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Where is the real debate on globalisation?
  1. J J Miranda1,
  2. A E Yamin2
  1. 1EDHUCASalud Founder Member, Civil Association for Health and Human Rights Education, Lima, Peru; and Peruvian Programme, Health Unlimited, Ayacucho, Peru
  2. 2Joseph L Mailman School of Public Health, Columbia University, New York, USA and EDHUCASalud Advisor, Lima, Peru
  1. Correspondence to:
 Dr J J Miranda;

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The debate section of the September 2001 issue was dedicated to the complex issue of globalisation.1–5 All the authors note the polarisation of the current debate and the importance of finding specific strategies to move forward.

Our point here is not to take sides as to the results of globalisation but to address the question of why these debates are so polarised. That is, precisely part of the problem is that there is no true “debate” occurring here because there is no level playing field between rich and poor countries, between the winners and the losers of the globalisation process. Indeed, the power of the pro-economic liberalisation forces is so great that in some senses this neo-liberal view of the world is taken to be “natural,” inalterable, and rejection of aspects of globalisation is portrayed as a return to the “Dark Ages.”4

So long as governments in the South internalise their role in this distorted economic system and those who are supposed to be critical thinkers accept that the basic processes of globalisation can only be ameliorated but not reformed, other academics and activists will always be in the position of protesting irately from the outside. As any heretics questioning an orthodoxy, they are forced to make the case ever more dramatically that the veil of “naturalness” must be pierced.

In this sense, as Krieger has pointed out: frameworks matter.6,7 The way we think about things determines what we do about them. We argue that a human rights approach to health brings these dynamics of power into focus and possibly provides what so many in the South have lost: hope for their future in this new world order. Taken together, the norms in international human rights instruments set out a vision of the world in which power is greatly diffused and entrenched disparities—with their obvious effects on health—are attacked at their root causes. A human rights approach is concerned with non-discrimination and equity, authentic social participation in health, and access to effective judicial remedies in the event of violations. In a larger sense it connects health to broader struggles for democracy and social justice. Conceptualising health issues as rights issues also provides a powerful way to place and keep them on the public agenda—a need expressed by various authors.

Clearly we need more systematic thinking about how to actually apply alternative frameworks, such as that suggested by human rights, to the issue of globalisation and health. Moreover, if the veil is to be pierced, not only health professionals but future generations of health professionals—who are still forming their views of what lies in the realm of the possible—must be made aware of these issues and mobilised. Indeed, because transnational trends determine the very possibilities for the provision of services as well as the health conditions in which populations live, it is especially crucial that future health professionals be exposed to these issues early on in their education and included in this debate.