Global change and health - the good, the bad, and the evidence

Debates over the merits and demerits of globalisation for health are increasingly polarised. Conclusions range from globalisation being essentially positive for health, albeit with a need to smooth out some rough edges, to one of utter condemnation, with adverse effects on the majority of the world's population. Anyone wading into this debate is immediately confronted by seemingly irreconcilable differences in ideology, opinion and interests. Both camps agree that global changes are occurring, and with them many of the determinants of population health status. While some skepticism persists about whether “globalisation” has value beyond being a fashionable buzzword, most agree that we need better understanding of these changes. Two difficult questions arise: (i) What are the health impacts of these changes; and (ii) how can we respond more effectively to them? To move beyond the stand-offs that have already formed within the health community, this paper reviews the main empirical evidence that currently exists, summarises key points of debate that remain, and suggests some ways forward for the research and policy communities. In particular, there is need for an informed and inclusive debate about the positive and negative health consequences of globalisation.