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Relative Standing Today from the Past to Today criteria:
a.) Nation’s Share of Capital
Definition of “Share Capital”: Funds raised by issuing shares in return for cash or other considerations. The amount of share capital a company has can change over time because each time a business sells new shares to the public in exchange for cash, the amount of share capital will increase. Share capital can be composed of both common and preferred shares.

Gross Domestic Product (GDP)
The GDP is monetary value of all goods and services produced in a nation during a given time period, usually one year. Basically, it’s a tally of everything bought for money during the course of a year. Consumer purchases from a candy bar to a car are counted in the GDP. When business buy computer, farmers sell their crops, or a corporation exports goods overseas, the transaction all increase the GDP. Government spending, whether for a highway or a new bomber, also contributes to the GDP.

Gross National Product (GNP)
It is an additional measure of the size of the economy. It is the market value of final goods and services purchased by households, by government, and by foreign in current year. It uses slightly different criteria than GDP, and GDP is more often used for comparison of a nation’s economic progress against that of other countries.

GDP and GNP in the Global Economy
Due to factors such as technological advances, of trade barriers, and expansion of international financial markets, the world’s economies are more interconnected than ever before and the weakness of one can affect the health of them all. An internal crisis that affects the financial health of one country can send shockwaves around the world.

Most government of the world maintains a national accounting system that compiles various measures of economic activity. There is even a set of international guidelines, the system of National Accounts, which provides on measuring GDP and other key statistic.

Income approach
Sum the income received by all producers in the country.

Production approach
Estimating the Gross values of Domestic output in various economic activities. Determining the intermediate consumption
Deducting intermediate consumption from domestic value to obtain the Net Value of domestic output.

Comparing GDP of Different Nations

When computing GDP, nations use their local currency. In order to compare it
to the GDP’s of other countries, it must be converted to a common currency.

Converting value of currency, however, may result in an incomplete understanding of the true worth of money on a foreign nation’s economy. The same goods and services do not the same amount in every country. In addition to asking how much local currency equal in U.S., dollars one should ask how much value of a dollar will buy in the country.

Expenditures Approach to Calculating GDP
The expenditures Approach to calculating GDP by summing the four possible types of expenditures as follows:

GDP = Consumption
+Government Purchases
+Net Exports

The largest components of the GDP, consumption are calculated by adding durable and non-durable goods and services expenditures.

Investments in fixed assets and increases in inventory.

Government Purchases
Equal to the government expenditures less government transfer payments (welfare, unemployment payouts, etc.)

Net exports
Exports minus imports. Imports are subtracted since the GDP is defined as the output of the domestic economy.

There are three approaches to calculating GDP
-Expenditure approach
Calculated the final spending on goods and services.
-Production approach
Calculate the market value of goods and services.

These three approaches are equivalent with each rendering the same result.

Per capita income

The concept of international inequality refers to inequality across countries due to differences in per capita income among them. This concept of inequality takes as the unit of analysis, countries (nations) and, implicitly, omits intra-country income differences among its citizens. There are several methodological considerations involved in cross-country comparisons of per capita income: the exchange rates used in the comparisons (observed or purchasing power parity), the source of income data (survey-based or national accounts), etc.

An important methodological issue, relevant for assessing the empirical recent evidence on the evolution of international inequality is how to weigh countries to compute an index of international inequality. One procedure —unweighted international inequality— is to assume that all countries count equally (in an analogy, a sort of UN General Assembly concept in which one country is one vote).

Another concept is to weigh countries by population weighted international inequality. Here a more populous country (e.g. China) counts more than a small country (e.g. Luxembourg) when making inferences about the welfare level of the “representative individual” in the world economy. Another concept is world inequality. Here the unit of analysis is the citizen of the world rather than countries. The concept of world inequality treats, in principle, all individuals in the world the same and ranks them from the poorest to the richest, regardless their country of origin (Milanovic, 2001). An index of world inequality can be decomposed as the sum of international (between countries) inequality plus national (within country) inequality plus an overlapping component or residual (Yitzhaki, 1994). In other words, the distribution of income (welfare) of an individual of the world is the outcome of distributional patterns within the country he/she lives and the distribution of income of his/her country with respect to
other countries (plus the overlapping term or residual).

National inequality, say the disparity of the distribution of income within a country, provide the bridge between international and world inequality. The determinants of international inequality are the forces generating different rates of growth across countries that, over time, generate (important) differences in per capita income, living standards and levels of development across nations. In turn, national inequality depends on factor prices, ownership of productive resources within countries, demographic patterns, technical change and macroeconomic cycles. Of course, several of these factors can affect also international inequality.

Health care Services
Although predicated on the premise that the global concept is new, it actually had its origins in the late 1800s. Religious foreign mission groups felt it was their spiritual calling to tend to the sick and afflicted in poor countries (Schroth & Khawaja, 2007). The religious work of missions was closely linked to medical work. These missionaries believed that the services they provided were designed to reduce human misery and suffering, thereby elevating the status of God in the minds of people. Mission hospitals and mission doctors served as important points of entry of Western medicine into other countries, and were the hub of medical knowledge and practice. Private healthcare facilities were established as part of the charitable mission.

Even now, medical mission groups, such as Doctors without Borders and Heal the Nations, provide charitable medical care to the developing world. Subsequent innovations in healthcare have made it possible to bring patients from other countries into US hospitals for care that is not available in their home country.

