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Why Should Health Professionals Care About Globalization?

Individuals enter the health care profession for many reasons.  However, most health care professionals would probably agree that helping others is one of those reasons.  On a broad scale, caring for others implies that you have a desire to promote good health, prevent bad health outcomes, and alleviate suffering in other individuals.

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WHO/P. Virot

All physicians have the opportunity to express caring and compassion in their practices.  The majority of physicians have clinical practices in which the focus is on individuals.  For example, family doctors prescribe anti-hypertensive medication to patients with high blood pressure because hypertension is a risk factor for coronary artery disease (CAD).  The family physician will consider individual patient risk factors for CAD and prescribe interventions or treatments to optimize and minimize those risks to help the patient to achieve a longer, disability-free life.

Other types of physicians look at health from a population point-of-view.  These physicians are often in the specialty of community medicine and act as Medical Officers of Health who care for the health of citizens in a community by ensuring municipal water supplies are safe, and infections, such as tuberculosis which pose a threat to a broader population, are treated.

However, what constitutes population health is the subject of much debate [1].  In general terms, health is made up of a number of different components, including your biology (genetics), your physical environment, as well as social factors like class and gender.  The Public Health Agency of Canada defines 12 key determinants of population health [2]:

  • Income and social status

  • Social support networks

  • Education and literacy

  • Employment/working conditions

  • Social environments

  • Physical environments

  • Personal health practices and coping skills

  • Healthy child development

  • Biology and genetic endowment

  • Health services

  • Gender

  • Culture

One important omission from this list is ethnicity.  The role of ethnicity as a determinant of health is the subject of debate.  Ethnicity is often intertwined with other determinants, such as education and income, and in the case of genetic diseases, biology, so it is difficult to determine its exact role as a health determinant.  However, Isaacs and Schroeder suggest that policy and intervention targeted to alleviate class disparities would have a greater effect than those targeted at ethnic disparities [3].

 

Research comparing access to general practitioners (GPs) and specialists for countries around the world, including Canada, shows how income (high versus low) can impact on access to physicians.  The Organization for Economic Cooperation and Development (OECD) Health Equity Research Group commissioned a study comparing access to GPs and specialists based on income [4].  Globally, when controlling for need (i.e., people with lower incomes generally have more health problems and need more access to physicians) their results showed largely equitable access to GPs.  However, access to specialists showed an inequitable distribution that favoured the rich. 

 

 

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Do Canada's results surprise you? Why or why not?

 

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1. Friedman DJ, Starfield B. Models of population health: their value for US public health practice, policy, and research. American Journal of Public Health. 2003; 93(3): 366-369.

2. Public Health Agency of Canada [homepage on the Internet]. Ottawa: Public Health Agency of Canada; [updated 2003 June 16; cited 2006 June 12]. Available from: http://www.phac-aspc.gc.ca/ph-sp/phdd/determinants/index.html

3. Isaacs SL, Schroeder SA. Class – the ignored determinant of the nation’s health. New England Journal of Medicine. 2004; 351(11): 1137-1142.

4. van Doorslaer E, Masseria C, Koolman X for the OECD Health Equity Research Group. Inequalities in access to medical care by income in developed countries. Canadian Medical Association Journal. 2006; 174(2): 177-183.

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