- Open Access
Understanding health systems, health economies and globalization: the need for social science perspectives
© Murray et al.; licensee BioMed Central Ltd. 2012
- Received: 14 February 2012
- Accepted: 14 February 2012
- Published: 31 August 2012
The complex relationship between globalization and health calls for research from many disciplinary and methodological perspectives. This editorial gives an overview of the content trajectory of the interdisciplinary journal ‘Globalization and Health’ over the first six years of production, 2005 to 2010. The findings show that bio-medical and population health perspectives have been dominant but that social science perspectives have become more evident in recent years. The types of paper published have also changed, with a growing proportion of empirical studies. A special issue on ‘Health systems, health economies and globalization: social science perspectives’ is introduced, a collection of contributions written from the vantage points of economics, political science, psychology, sociology, business studies, social policy and research policy. The papers concern a range of issues pertaining to the globalization of healthcare markets and governance and regulation issues. They highlight the important contribution that can be made by the social sciences to this field, and also the practical and methodological challenges implicit in the study of globalization and health.
The peer-reviewed, online open-access journal Globalization and Health was established in with the aim of providing an international forum for high quality original research, knowledge sharing and debate on the topic of globalization and its effects on health, both positive and negative. Within its stated scope the journal recognises the complexity and breadth of topics and the range of disciplinary perspectives required to understand the relationship between globalization and health. In this editorial and special issue we pay attention to the particular contribution of social science. Social scientists, including economists, political scientists and sociologists, have undoubtedly been key contributors to the discussions and theorising about globalization processes since they began to use the term in thes, long its current widespread use. That theoretical armoury is combined with research approaches that lend themselves well to exploration of the micro, meso and macro forces that confront health systems in the globalizing world, and one would expect to see prominent participation of these disciplines in current published research in this field. The review paper by Bisht et al. published in this special issue examines the broader ‘state of the art’ in this regard using the case of research on India, and gives suggestions for future ways forward. We also undertook a mapping of this journal’s own content in order to track trends, emphases, commonalities and differences in the work published over the first six full years of its operation ([2005, 2010]) and to locate the place of social science within its content so far. Ninety four papers were reviewed for topic, author’s institution, disciplinary perspective, geographical focus, methodology and funding. Topics were then grouped into more general themes.
The topic areas of HIV/AIDS and globalization and food, diet and obesity have been consistent themes throughout the early years of the journal, as have access to medicines and issues concerning TRIPS and trade agreements. Non-communicable and chronic diseases have seen a growth in the later years, particularly in and with the special issue dedicated to ‘Africa’s chronic disease burden: local and global perspectives’, reflecting the greater attention being given to non-communicable diseases (NCDs) at a global level. Some topics have received concentrated but one-off attention such as a mini-series of papers relating to globalization and social determinants of health published in[2, 4] to coincide with the Interim Statement of the Commission on Social Determinants of Health.
Most papers published in the initial period of publication focus on how economic development and trade may impact on proximal determinants of health, confirming the need for a new journal with the scope for such work. A number of papers also focus on what Huynen et al. refer to as institutional responses, looking at global governance and policy issues (e.g.[6–9]). Less attention has been given to the role of global communication, global mobility and cross-cultural interaction and, despite its currency, very little to the impact of global environmental changes.
There has been a notable change in the type of study published in this journal over time. All but four of the papers published in 2005 and 2006 were non-empirical in content. These included editorials, debates, reviews without explicitly reported methodology, and conceptual work. In contrast, in years 2008-2010 these sorts of contributions comprised only around half of papers published each year. In total, out of 94 papers across the six years 10 presented primary research, 15 secondary analysis and 7 structured or systematic literature reviews. Methodological approaches used in studies began to represent the diversity that is needed in this field, ranging from macro-level quantitative research such as a statistical analysis of effects of globalization on health analysis of the dynamics of global antiretroviral medicine markets to micro level, inductive studies aimed at explaining how processes of globalization are experienced such as that of Read et al. () exploring local suffering within global discourses on mental health and human rights. In general more papers (n = 53) refer to a ‘global’ context or to developing countries in general, and fewer give focus to individual countries or specific world regions (n = 32). In 2009 and 2010 there was an increase in the number of papers focusing on specific countries and this may reflect the increasing number of empirical studies published during this time.
