Global Healthcare Systems: Comparing Models and Outcomes

Health Transitions in a Globalizing World

Martens, Pim. (2002). "Health Transitions in a Globalising World: Towards More Disease or Sustained Health?" Futures, Vol. 34, Issue 7, p. 635+.

In this journal study, Pim Martens argues that the concept of "transitions" is useful for addressing and defining the current and future health status of the world as directly related to the process of globalization. Martens begins with a discussion of the current factors that affect human health and then examines the health transitions evident throughout history. He then focuses on trends and developments in health and disease among various populations of the world, measuring these trends according to three suppositions about future ages: the age of emerging infectious diseases, the age of medical technology, and the age of sustained health (Martens, 2002, p. 635).

More specifically, Martens attempts to define global and regional dynamics that might influence health and disease trends. He concludes that managing health variations and transitions effectively in the future will require "a micro and macro approach" that takes into consideration the social, cultural, and behavioral determinants of health (Martens, 2002, p. 635).

Martens claims that socioeconomic change, public health initiatives, and technology have contributed to a positive shift in health and disease outcomes. To support this premise, he points out that average life expectancy has doubled across the globe and that infant and maternal mortality rates have sharply declined.

However, Martens also identifies large health disparities that exist around the world. He suggests that the "pattern of infectious diseases" is less stable and that a trend toward anti-microbial resistance is evident worldwide. He also notes that in certain poor countries and in Sub-Saharan Africa, diseases such as HIV/AIDS are severely reducing life expectancy (Martens, 2002, p. 635).

Martens further points out that although life expectancy is generally rising, fertility rates are declining and health inequalities still exist between poor and wealthy populations (Martens, 2002). He suggests that the future health of individuals will depend on the process of globalization and environmental influences (Martens, 2002).

Martens poses the question: "given the current and anticipated socio-economic and environmental trends, will sustainable healthy life be possible in the future?" (Martens, 2002, p. 635). He then enters into a lengthy discourse about the forces that affect health, including trends in developing countries where health gains are occurring thanks to knowledge transfer regarding vaccination and sanitation. Increased literacy, family spacing, and improved nutrition are also cited as reasons for improved health conditions in developing countries. In Western populations, Martens proposes that health changes are more directly related to social and environmental factors as well as technological medical interventions (Martens, 2002).

Martens examines trends in health status against a background of economic, social, and cultural forces. He notes that access to sufficient quantities of food and water is critical to good health, and observes that individuals living in urban areas or poor countries still struggle with water and sanitation issues (Martens, 2002). He also notes that more than a third of the world's population lives in areas where the water supply is scarce, due in part to large population growth (Martens, 2002). Such inadequacies often impact health negatively. Malnutrition is also identified as a global risk factor for disease and a growing problem in the developing world (Martens, 2002).

Martens also suggests that social factors including literacy and education impact health, and that globally there is a consistent trend whereby people with more education generally receive better healthcare (Martens, 2002).

With regard to economics, Martens claims that rapid economic growth and wealth have globally enhanced life expectancy, which he attributes to improved income levels generally associated with lower mortality (Martens, 2002). After a certain economic level has been attained, however, Martens notices a trend in which health is determined by other factors, including poverty, which is present even in the wealthiest societies.

Martens proposes a conceptual framework for defining healthcare trends, which he calls the "health transition," suggesting that health trends can be defined by transitional stages. The first stage is characterized by mortality associated with "epidemics, pestilence and famine," usually resulting from a lack of economic means to provide adequate healthcare services. In this environment, infectious diseases are most common, causing high mortality rates (Martens, 2002). The next stage he describes as the age of "receding pandemics," where a fall in mortality rates is evidenced and life expectancy climbs alongside increased economic growth (Martens, 2002). During this stage, social factors become important and the introduction of modern healthcare techniques and technology becomes common.

Martens then proposes that a trend follows toward chronic diseases, where infectious diseases are virtually eliminated and chronic disease surfaces (Martens, 2002). He suggests that this stage occurs at different times in different nations and is driven primarily by economic and social factors (Martens, 2002). Most developed countries — including European nations, North America, and parts of Asia — are now in this stage, characterized by low fertility rates and chronic rather than infectious disease patterns (Martens, 2002).

Martens also suggests that most developing countries are still in a state dominated by infectious disease, where the fertility rate remains high, and that most poor countries will likely remain in this state unless economic conditions shift favorably to allow for better care, access to supplies, and health information.

In summary, Martens's account reveals that healthcare trends vary significantly between developing and developed countries, and that even within those broad categories, considerable variation exists. He presents the idea that many factors contribute to healthcare outcomes — not simply the healthcare system itself.