cover releases carbon back into the environment which could contribute to greenhouse gases. Deforestation also limits the amount of oxygen in the atmosphere as if there are fewer trees, less oxygen is released into the atmosphere. In terms of health, if there are more greenhouse gases in the air due to deforestation, this could cause lung and breathing issues such as asthma. This is a negative environmental impact of globalisation that has poor health outcomes. 

6. Links between globalisation and climate change

Interestingly, the sea surface temperature and power of tropical storms appears to coincide with globalisation. Between 1949 and 2015 the world has become increasingly interconnected due to new technology that allows people all over the world to communicate with ease, as well as large amounts of trade and the popularisation of air travel. With this globalisation comes wider transport of goods and movement of people, producing larger amounts of greenhouse gas. The graph suggests that generally, the sea surface temperature has been increasing since 1980, this roughly coincides with the increased globalisation seen in the last 40 years. In my view, this suggests a relationship between globalisation and the amount of greenhouse gas in the atmosphere, as more globalisation occurs, more fossil fuels are burnt producing more greenhouse gases. In turn, this contributes to global warming and causes an increase in sea surface temperature, which can cause more powerful tropical storms, as shown in Figure 1. More powerful storms result in greater devastation and can cause homelessness, loss of life and injury, supporting the idea that globalisation does not always have good health outcomes. 

TNCs also often manufacture products in LICs or newly emerging economies (NEEs) due to cheaper labour. This lowers manufacture costs but also takes away jobs in manufacturing in high income countries (HICs). This is a common issue in the clothing industry, many retailers on the UK highstreets such as New Look manufacture their clothes in NEEs and LICs. New Look is a popular ‘fast fashion’ clothing retailer, producing its relatively cheaply made clothes in Bangladesh, Cambodia and Turkey. These countries are at low levels of development compared to the UK, so labour costs are much lower. As a result, there are fewer jobs in textiles and manufacturing in the UK compared to NEEs and LICs, leaving people in the UK unemployed. Unemployment plunges families into poverty, they cannot afford balanced diets or high standard education, leading to poor health outcomes such as diabetes from a poor diet and lack of education on health. 

Although clothing retailers such as New Look create jobs for people in less developed countries, which improves their health as they can afford healthier nutrition and better housing, the ethics of a company may cause negative health impacts. Workers have few rights, so may be exploited – this has a negative impact on health if employees are overworked and under-paid, as this may contribute to poverty as well as lack of job satisfaction.  

Another way in which globalisation can negatively impact health is the lack of safety of factories in developing countries. Globalisation can create large inequalities across the world, with large TNCs sometimes cutting corners when it comes to safety due to the lack of safety policies in poorer countries. Often factories are built cheaply in LICs and NEEs, which do not have the same employee protection standards as HICs, these factories may be unsafe. The Rana Plaza disaster is a tragic example of the lack of building safety standards in lower income countries, shown in Figure 2.

The Rana Plaza was an eight-storey garment factory in Bangladesh which collapsed due to lack of maintenance. Burke (2014) suggests that the workers initially protested due to cracks in the walls and the obvious structural weakness, however, the owners ignored the warnings and ordered workers to return to the factory. The collapse occurred on the 24^th April 2013 and 1,129 workers were killed in the disaster. An additional 2,500 were injured, making this the worst garment factory incident in history. Injured workers were left devastated and unable to work due to their injuries, which may have rendered some unemployed and poor, leading to illnesses and poor health.  

7. The Covid-19 pandemic in relation to globalisation

There are many instances where economic gains have been put above health and safety. The lack of disease screening combined with widespread travel of people rapidly amplifies disease spread. Covid-19 is a significant example of this, the disease originated in Wuhan, China and is now prevalent in the rest of the world due to the travel enabled by globalisation. 

Figure 3 is a map taken from WHO, showing the global distribution of Covid-19 and highlights how widespread this disease is. The Covid-19 pandemic has left millions ill, unable to work and unemployed. More than 26.4 million people in the US have claimed unemployment benefit amid the pandemic. This staggeringly high figure indicates the severe economic and social impacts that the pandemic has caused. Globalisation has enabled people to easily travel around the world and is a major factor in the rapid spread of the virus. Unemployment and illness caused by the pandemic prevents people earning an income and limits their access to healthcare, particularly in the US where there is no state funded comprehensive national health service.  

On the other hand, globalisation has helped to manage the current Covid-19 pandemic. Many countries around the world are following the WHO guidance and working in unison to tackle the pandemic. The WHO links countries together and provides crucial information to improve global health. Globalisation and technology have made this possible, as communities and countries can work together and have a greater positive impact on health. Wealthy developed countries like the UK can also contribute money to the LICs, which Covid-19 will have the worst impacts upon. LICs do not have the healthcare facilities or the expertise to deal with a pandemic like Covid-19, consequently, experts from HICs like Italy can help to advise those in LICs and NEEs to try to educate the public on the spread and the treatment strategies. This globalisation is helping world leaders to work towards good health outcomes in the Covid-19 pandemic.

8. Conclusion

Overall, globalisation has both positive and negative health outcomes, all of which have significant impacts on individuals and the health of a nation. It could be argued that there are equal numbers of positive and negative health outcomes created by globalisation. The current Covid-19 pandemic is an example of the way in which globalisation caused and could reduce the spread of Covid-19 as countries are well linked and can work collaboratively to lead to good health outcomes in the case of working conditions, disease spread and trade. 

Globalisation has also accommodated the spread of TNCs into LICs and MICs as well as HICs. In recent years the popularity of fast food TNCs has contributed to obesity and CVD. As discussed, CVD is the leading cause of death globally; a negative health outcome caused by globalisation. Alternatively, as seen there are positive health outcomes associated with globalisation such as the creation of jobs in LICs and MICs, which give people a source of income and a better quality of life which can reduce their risk of developing some diseases such as cholera if they have the money to access sanitation products. 

Globalisation is shown to contribute significantly to greenhouse gas emissions and also air pollution in industrial regions. The deforestation and pollution caused by globalisation can cause higher instances of greenhouse gases in the air. These contribute to climate change which, in turn, can cause higher instance of tropical storms which have negative health outcomes as they cause homelessness, poverty and injury. The polluting gases released by agriculture and factories can also cause chest irritations and contribute to conditions such as asthma. These conditions can be damaging to health, highlighting how globalisation can cause environmental impacts that also have negative health outcomes. 

After consideration, I believe that in the examples examined, globalisation appears to have more negative health outcomes than positive. This is due to the detrimental impacts on health such as rising levels of obesity and pollution caused by globalisation. Travel associated with globalisation is also accelerating global warming and climate change contributing to natural disasters and loss of biodiversity. These consequences of globalisation can have negative health outcomes such as injury, chronic chest conditions and homelessness. This discussion is limited by the selection of cases and examples that have been analysed. In addition, the health outcomes of globalisation can be interpreted subjectively, therefore it is possible there are differing views as to whether it leads to good health outcomes. 

9. Acknowledgements

I am a Lower Sixth Form student, my A-Level Geography teacher Mr Andrew Talks at Lancaster Royal Grammar School has encouraged me to submit my essay.

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