Gender Globalization Health

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Gender Globalization - Health

• Fogarty International Center
• Advisory Board Meeting
• May 24, 2005

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Gender is a central political determinant of
health

• Gender refers to structural inequalities marked
  by unequal access for women and men to material
  and non material resources. It is not just a
  question of roles and behaviors or income but
  it permeates social institutions and political
  structures and processes. It is an organizing
  principle of social life.
• (Gender and Global Governance 2000)

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Gender Inequality A problem with a solution

• Two decades of innovation, experience, and
  activism have shown that achieving the goal of
  greater gender equality and womens empowerment
  is possible.
• BUT
• Because gender inequality is deeply rooted in
  entrenched attitudes, societal institutions, and
  market forces, political commitment.is
  essential Millennium Project Task Force 3
  report 2005

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Key question

• Whos got the power?
• The chasm between what we know and what we do is
  deeply and fundamentally political.
• This is a consequence of neutralizing the problem
  MP Task force MCH 2005

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Gender, Health and Globalization

• DRIVING FORCES
• THEIR IMPACT
• AGENCY
• ETHICS
• AGENDA

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New context new challenges

• In the face of globalization and modernization we
  need
• a conceptual tool kit
• analytical frameworks
• Better evidence
• Understanding of patterns rather than causality

• We need a better understanding of the
  relationship between changed conditions of life
  and the health of individuals and communities
• direct and indirect pathways

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Example Dimensions of gender equality

• MP task force 3 framework three interrelated
  domains
• The capabilities domain basic human abilities as
  measured by education, health and nutrition
• The access to resources and opportunities domain
  use capabilities
• The security domain reduced vulnerability

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Driving Forces Three social constructs and
dynamics

• Gender

• Globalization

Health
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Initial Explorations globalization is gendered

• The impact of globalization processes on health
  are gendered life chances and life choices
• By shifting gender relations globalization
  becomes a pathway to differential health impact
• The globalization of health is also pathway to
  changed gender relationships
• Kickbusch/Hartwig/List Globalization, Gender and
  Health in the 21st Century. Palgrave 2005

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Driving Force Health

• Health is created where people live, love, work
  and play.
• Ottawa Charter for Health Promotion 1986
• Health systems are
• Social institutions

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Association of health, social change and
modernity smoking

• Signifier of modernity (accessible and
  affordable)
• Correlation between gender development index and
  rate of female smoking
• Multidimensional me contemporary, feminine,
  sensory pleasure

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Association of health, social change and
modernityreproductive health and rights

• Control over fertility, access to contraception
  and safe abortion
• Safe pregnancies, lactation, child survival,
  freedom from diseases of the reproductive tract
• Access to information and freedom to exercise
  reproductive choice, freedom from violence. right
  to enjoy and healthy sexual life ICPD

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Modernity Health is an individual right
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Driving Force Globalization

• Internationalization
• Liberalization
• Universalization
• Westernization modernization
• DETERRITORIALIZATION
• Reconfiguration of geography, so that social
  space is no longer wholly mapped in terms of
  territorial places distances and borders

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Globalization everyday lives

• Division of labor - gendered change in labor
  markets
• Impact on paid and unpaid labor
• Changing relations of caring at household level
• Commercialization and Privatization (water
  health)
• Product opportunities

• The intensification of worldwide social
  relations which link distant localities in such a
  way that local happenings are shaped by events
  occurring many miles away and vice versa.
• Giddens 1990

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The new global geography Scapes
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Direct Impacts on health, health services and
health access

• Commercialization and Privatization (water
  health)
• Structural adjustment
• Trade in health services
• WTO agreements
• TRIPS
• Foreign direct investment
• Mobility of health workers

• Health both impacts on - and is an outcome of
  processes of globalization (WHO Commission on
  Macro Economics)
• Access to health and reproductive health services
  is part of larger global restructuring

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Health systems as core social institutions

• The health system as a core social institution is
  part of the very fabric of social and civic life,
  has enormous potential to contribute to
  democratic development
• Health claims are assets of citizenship.

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Direct lifestyle impacts The rise of the MNC

• GLOBAL OBESITY
• The institution that most changes our lives we
  least understand
• JK Galbraith 1976

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MNC Gendered product opportunity

• Selling tobacco products to women has been
  described as the largest single product
  marketing opportunity in the world

• Framework Convention on Tobacco Control

First global public health treaty
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MNC Sex as a product

• Sex itself is a global driving force for new
  technologies, markets and new consumers and
  global crime networks
• We badly need a political economy of sexuality.
  (that) avoids the tendency to see sexuality as
  private and the political and economic as public.
  D. Altman 2001

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Gendered global mobility

• Migration and increased mobility of women
• new slave markets
• Forced prostitution
• Domestic workers
• Low paid service work
• remittances

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Globalization and its impact

• Fragmented and contradictory
• Opportunities and risks
• Direct and indirect pathways
• Constant interplay of structure and agency
• The local and the global

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Gender and Globalization

• Sex and gender are at the core of global change
  not just an additional variable of analysis
• Characterized by ambiguity
• New identities
• New cognitive images of male and female roles
• New social relations globalization impacts on
  gender relations in all its dimensions issue of
  politics and power

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Key social consequence

• A. Giddens and M. Castells both maintain that the
  social processes brought about by globalization
  will bring about the downfall of patriarchy as a
  system of social organization similar to the
  revolution of the making of the working class
  in the 19th century.

