Globalization' refers to the increasing integration of economies around the world, the movement of people (labour) and knowledge (technology) across international borders₁. Along with undeniable world economic development, inequalities within and between nations, rising unemployment and sluggish social progress in countries not being able to cope with the pace of globalization, is of great concern₂. Where some of the world population segments have made tremendous progress like UK and USA, there is a fear that globalization is exacerbating poverty and jeopardizing health status of the vulnerable segments in developing countries₃. Tremendous benefits conferred to almost 5 billion people through superior technologies and knowledge, highlight the concomitant challenge of bringing the same to 1 billion people of sub-Saharan Africa and South Asia who are yet to benefit. Standards of living have improved. Infant mortality rates declined globally during 1970-1997, from 107 to 56 per thousand and life expectancy has risen from 55 years to 67 years. Judged by their Human Development Indicators (HDIs), today's poor countries are well ahead of where the leading countries were in 1870₄.This is largely because medical advances and improved living standards. Yet the quality of life for many people living in what we call third world (Table1) has not improved, with many still living in abject poverty and moribund health systems, thus hampering access to essential drugs that could alleviate suffering or even prevent deaths₄.

Merging borders may pose new challenges to global health, social fabrics and cultural identities. The risks and adverse consequences of globalization must be confronted, but they must not be allowed to obscure its overall positive impact on health and development. Low-income countries have not been able to integrate with the global economy as quickly as others, partly because of their chosen policies and partly

Figure 1

Table 1

because of factors outside their control. Does globalization really exacerbate health inequities? How can the developing countries be helped to catch up? Are countries that integrate with the global economy inevitably, become vulnerable to an overall instability? In this scenario, the key international organizations and alliances ought to facilitate the developing countries in all possible ways to combat with the diseases prevailing in these regions. Investing in health is imperative and the individual countries, donors and all other international players have to have this realization that this is the only way to development and boosting the economies and thus reducing poverty, the prime determinant of health₅. That is the only way to ensure all people in all countries have access to the benefits of globalization.

Correspondence to

Mr MS Sajid (surgeon1wrh@hotmail.com) Senior Clinical Fellow, Department of Vascular Surgery Royal Free Hospital, Hampstead, London NW3 2QG