How does globalisation affect women's health?
Authors: Johanna Hanefeld
Journal: The Lancet Global Health (2017)

In the past 20 years, a body of research has developed that explicitly examines the effects of the economic, environmental, and social changes associated with globalisation on health.1Cornia GA Globalization and health: results and options.Bull World Health Organ. 2001; 79: 834-841PubMed Google Scholar, 2McMichael Anthony J Globalization, climate change, and human health.N Engl J Med. 2013; 368: 1335-1343Crossref PubMed Scopus (335) Google Scholar, 3Schrecker T Labonté R De Vogli R Globalisation and health: the need for a global vision.Lancet. 2008; 372: 1670-1676Summary Full Text Full Text PDF PubMed Scopus (48) Google Scholar This research has focused, for example, on the effect of increasing levels of trade in health services, such as movement of health workers, medical tourism, and foreign direct investment,4Smith RD Chanda R Tangcharoensathien V Trade in health-related services.Lancet. 2009; 373: 593-601Summary Full Text Full Text PDF PubMed Scopus (132) Google Scholar on nutrition, and on related risk factors for non-communicable disease.5Hawkes C Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases.Global Health. 2006; 2: 4Crossref PubMed Scopus (547) Google Scholar The research has also included macro-level research on the effects of foreign direct investment on specific aspects of health.6Hawkes C The role of foreign direct investment in the nutrition transition.Public Health Nutr. 2005; 8: 357-365Crossref PubMed Scopus (159) Google Scholar Evidence generated shows that the processes associated with globalisation have substantial effects on health; for example, an increase in obesity as a result of increased availability of low-cost, processed foods through increased trade.5Hawkes C Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases.Global Health. 2006; 2: 4Crossref PubMed Scopus (547) Google Scholar The evidence also suggests that gender intersects with many of the health effects of globalisation, leading to specific consequences for women's health.7Sen G Ostlin P Gender inequity in health: why it exists and how we can change it.Glob Public Health. 2008; 3: 1-12Crossref PubMed Scopus (143) Google Scholar Specific health effects for women have been shown to be related to changing patterns of employment, resulting from changed realities in ownership and investment, and to the effects of migration and urbanisation.6Hawkes C The role of foreign direct investment in the nutrition transition.Public Health Nutr. 2005; 8: 357-365Crossref PubMed Scopus (159) Google Scholar, 7Sen G Ostlin P Gender inequity in health: why it exists and how we can change it.Glob Public Health. 2008; 3: 1-12Crossref PubMed Scopus (143) Google Scholar Research published in the past 20 years has included a focus on how labour migration affects women's health.8Zimmerman C Kiss L Hossain M Migration and health: a framework for 21st century policy-making.PLoS Med. 2011; 8: e1001034Crossref PubMed Scopus (371) Google Scholar This reseach extends to the type and pattern of employment and the associated health risks, including trafficking of women and sexual exploitation.9Hanefeld J Globalisation and health. McGraw-Hill Education, UK2015Google Scholar Mental health also emerged as an important area for which the effects of globalisation on health are gender specific.10Hossain M Zimmerman C Abas M Light M Watts C The relationship of trauma to mental disorders among trafficked and sexually exploited girls and women.Am J Public Health. 2010; 100: 2442-2449Crossref PubMed Scopus (225) Google Scholar However, research and evidence focusing explicitly on how globalisation affects women's health has been comparatively limited so far.11Loewenson R Nolen LB Wamala S Review article: globalisation and women's health in Sub-Saharan Africa: would paying attention to women's occupational roles improve nutritional outcomes?.Scand J Public Health. 2010; 38: 6-17Crossref PubMed Scopus (21) Google Scholar The scientific literature has significantly advanced understanding of how globalisation interacts with health, including women's health. However, much of this research on the interaction between globalisation and women's health has focused on developing frameworks for causal association,9Hanefeld J Globalisation and health. McGraw-Hill Education, UK2015Google Scholar mapping the effect,7Sen G Ostlin P Gender inequity in health: why it exists and how we can change it.Glob Public Health. 2008; 3: 1-12Crossref PubMed Scopus (143) Google Scholar analysing macro-level trends and data sets,12Dollar D Is globalization good for your health?.Bull World Health Organ. 