Labonté Ronald, Schrecker Ted
Department of Epidemiology and Community Medicine, Faculty of Medicine and Institute of Population Health, University of Ottawa, Canada.
Global Health. 2007 Jun 19;3:7. doi: 10.1186/1744-8603-3-7.
This article is the third in a three-part review of research on globalization and the social determinants of health (SDH). In the first article of the series, we identified and defended an economically oriented definition of globalization and addressed a number of important conceptual and metholodogical issues. In the second article, we identified and described seven key clusters of pathways relevant to globalization's influence on SDH. This discussion provided the basis for the premise from which we begin this article: interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy. Reflecting this insight, and against the background of the Millennium Development Goals (MDGs), we focus on the asymmetrical distribution of gains, losses and power that is characteristic of globalization in its current form and identify a number of areas for innovation on the part of the international community: making more resources available for health systems, as part of the more general task of expanding and improving development assistance; expanding debt relief and taking poverty reduction more seriously; reforming the international trade regime; considering the implications of health as a human right; and protecting the policy space available to national governments to address social determinants of health, notably with respect to the hypermobility of financial capital. We conclude by suggesting that responses to globalization's effects on social determinants of health can be classified with reference to two contrasting visions of the future, reflecting quite distinct values.
本文是关于全球化与健康的社会决定因素(SDH)研究的三篇系列综述中的第三篇。在该系列的第一篇文章中,我们确定并捍卫了一个以经济为导向的全球化定义,并探讨了一些重要的概念和方法论问题。在第二篇文章中,我们确定并描述了与全球化对健康的社会决定因素的影响相关的七个关键途径集群。这一讨论为我们在本文开始时所依据的前提提供了基础:通过健康的社会决定因素来减少健康不平等的干预措施与社会保护、经济管理和发展战略有着千丝万缕的联系。反映这一见解,并在千年发展目标(MDGs)的背景下,我们关注当前形式的全球化所特有的收益、损失和权力的不对称分配,并确定国际社会在创新方面的一些领域:作为扩大和改善发展援助这一更广泛任务的一部分,为卫生系统提供更多资源;扩大债务减免并更认真地对待减贫问题;改革国际贸易体制;考虑健康作为一项人权的影响;以及保护国家政府为解决健康的社会决定因素而拥有的政策空间,特别是在金融资本高度流动方面。我们在结论中指出,对全球化对健康的社会决定因素的影响的应对措施可以参照两种截然不同的未来愿景进行分类,这两种愿景反映了截然不同的值。