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EDITORIALS: Nigel Unwin, George Alberti, Terry Aspray, Richard Edwards, Jean-Claude Mbanya, Eugene Sobngwi, Ferdinand Mugusi, Seif Rashid, Philip Setel, and David Whiting Economic globalisation and its effect on health BMJ 1998; 316: 1401-1402 [Full text]

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Globalisation and the immigrant worker

Dan Michaeli   (9 May 1998)

Who decides health policy ?

Dorothy Logie   (9 May 1998)

Globalisation and the immigrant worker 9 May 1998
Dan Michaeli, chairman of the board of directors kupat holim clalit, israel Send response to journal: Re: Globalisation and the immigrant worker	The authors of the article on Economic Globalization and it Effects on Health raise important issues, but omitted one aspect. This is the fate of the labourers who move from less developed countries to the richer countries. These displaced people who must follow the shift in the investment of the industry are deprived of the adequate insurance and access to the health services of the richer local population. They pose on one hand a health problem exposing indigeneous populations to diseases they are not accustomed to, but at the same time they are sometimes deprived of very essential healthcare. The problem is even worse when these people are "illegal" and so prone to a worse situation vis a vis the local health and social systems. The scope of the problem is vast and cannot be discussed in a short letter but I suggest that the WHO and its member states should recognize this as a priority item and try to establish an international convention that will define the essential insurance and health services to which these people will be eligible . Sincerely,
Who decides health policy ? 9 May 1998
Dorothy Logie, adviser in primary care Scottish Borders Health Board Send response to journal: Re: Who decides health policy ?	Guerrero et al argue convincingly that health is too important to be left to doctors as the number of people who live in poverty increases each year. Health policy is also too important to be left to bankers and economists whose public health motives are even more suspect. Since 1993, with the publication of the World Development Report on health, the World Bank has been the leader in deciding gloabl health policy. It is also the main source of funding for health ( total annual health lending is roughly $3 billion). Meanwhile WHO has lost influence and been starved of funds. The economic adjustment policies of the World bank forced upon indebted countries have contributed to the present gross disparities in health. Not only have they reduced health spend but these policies have had " knock-on" effects which greatly impact on health, like reducing food subsidies, increasing illiteracy, especially among women,encouraging privatisation of health services, introducing user-fees for health care, alterating behaviour, increasing violence, encouraging migration,increasing the demand on women's work and time etc. How can public health doctors be encouraged to recapture the health agenda from the World Bank and ensure that health and social spending is given the priority it deserves ? Even in economic terms, and in our own self-interest, it makes no sense for the health of whole populations to be neglected to such an extent. Dorothy Logie.