2001; 79: 827-833PubMed Google Scholar or exploring effects on a specific section of the population.10Hossain M Zimmerman C Abas M Light M Watts C The relationship of trauma to mental disorders among trafficked and sexually exploited girls and women.Am J Public Health. 2010; 100: 2442-2449Crossref PubMed Scopus (225) Google Scholar Empirical research focusing especially on foreign direct investment has been limited so far, partly because of the difficulty in obtaining reliable data.4Smith RD Chanda R Tangcharoensathien V Trade in health-related services.Lancet. 2009; 373: 593-601Summary Full Text Full Text PDF PubMed Scopus (132) Google Scholar The study by Gábor Scheiring and colleagues13Scheiring G Stefler D Irdam D et al.The gendered effects of foreign investment and prolonged state ownership on mortality in Hungary: an indirect demographic, retrospective cohort study.Lancet Glob Health. 2017; (published online Nov 27.)http://dx.doi.org/10.1016/S2214-109X(17)30391-1PubMed Google Scholar presented in The Lancet Global Health breaks new ground. It links, for the first time, data on company ownership (whether state owned, domestic–private owned, or foreign owned) with individual health, focusing on 52 towns in Hungary. The study shows with much greater certainty the effect of a wider determinant of health, foreign direct investment and the patterns of company ownership, on individual health. The findings present the particularly gendered effect of type of company ownership. The study shows the extent to which changes in employment affect individual health, and that this effect differs between men and women. The study findings13Scheiring G Stefler D Irdam D et al.The gendered effects of foreign investment and prolonged state ownership on mortality in Hungary: an indirect demographic, retrospective cohort study.Lancet Glob Health. 2017; (published online Nov 27.)http://dx.doi.org/10.1016/S2214-109X(17)30391-1PubMed Google Scholar are fascinating because they reveal that prolonged state ownership had protective effects for women's health when compared with private ownership, and that despite greater income in communities with predominately foreign ownership, health was worse. This finding holds immediately relevant policy advice for countries seeking to transition from state to private ownership—ie, that rapid privatisation will be bad for health, and particularly bad for the health of women. The findings also underline the importance of strong regulation. The study results13Scheiring G Stefler D Irdam D et al.The gendered effects of foreign investment and prolonged state ownership on mortality in Hungary: an indirect demographic, retrospective cohort study.Lancet Glob Health. 2017; (published online Nov 27.)http://dx.doi.org/10.1016/S2214-109X(17)30391-1PubMed Google Scholar are perhaps even more tantalising for what they suggest but do not fully investigate. Did gender relations and norms change as a result of changes in employment more generally? Are specific associated social changes or organisational changes occurring within the privatised companies (foreign and domestic) that help further account for the findings and that might hold lessons on how to mitigate the effect of privatisation on women's health in future? In addition to showcasing a novel method of investigating the effect of privatisation on health, the study13Scheiring G Stefler D Irdam D et al.The gendered effects of foreign investment and prolonged state ownership on mortality in Hungary: an indirect demographic, retrospective cohort study.Lancet Glob Health. 2017; (published online Nov 27.)http://dx.doi.org/10.1016/S2214-109X(17)30391-1PubMed Google Scholar also underlines the importance of doing such quantitative analysis together with qualitative work. I would hope that further qualitative research will be done to explain the findings further, both in Hungary and in other countries where researchers could do similar research. Most importantly, I hope that these study findings, particularly those relating to the cost to women's health, will be considered in future plans for privatisation. I declare no competing interests. The gendered effects of foreign investment and prolonged state ownership on mortality in Hungary: an indirect demographic, retrospective cohort studyProlonged state ownership was associated with protection of life chances during the post-socialist transformation for women. The indirect economic benefits of foreign investment do not translate automatically into better health without appropriate industrial and social policies. Full-Text PDF Open Access