Sources of research funding were poorly reported but where information was available there was a fairly equal spread between public (n = 15) and private sources (n = 19). Public funding sources included government departments such as the Department for International Development, UK and national research councils. Private sources included pharmaceutical companies, not-for-profit organisations, private foundations and university departments in US universities. For the vast majority of papers (n = 87) the first author was affiliated to an institution in a high income country, despite the publisher’s policy to waive the article processing fee for authors from low-income countries and long standing calls to ensure research from developing countries is represented in international health literature Langer et al..
The majority of papers each year, and 54 out of 94 in total, have lead authors with a bio-medical or population health perspective (including epidemiology and public health) but in more recent years a greater proportion of social science papers have been published rising to 9 out of 23 in 2010. No one social science discipline dominated and there have been contributions from economics (incorporating health economics), psychology, political science and international studies, demography, development studies, management and business studies, human geography, social policy, sociology and anthropology.
This editorial began by highlighting the dominance of ‘population health science’ perspectives and the relative lack of social science perspectives in papers published in this journal Globalization and Health during its early years. The papers we have introduced in this special issue make a contribution to redressing that balance and in doing so they demonstrate the valuable contribution that social sciences can make in questioning the taken-for‐granted assumptions of prevailing ideology, in developing illuminating theory, and in testing and modifying existing theory in the light of empirical situated data. The range of disciplinary perspectives captured in the special issue is broad and reflective of the range of disciplines that may contribute to the understanding of the complex relations between globalization and health. Where there is less diversity is in the research methods that were employed and this highlights a persistent challenge for researchers concerned with the study of globalization and health. An understanding of the relationships between globalization and health requires perspective on macro, meso and micro levels, and innovative methodological approaches to enable this. Bisht et al. highlight, for example, that the extended case study method as one approach seldom used in the health sphere that may have particular purchase through its ability to move between the micro to macro. Similarly, Brown and Labonte have recently highlighted the potential of qualitative methods in particular in understanding how the “intersects of globalization are manifested in particular locations”. The journal invites further contributions to this discussion and warmly encourages submissions that explore and employ new methodology that will help to extend our understanding of the field and of the accompanying processes of social change.
This paper and special issue resulted from work funded by ESRC Rising Powers Network grant RES-075-25-0015.
- Bisht R, Pitchforth E, Murray SF: Understanding India, globalisation and health care systems: a mapping of research in the social sciences. Glob Heal. 2007, 8: 32-View ArticleGoogle Scholar
- Labonte R, Schrecker T: Globalization and social determinants of health: introduction and methodological background (Part 1 of 3). Glob Heal. 2007, 3: 5-10.1186/1744-8603-3-5.View ArticleGoogle Scholar
- Labonte R, Schrecker R: Globalization and social determinants of health: the role of the global marketplace (part 2 of 3). Glob Heal. 2007, 3: 6-10.1186/1744-8603-3-6.View ArticleGoogle Scholar
- Labonte R, Schrecker T: Globalization and social determinants of health: promoting health equity in global governance (part 3 of 3). Glob Heal. 2007, 3: 7-10.1186/1744-8603-3-7.View ArticleGoogle Scholar
- Huynen M, Martens P, Hilderink H: The health impacts of globalisation: a conceptual framework. Glob Heal. 2005, 1 (1): 14-10.1186/1744-8603-1-14.View ArticleGoogle Scholar