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Driving force gender

• Human rights, peace
• Reproductive rights
• Politics of place/ Agenda 21, sustainable
  Development
• Micro economics
• Health and human rights
• Violence

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Gender politics in global governance

• UN system UNIFEM, INSTRAW, CEDAW, new structures
  within organizations WID
• UN Decade and Conferences women, population,
  human rights, agenda 21, social development,
  UNGASS HIV/AIDS, children
• Transnational NGOs and network governance
• Soft law womens rights as human rights
• Millennium Development Goals

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Empowerment means to exercise Agency

• .use the rights, capabilities, resources, and
  opportunities to make strategic choices and
  decisions
• Leadership opportunities and participation in
  political institutions
• Poor women, adolescents, conflict and post
  conflict settings

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Human agency

• Human beings are subjects who can affect the
  interplay of these forces as they carry out their
  social roles
• Resistance

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A new political space

• The very nature of politics has changed
  Globalization has provided opportunities for
  women, lesbians and gay men, disabled persons,
  indigenous people to mobilize to a degree that
  was generally unavailable to them in territorial
  politics.
• (Scholte 1999)

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Practical and gendered resistance

• Phenomenal flow of ideas
• Success of ICPD CAIRO Agenda
• Different forms of resistance - multiple
  practices, strategies and sites of resistance

• Constant renegotiation of boundaries

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Health HIV/AIDS is at the frontier of global
governance

• Human rights
• Creates new forms of global cooperation to fight
  disease (voice and governance)
• Access to treatment and care
• Intellectual property and trade
• Vaccine and drug development
• Public private partnerships

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Health HIV/AIDS could be the frontier of gender
politics in a globalized world

• Opens the dialogue on sex and sexual politics
  (but strengthens Western disease concepts)
• Poses central challenges to existing social,
  economic and gender relations
• Reflects the failure of policies that did not
  address gender and empowerment

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Relevance of ethical theory in a global world

• Injustice
• Clarify means and goal
• Prove moral lens
• Provide basis for collaboration moral
  commitments (Cahill)
• Capabilities approach
• Rights based theory
• Global public goods

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Central Human Capabilities

• Life, Bodily health and integrity
• Senses, imagination, thought,emotions
• Practical reason
• Affiliation
• Other species
• Play
• Control over ones environment
• (Nussbaum)

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A life worth living

• A life that lacks any one of these capabilities,
  no matter what else it has, will fall short of
  being a good human life it describes the task
  of public policy to move all citizens above a
  basic threshold and sets an agenda for a society
  in which both males and females could learn both
  to love and to reason (Nussbaum)

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A new global mindset

• Implicit in the term globalization rather then
  the older internationalization is the idea that
  we are moving beyond the era of growing ties
  between nations and are beginning to contemplate
  something beyond the existing conception of the
  nation state.
• Peter Singer, Princeton 2002

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Evidence Research on political determinants of
health

• Public health research will increasingly need to
  incorporate not only epidemiological evidence but
  move into compiling new types of evidence related
  to implementation this inevitably relates to
  the analysis of the distribution of power and
  resources within and between countries and
  different actors.
• Recommended at Global Forum on Health Research
  2004
• Gendered Research Agenda

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Evidence base 1

• an evidence based understanding of the medical,
  behavioral or public health interventions that
  will successfully address the primary causes of
  . mortality and morbidity

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Evidence base 2

• an evidence based understanding of and approach
  to the social, political, economic and
  institutional structures that will enable
  societies locally, nationally and globally to
  ensure that all people have access to those
  interventions.
• MP task force interim report 4

Power mapping
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Political determinants

• This means opening up a line of inquiry, analysis
  and evidence building that begins not ends with
  the social and political determinants of health
  and health care MP task force interim report 4
• And that recognizes their global nature Risks in
  the 21st century are transnational and all
  attempts to control them lead into the
  international arena

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Move away from methodological nationalism

• Study transnational issues and the global /local
  interface
• study und understand the production of risk at a
  global level and the localization of risk
  through the globalization of everyday life
• Study how the global public goods produced for
  economic globalization can be complemented by GPG
  that address the other dimensions of
  globalization

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Sex does matter. It matters in ways that we did
not expect.. Undoubtedly, it matters in ways that
we have not yet begun to imagine.
IOM 2001