Health Equity: 07/11/11

Monday, July 11, 2011

[EQ] Globalization and Health - Framing International Trade and Chronic Disease

Globalization and Health
– Framing International Trade and Chronic Disease

Ronald Labonté 1*, Katia S Mohindra 1, Raphael Lencucha 2

1 Institute of Population Health, University of Ottawa, Ottawa, Canada

2 University of Lethbridge, Lethbridge, Alberta, Canada

Globalization and Health 2011, 7:21 doi:10.1186/1744-8603-7-21 – July 2011

Available online at: http://bit.ly/pWL8KA

“…..There is an emerging evidence base that global trade is linked with the rise of chronic disease in many low and middle-income countries (LMICs). This linkage is associated, in part, with the global diffusion of unhealthy lifestyles and health damaging products posing a particular challenge to countries still facing high burdens of communicable disease.

We developed a generic framework which depicts the determinants and pathways connecting global trade with chronic disease. We then applied this framework to three key risk factors for chronic disease: unhealthy diets, alcohol, and tobacco. This led to specific ‘product pathways’, which can be further refined and used by health policy-makers to engage with their country’s trade policy-makers around health impacts of ongoing trade treaty negotiations, and by researchers to continue refining an evidence base on how global trade is affecting patterns of chronic disease.

The prevention and treatment of chronic diseases is now rising on global policy agendas, highlighted by the UN Summit on Noncommunicable Diseases (September 2011). Briefs and declarations leading up to this Summit reference the role of globalization and trade in the spread of risk factors for these diseases, but emphasis is placed on interventions to change health behaviours and on voluntary corporate responsibility.

The findings summarized in this article imply the need for a more concerted approach to regulate trade-related risk factors and thus more engagement between health and trade policy sectors within and between nations. An explicit recognition of the role of trade policies in the spread of noncommunicable disease risk factors should be a minimum outcome of the September 2011 Summit, with a commitment to ensure that future trade treaties do not increase such risks….”

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[EQ] Politics, primary healthcare and health: was Virchow right?

Politics, primary healthcare and health: was Virchow right?

Barbara Starfield*

Primary healthcare
*Editors' note Just as this issue was going to press, we learned that Barbara Starfield MD, MPH, died suddenly and unexpectedly while swimming. Dr Starfield was a world-renowned scholar and tireless advocate for primary care and health inequalities research. She made an enormous impact in both of these fields and her contributions will be greatly missed by our research community.
We thank Normalie Barton for checking the proofs on behalf of Dr Starfield

J Epidemiol Community Health 2011;65:653-655 doi:10.1136/jech.2009.102780

Website: http://bit.ly/pTuxH3

“…..In this issue of JECH, authors from both the People's Health Movement 1 and WHO 2 agree that primary healthcare makes a considerable contribution to reducing the adverse impact of social inequalities on health.

That is, primary healthcare is a ‘health equity-producing’ social policy. Both groups of authors agree that health systems do not exist in isolation from other social systems. Both provide examples of how the market orientation of neo-liberal globalisation has worked against improvements in general and equity in health specifically. The role of world trade agreements in compromising nutritional status of socially disadvantaged populations provides a powerful case for the importance of inter-sectoral approaches in health policy activities.

Both papers speak of ‘primary health care’ rather than of ‘primary care’. The distinction between the two is at the heart of achieving greater equity in health through societal actions. Both clinical practices and system policies need consideration. 3

The literature on ‘primary care’ is largely clinical, having to do with the behaviour of health services professionals and their interactions with people and, increasingly, the subpopulations for whom they provide services. Within the last two decades there has been increasing clarity about which ‘behaviours’ are most important to adequacy of primary care: first contact accessibility and use, identification with a regular source of care that is person (rather than disease) focused care over time, comprehensiveness of services available and provided, and coordination (when care from other places is required).

Issue – content: http://bit.ly/o87RK4

Related Articles:

Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health

Kumanan Rasanathan, Eugenio Villar Montesinos, Don Matheson, Carissa Etienne, Tim Evans

J Epidemiol Community Health 2011;65:656-660 Published November 2009 doi:10.1136/jech.2009.093914

Revitalising primary healthcare requires an equitable global economic system - now more than ever

David Sanders, Fran E Baum, Alexis Benos, David Legge

J Epidemiol Community Health 2011;65:661-665 Published December 2009 doi:10.1136/jech.2009.095125