Specialists from US hospitals may also be utilized in countries that have no such physicians. For instance, Operation Smile, an international medical humanitarian organization, has a presence in over 50 countries (Magee, 2009). Their focus is surgical treatment of children with cleft lip and palate while providing the necessary medical training for local medical volunteers that will result in self-sufficiency for these communities. Often persons travel to the US to avoid delays in care due to long lines and waiting periods experienced in other countries that may have universal coverage.

Telemedicine is the exchanging of patient information through the Internet or cybertechnology. This ability allows healthcare professionals to communicate patient status regardless of distance (Goldbach & West, 2010). Telehealth and teleconferencing have been used extensively for consulting with other professionals as well as reaching patients who live in rural or remote areas. The most popular direction globalization has taken is in the area of medical tourism.

This aspect involves patients choosing to leave one country for another in order to seek quality specialized care or major surgery at a reduced cost (Keckley & Underwood, 2007; Goldbach & West, 2010). Countries such as India, Singapore, and Thailand provide care such as cardiac surgery, joint replacements, and reconstructive surgery at significant differences in cost. For instance, in India, a person can have cardiac surgery for approximately $25,000 less than the cost in the US. Along with the medical care provided, these locations offer a vacation-like atmosphere. Another feature that encourages the use of medical tourism is the availability of medications and technologies that may be experimental in some countries but readily available in others.

Because of the cost differential, some private insurers also offer incentives to utilize medical tourism as a means of accessing health care services. Although medical tourism has led to knowledge development on a worldwide scale, concerns remain as to quality and liability. However, despite these concerns, entities such as medical tourism have the potential to increase awareness of illness and disease processes. This knowledge could be empowering to developing countries.

Since the early 1990s, over 48 million people have been displaced due to the environmental crisis and its health related impact (Toole, 1995). HIV rates are increasing both in the US and abroad, infecting nearly 25 million people. Other diseases such as tuberculosis and cholera have developed into drug-resistant strains proven difficult to treat, thus increasing the disease transmission rates. It is predicted that by 2020, heart disease will become the leading cause of disease an disability followed by depression and traffic accidents (Murray & Lopez, 1996). Poverty has been found to be a leading predictor of health disparities. More than 25 percent of the world’s population lives in poverty. This economic burden results in decreased access to necessary and affordable healthcare. Public and private healthcare expenditures worldwide equal about 8 percent of the world’s economic output (World Bank, 1993).

Life Expectancy
As noted at the beginning of this chapter, globalization is here to stay even if it benefits just one set of nations of the world. However, that does not mean that it is fair, justifiable, and that its course cannot be altered. On thing remains clear: Most citizens of this world realize the injustices and are asking the major powers and corporations that benefit from the system to ensure that the planet is the ultimate winner, bringing an end or reduction to inequities or disparities, especially in health, the theme of this chapter, and provide the means, the knowledge, and the empowerment they need politically, economically, and environmentally to live better lives.

This chapter has argued, and many others have done, that one of the most potent sticks through which to measure the objectives and the success of the phenomenon we have come to call globalization is the extent to which health and health care systems function for the extension of life expectancy and access to quality health care services.

One can argue that, in the final analysis, globalization and its acclaimed successes are interdependent on people’s health. Health concerns and priorities dominate our lives and without it, life is almost meaningless, as it is for many who carry the burden of disease, especially when this condition can be easily alleviated, as is the case with many infectious and communicable diseases in the developing world. According to Okasha (2005): The process [of globalization] has clearly both negative and positive results and is likely to create both losers and winners. Globalization has promised to grant the world instant communication, fast and efficient means of travel, a widened access to technology, cross-border cultural interaction and globalized approaches to environmental issues. However, it also entails deregulation of commerce and the creation of supernational political and economic bodies. As a result, the gap is widening between societies that “enjoy knowledge, technology and the ability to control events and others which are still backward, ignorant, frustrated, helpless and unable to follow progress and selfactualization” (Okasha, 2005). The public response

It is encouraging, however, that the unfairness of the system has not gone unnoticed. Labonte & Torgerson (2003) remind us that the WTO has actually been under fire from social and human rights activists, the United Nations, civil society, and non-governmental organizations (NGOs), and even from the European countries themselves, which created it at the Uruguay Round of Talks on the General Agreement on Tariffs and Trade (GATT). The WTO’s “level playing field,” with different rules and treatment, “is pushing many of these countries into deeper health-compromising poverty. Its negotiations to open public services to trade will hasten their privatization, with loss of access for the poor.” In other words, the health needs for most inhabitants of this planet appear gloomy for the foreseeable future.

Looking toward solutions

What is the solution? The intent of our chapter was not to give solutions to the problems of globalization but to provide an overview of what the phenomenon and its system have done to the health of many people of the world, currently reflected in the existing health disparities or inequities that have prevented them from enjoying access to quality health “care, life saving knowledge, reasonable income, clean air, clean water, sanitation, land, and gainful employment.” In order to reap the benefits of globalization, say many experts, “we need novel approaches to international cooperation that place national self-interest in the context of global mutual interest to promote international cooperation and goodwill” (Frenk and Gomez-Dantes, 2000; Pang & Guindon, 2004).


The Impact of Globalization Determinants and the Health of the World’s Population Mario J. Azevedo and Barbara H. Johnson
School of Health Sciences, Jackson State University, Jackson, Mississippi, USA

Globalization for Development: Trade, Finance, Aid, Migration and Policy Golding Kenneth A. Reinert

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