This brief review of papers points to several important gaps in the initial coverage of Globalization and Health, some of which mirror challenges facing the wider international publishing field. One important conclusion is that, despite its importance to the field, social science has been somewhat under-represented in the journal to date. This situation begins to be addressed with publication of this special issue, a selection of peer reviewed papers from those presented at a research sympo-sium organised by King’s College London, Jawaharlal Nehru University and LSE Health, London School of Economics and Political Science (LSE) on this theme in July 2010. The international meeting was held at the LSE and supported by the UK Economic and Social Research Council (ESRC). The special issue brings together review articles, reports of original research studies and concept papers that reflect current developments within a range of social science disciplines contributing to this area of enquiry. The aim of the collection is to highlight challenges and innovative approaches and to inform future research agendas. The full collection can accessed athttp://www.globalizationandhealth.com/series/social_science_perspectives
The special issue draws together empirical and non-empirical studies from different disciplines with first authors from economics[15–18], political science, psychology, sociology, business studies, social policy. It also includes a perspective from public health that takes up the case for greater funding of social science research.
Bisht et al. ()’s systematic scoping exercise directly investigates the current social science contribution to an understanding of globalization and healthcare using the lens of India. Using an extensive multistage search process across electronic databases, journal indexes and books, the paper maps social science contributions in seven thematic areas: transnational movement of healthcare workforce; transnational consumption of services; production, consumption and trade in specific healthcare related commodities; transnational diffusion of ideas and knowledge; new global governance issues and structures; transnational delivery of services; and transnational movement of capital. The review demonstrates that there is a recent and expanding literature with some important empirical studies despite inherent difficulties such as obtaining global comparative data and in accessing commercially sensitive information.
The remaining articles in this issue fall into two broad thematic areas: Globalization of healthcare markets and Governance and regulation issues.
Globalization of healthcare markets
Early content of this journal gave relatively little attention to transnational trade and delivery of health services, and the current transnational movement of health care providers, consumers or capital. A number of the papers in this special issue address this deficit, with research relating directly to the globalization of health care markets.
Three of the contributions explore the potential for bi-lateral agreements between India and other countries. Chanda (2011) considers the opportunity for and constraints to India-European Union (EU) relations in health services against a backdrop of the India-EU Trade and Investment Agreement (TIA) currently under negotiation. The paper draws on interviews with management and practitioners from a variety of healthcare establishments in four Indian cities as well as official representatives from the Indian and EU countries. The paper argues that whilst there are evident opportunities for trade, for example, in the case of e-health services and medical value travel, significant steps would be required before realising these. Not least, concerns about the commercialization of health services would have to be overcome by EU partners who are more comfortable with and confident of public sector healthcare delivery. Two further papers by Martinez Alvarez and colleagues[16, 17] explore in more depth the potential for bi-lateral agreements between India and the UK for medical tourism and for telemedicine. Using a similar approach -structured interviews with stakeholders in the UK and India - these papers highlight the many concerns and a degree of scepticism that remain around bi-lateral agreements.
Lethbridge (2011) is an example of the value of ‘cross-fertilization’ of ideas to illuminate health questions. In her qualitative study of the actions and motives of five multinational companies engaged in provision and management within public health systems she draws on Porter’s Five Forces theory of company expansion, a business strategy framework not often applied to studies in health policy. Pocock and Phua (2011) draws on experience of Thailand, Singapore and Malaysia in order to propose a conceptual framework to understand medical tourism and its policy implications for health systems. The framework identifies five key components for consideration and future empirical analysis: governance; regulation; delivery; financing and human resources. The authors highlight that whilst medical tourism can bring economic benefits for countries this may come at the expense of access and use of health services by the local population and that policies in these five areas must be adequately addressed at a national level.
Sarojini et al. () consider the specific issue of the globalization of ‘birth markets’ and the equity and ethical implications of growth of Assisted Reproductive Technologies (ART) in India. The paper draws on exploratory qualitative research undertaken by SAMA Resource Group for Women and Health, a Delhi-based resource group working on gender, health and rights. Their work captures what Brown & Labonte (2011) have referred to as the dialectical features associated with globalization. The paper maps the growth and features of the fertility industry in India including actors, costs, marketing and regulation and sets this against the concern about exploitation and the failure to ensure wellbeing, rights and security for the women involved. In conclusion it raises the important question, “how can we ensure that the crossing of geographic and ‘biological’ boundaries does not become a crossing of ethical boundaries?”.
Governance and regulation
Four papers consider issues of governance and regulation, two of these within the sphere of pharmaceuticals. Iriart et al. (2011) consider the challenges for health sector regulation in Latin America following the liberalisation of markets and expansion of neo-liberal ideas. Drawing on primary and secondary sources, the authors use the concepts of biomedicalization and biopedagogy to show how the pharmaceutical industry has developed strategies to increase their share of the health market. The authors argue that regulatory agencies in both developed and developing countries lack capacity to keep pace with and regulate data gathering and communication tools that the multinational corporations create to reach their populations. Mackintosh et al. () consider the potential role of non-governmental organisations (NGOs) in pharmaceutical market regulation, given the recognised lack of adequate regulation in countries such as India and Tanzania. Based on data from interviews with trading NGOs and social enterprises operating in Europe, India and Tanzania, the authors apply a socio-legal and economic perspective to assess the activities of these enterprises in essential medicines wholesaling. Their findings suggest that social enterprise wholesaling can improve access to medicines in the absence of effective governmental activity but that it should not replace state action.
Salter & Faulkner (2011)’s concern is the governance of global life science and biomedical innovations with particular reference to the ‘Rising Powers’ such as India and China. They draw on contributions from across political science, political economy, sociology of technology, innovation studies and science and technology studies. Following a thorough review of existing conceptual approaches, Salter and Faulkner conclude that an approach is required that “enables innovation and governance to be seen as ‘co-producing’ each other in a multi-level, global ecology of innovation, taking account of the particular, differing characteristics of different emerging scientific fields and technologies”.
The final paper comes from a public health commentator who argues strongly for greater input and recognition for social science in research policies. McCarthy (2011) considers how global knowledge transfer has long been an important driver of cultural and economic development. Reviewing current policies of the European Commission that promote science for innovation within European member states and the international transfer of people and ideas, he concludes that there is too much attention on biomedical innovation at the expense of the need for innovation in health and social systems and for increased participation of civil society organisations that will be required to meet the challenges of globalization on health.