Education And Debate

Globalisation and the challenges to health systems

BMJ 2002; 325 doi: (Published 13 July 2002) Cite this as: BMJ 2002;325:95
  1. Julio Frenk, minister of health,
  2. Octavio Gómez-Dantés, assistant director for performance evaluation (
  1. Ministry of Health, 06600 Mexico City, Mexico

    In this article, based on a talk given to a recent meeting on global health, Julio Frenk and Octavio Gómez-Dantés argue that, although there are many threats inherent in globalisation, improving health is a unifying activity. They suggest that “exchange, evidence, and empathy” should characterise international activities to improve health and health care for all the world's people

    In the aftermath of the events of 11 September Britain's prime minister, Tony Blair, reminded us of what he called “the fragility of our frontiers in the face of the world's new challenges” (Labour Party Conference, Brighton, October 2001). This shift of human affairs from the restricted frame of the nation state to the vast theatre of planet earth is not only affecting trade, finance, science, the environment, crime, and terrorism; it is also changing the nature of health challenges facing people all over the world.1

    In 1997 an influential report by the US Institute of Medicine stated: “Distinctions between domestic and international health problems are losing their usefulness and are often misleading.”2 We are all coming closer to each other. One of the great revolutions of the 20th century was, in the words of the historian Eric Hobsbawm, the virtual annihilation of time and distance.3

    Summary points

    Globalisation is affecting health as well as other aspects of human activity

    All countries must deal with the international transfer of risks—whether this is of microbes, unregulated distribution of drugs, or tobacco marketing

    On the other hand, globalisation makes the sharing of information on health care easier

    The aspiration for good health is also a unifying factor across different parts of the world, cultures, and religions

    The death of distance

    Intense international contacts are not new. From time immemorial the forces of trade, migration, war, and conquest have bound together people from distant places. The expression “citizen …

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