- Coovadia H, Hadingham J: HIV/AIDS: global trends, global funds and delivery bottlenecks. Glob Heal. 2005, 1 (1): 13-10.1186/1744-8603-1-13.View ArticleGoogle Scholar
- Magnusson R: Non-communicable diseases and global health governance: enhancing global processes to improve health development. Glob Heal. 2007, 3 (1): 2-10.1186/1744-8603-3-2.View ArticleGoogle Scholar
- Ooms G, Van Damme W, Baker B, Zeitz P, Schrecker T: The “diagonal” approach to Global Fund financing: a cure for the broader malaise of health systems?. Glob Heal. 2008, 4 (1): 6-10.1186/1744-8603-4-6.View ArticleGoogle Scholar
- Ooms G: Shiftng paradigms: how the fight for “universal access to AIDS treatment and prevention” supports achieving “comprehensive primary health care for all.”. Glob Heal. 2008, 4 (1): 11-10.1186/1744-8603-4-11.View ArticleGoogle Scholar
- Martens P, Akin S-M, Maud H, Mohsin R: Is globalization healthy: a statistical indicator analysis of the impacts of globalization on health. Glob Heal. 2010, 6 (1): 16-10.1186/1744-8603-6-16.View ArticleGoogle Scholar
- Waning B, Kyle M, Diedrichsen E, Soucy L, Hochstadt J, Barnighausen T, Moon S: Intervening in global markets to improve access to HIV/AIDS treatment: an analysis of international policies and the dynamics of global antiretroviral medicines markets. Glob Heal. 2010, 6 (1): 9-10.1186/1744-8603-6-9.View ArticleGoogle Scholar
- Brown G, Labonte R: Globalization and its methodological discontents: Contextualizing globalization through the study of HIV/AIDS. Glob Heal. 2011, 7 (1): 29-10.1186/1744-8603-7-29.View ArticleGoogle Scholar
- Read U, Adiibokah E, Nyame S: Local suffering and the global discourse of mental health and human rights: An ethnographic study of responses to mental illness in rural Ghana. Glob Heal. 2009, 5 (1): 13-10.1186/1744-8603-5-13.View ArticleGoogle Scholar
- Langer A, Díaz-Olavarrieta C, Berdichevsky K, Villar J: Why is research from developing countries underrepresented in international health literature, and what can be done about it?. Bull World Health Organ. 2004, 82 (10): 802-803.PubMedPubMed CentralGoogle Scholar
- Mackintosh M, Chaudhuri S, Mujinja P: Can NGOs regulate medicines markets? Social enterprise in wholesaling, and access to essential medicines. Glob Heal. 2011, 7 (1): 4-10.1186/1744-8603-7-4.View ArticleGoogle Scholar
- Martinez Alvarez M, Chanda R, Smith R: How is Telemedicine perceived? a qualitative study of perspectives from the UK and India. Glob Heal. 2011, 7 (1): 17-10.1186/1744-8603-7-17.View ArticleGoogle Scholar
- Martinez Alvarez M, Chanda R, Smith R: The potential for bi-lateral agreements in medical tourism: A qualitative study of stakeholder perspectives from the UK and India. Glob Heal. 2011, 7 (1): 11-10.1186/1744-8603-7-11.View ArticleGoogle Scholar
- Chanda R: India-EU relations in health services: prospects and challenges. Glob Heal. 2011, 7 (1): 1-10.1186/1744-8603-7-1.View ArticleGoogle Scholar
- Salter B, Faulkner A: State strategies of governance in biomedical innovation: aligning conceptual approaches for understanding “Rising Powers” in the global context. Glob Heal. 2011, 7 (1): 3-10.1186/1744-8603-7-3.View ArticleGoogle Scholar
- Iriart C, Franco T, Merhy E: The creation of the health consumer: challenges on health sector regulation after managed care era. Glob Heal. 2011, 7 (1): 2-10.1186/1744-8603-7-2.View ArticleGoogle Scholar
- Lethbridge J: Understanding multinational companies in public health systems, using a competitive advantage framework. Glob Heal. 2011, 7 (1): 19-10.1186/1744-8603-7-19.View ArticleGoogle Scholar
- Pocock N, Phua KH: Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia. Glob Heal. 2011, 7 (1): 12-10.1186/1744-8603-7-12.View ArticleGoogle Scholar
- McCarthy M: European health research and globalisation: is the public-private balance right?. Glob Heal. 2011, 7 (1): 5-10.1186/1744-8603-7-5.View ArticleGoogle Scholar
- Sarojini N, Marwah V, Shenoi A: Globalisation of Birth Markets: A Case Study of Assisted Reproductive Technologies in India. Glob Heal. 2011, 7 (1): 27-10.1186/1744-8603-7-27.View ArticleGoogle Scholar
- Burawoy M: The extended case method. Sociological Theory. 1998, 16 (1): 4-33. 10.1111/0735-2751.00040.View ArticleGoogle Scholar
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