Globalization And Health Research Paper

Health care in this increasingly disparate com- munity must shift from the high-technology focus, which has gained predominance in technologically sophisticated societies, to incorporate broader social, cultural, and psychological concerns. For example, it is probably of far greater importance in the fight against disease to provide clean water in most parts of the world than it is to even provide doctors. Concerns with malaria, TB, AIDS, and HIV dominate global health while poverty, discrimination, inadequate education and environmental contamination provide fertile growth for even greater social epidemics. Health- care disparities are extreme with most of the world’s health-care money, interest, and attention being focused on those with the least need. Ultimately, however, health care in both the developing and the developed world are interrelated and setting priorities as to how these issues can be addressed with mutual benefit is needed.

A number of themes characterize health in the global environment in the past and future decades. These will be dealt with in turn.

1. Technological Development

Health care in the industrialized world has mirrored the dominant ethic of the twentieth century: technology development. The remarkable advances in technology that have resulted in a rapidly changed and changing environment at the close of the millennium have also brought with them increasingly complex challenges.

As technology is developed, so too is the commercial basis for its adaptation and use. Overuse of technology in health care has been the result, with new advances being applied for the benefit of all rather than only the few for whom the technology is specifically directed.

On the other hand, technology is not readily available in less affluent societies. We need to ask whether it is acceptable to have a two-tiered system of health care with regard to appropriate use of technology for developing and developed countries? How well have we addressed issues of equity regarding access to appropriate medical care? How do financial considerations influence who receives differing types of care? To what extent does remuneration of health care providers and/or health care services influence the quality of care provided or the use of available technology? How well are we monitoring the appropriate use of technology and the medical model worldwide? Are the currently available indicators of health sufficient to assess the influence of this level of functioning or are alternative indicators needed to address this issue? How should we evaluate the appropriate use of technology worldwide?

2. Evidence-Based Medicine

Evidence-based medicine is one response to emerge in reaction to the technological explosion. Demanding that technology be applied when, and only when, it is effective, and ensuring that the strictest scientific rigor be applied to judge such effectiveness is leading caregivers to question the overuse of technology (Cochrane Collaboration 2000, Entin et al 1996).

We have developed a computer-based globe, moving increasingly into cyberspace in addition to its more earthly properties. Health and health care have become enmeshed in this web so that medical information and knowledge are moving more readily into the hands of the layperson than ever before. Medical practitioners are having to share their knowledge with their clients, raising issues such as shared decision making, collaborative care, information exchange, confidentiality, and informed choice by recipients of care. Decision making regarding health care, by both professionals and by families, needs to be evidence based: a fair challenge to achieve. Central to these developments are also legal and ethical issues which surround the management of health care and influence health-care decisions. Health-care services, to cope with these demands, need to move from a physician focused service to a client-centered approach.

3. Family-Centered Care

The client too is changing and is being viewed not just as a single entity but as a member of a family unit (whatever that may be), so that care is becoming family-centered care (Chalmers and Levin 2001). The family itself is changing rapidly too, meaning that health care is directed to anything from nuclear, extended, or single-parent families, or to same-gender couples. The traditional role of the doctor–patient relationship is becoming chameleon-like in its complexities.

4. Psychosocial Health Care

The need to incorporate holistic components of care into health has never been more strongly felt than now, although this is not a new idea. As long ago as 1948, the World Health Organization’s Constitution (World Health Organization 1948) defined health as ‘a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.’ It is far preferable to care for the client as a whole person rather than as separated fragments. In earlier medical texts, support was often expressed regarding treating the ‘patient as a whole person with thoughts, feelings, and fears, and not only as a body progressing through the health care system.’ Unfortunately, in technologically sophisticated societies, superspecialization also occurs. Physicians no longer care for all aspects of a client personally: For example, in reproductive health, some specialists are focused on care of the cervix, others on the endometrium, ultrasound diagnosis is delegated to specialized technicians, and even such simple procedures as taking blood are relegated to yet other caregivers. Research has documented that as many as 16 different caregivers in a 6 hour period (Enkin et al. 1996) may look after a woman during a normal birth. A holistic or psychosocial approach to care hardly exists in this structure. Assessing people’s perceptions of their satisfaction with care is one approach to monitoring the integrity of their health care. Feedback regarding educational programs is well accepted in technologically sophisticated societies. No conference ends without a delegate evaluation being completed. Why is this not similarly integrated into health-care services? Is it because the clients’ voices are still not acknowledged as an integral part of healing and are weighted as of far less significance than the biological basis of their illness? Becoming partners in care, rather than simply clients, is still the challenge for the future. ‘Humanizing’ the medical setting has become a cliched term, yet it is still needed.

5. Cultural Differences In Understanding Of Health And Illness

Cultures differ widely in their beliefs and understanding of health, illness, and appropriate health care. Many regard the biological level of functioning as of primary significance. In contrast, significant sections of the global village regard this level of functioning as of least importance with spiritual, social, and psychological concerns playing a primary role in illness etiology, treatment, and prognosis (Chalmers 1990). It is as unacceptable to the latter to neglect consideration of spiritual rites in diagnosis and treatment of illness as it would be to fail to take a woman’s blood pressure during pregnancy in technologically sophisticated societies.

While these differing approaches to care have existed peaceably side-by-side for centuries, recent global population movements have encouraged the intermingling of cultures through migration, refugee relief and more temporary forms of translocation, with resulting conflicting health care paradigms. Compounding the problem are language differences combined with status inequalities which may make it extremely difficult for the foreigners’ health care needs to be met or, indeed, understood in their adopted country. As multicultural societies continue to develop rapidly in the coming decades, the challenge of integrating their health care needs will become increasingly evident.

Traditional practices of healing should be considered with sensitivity and tolerance, and encouraged unless evaluated as distinctly harmful. Condemning or disallowing such practices because they are different is insufficient for although they may not contribute to biological health, they might be important for psychological health and should be encouraged. They should be evaluated as biologically beneficial, inconsequential, or harmful with only the latter forms of care being discouraged.

6. Education

Education to prepare for a multicultural, psychosocial, and evidence-based approach to health is a prerequisite in the twenty-first century. A number of medical institutions have introduced teaching psychosocial issues to medical and allied students. For the most part these have failed. Frequently based in Social or Behavioral Science Departments, they tend to be offered in preclinical years and to focus on theory. They are often perceived by students as programs to be endured, or which are undemanding, and not central to their ability as future caregivers. When offered at a graduate level, as the real challenge of caring for people is encountered in clinical practice, their worth is sometimes reconsidered.

Rather than being offered as distinct, independent course modules, the psychosocial and cultural issues involved in clinical practice should be integrated into mainstream medical teaching programs, e.g., when clinical management of a fetal death is discussed the psychological impact of diagnostic and treatment procedures in addition to longer-term family adjustment issues should be considered. Teaching should be shared by the physician and social scientist concurrently and such joint teaching programs, when tried, have shown much promise of a new and better model to develop for educational success (Chalmers and McIntyre 1993). In addition, providing an integrated model of teaching in the classroom will also establish a model for integrated clinical practice.

It is evident that health science faculties will need to undertake radical curriculum reforms in the twenty-first century to incorporate new, and fundamental, principles of education into their teaching. At the very least, these reform programs need to incorporate evidence-based medicine, family-centered care, multidisciplinary approaches, and psychosocial and multicultural aspects of care. Educational institutes need to be structured in such a way that facilitates the advocacy of both medical and social models of health care. How many medical schools teach social and cultural components of care as an integral component of medicine and how many simply pay lip service to this? Do we even know?

7. Efficiency Of Care

A significant contributory factor to unease about care are the lengthy delays often encountered when seeking consultations with specialists, diagnostic assessments and their results, and treatment. Once a problem has developed, anxiety levels are high, particularly when fear of severe illness (such as cancer) or potential surgery becomes a possibility. Yet people frequently have to wait weeks or longer for simple diagnostic procedures such as ultrasound and even longer for more sophisticated tests. Further delays before receiving the outcomes of tests compound the problem. It is not surprising that frustration, fear, and helplessness are aroused with concurrent irritation and suspicion of the health-care services.

We frequently use the term ‘consumers’ to describe health-care clients. If customers in commercial stores were treated with similar delays in service and impersonal attention they would simply shop elsewhere. Within the health care service, with its more threatening and intimate experiences for clients, and its lack of real alternatives from which to choose in many instances, there is reluctance to apply a similar model. This does not mean that all is well in the state of health care, however. That dissatisfaction exists is evident in the increasing reality of litigation.

8. Conclusion

This research paper highlights some of the critical issues surfacing in the health-care services of the developed world from a broader global perspective. These kinds of concerns underscore the importance of those long held values: concern for the whole person and not only the body, respect for people (and their families) and for their perceptions and needs when undergoing medical care, a sincerely gentle and caring approach to care with sensitivity rather than routine politeness being the order of the day combined with evidence-based practice. It is apparent that while we have long recognized the importance of providing respectful treatment and care and have gone far in introducing systems which encourage such approaches, we are still grappling with the effective application of this fundamental tenant in many parts of the world, both developed and developing.

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