This paper examines the impact of globalization on nursing practice and global healthcare equity, highlighting how economic disparities, transnational disease transmission, and environmental degradation disproportionately burden low-income populations. It then proposes a policy change focused on regulating pharmaceutical pricing to improve access to affordable healthcare worldwide. Using the Kingdon streams model as a theoretical framework, the paper outlines agenda-setting, design, implementation, and evaluation strategies for achieving international pharmaceutical industry regulation through the World Health Organization and the United Nations. The paper underscores the central role nurses play in both advocating for and evaluating such policy reforms.
The term globalization has been used to describe the increasing social and economic interdependence among and between countries (Bradbury-Jones & Clark, 2017). Shifting disease and health patterns have been linked to this phenomenon. Global health refers to health issues that are not geographically contained and that no single country can address alone (Bradbury-Jones & Clark, 2017). In response to the global challenges of health and globalization itself, nurses have had to practice their profession within the context of emerging transnational situations (Bradbury-Jones & Clark, 2017). For this reason, nurses must proactively respond to dynamic global changes and understand the consequences of globalization on health.
In this era of healthcare globalization, it is necessary to underscore the positive changes in biotechnology and communication (Da Silva, 2008). Globalization, however, appears to have more negative effects on the health of poorer populations worldwide. This is because poverty is closely associated with health expectations and conditions (Da Silva, 2008). Close to 2.8 billion of the approximately 6 billion people globally live on less than $2 per day, while another 1.2 billion people live on less than $1 per day. Of all people living in poverty, 44% are found in Southern Asia (World Bank, 2012). As a result of these conditions, 90% of global diseases are concentrated in poor countries, yet those countries command less than 10% of global healthcare resources (Da Silva, 2008). This disparity is reflected in the slow development of poor countries, driven by poor health outcomes and the loss of productive young lives.
African children under the age of five have seven times greater odds of dying than children from Europe. Similarly, people aged between 15 and 59 years in Africa have a 4.5 times higher chance of dying than their European counterparts. Maternal mortality in Africa is 16 times higher than in Europe (World Health Organization, 1999). Transnational trade is one of the major risks to global health, as globalization through cross-border trading has led to the increased spread of disease (Da Silva, 2008). Hepatitis B and other viruses can be transmitted internationally through the transnational blood-product trade. The trade in food products, disease variants of Creutzfeldt-Jakob disease, and bovine spongiform encephalopathy represent additional pathways through which diseases can be transmitted across borders (Da Silva, 2008).
Environmental harm resulting from the unsustainable industrial activities of developed nations is another negative consequence of globalization. Such harm has degraded the social and environmental quality of communities, greatly affecting the health of their populations (Da Silva, 2008). These consequences carry significant implications for the Advanced Practice Registered Nurse, whose profession must participate in developing strategic programs to contain the negative effects of globalization on healthcare. The growing rate of urbanization, supported by industrial development and economic growth, has transformed the political, economic, and social spheres of society and introduced new healthcare risks. The consequences of urbanization negatively affect population health, particularly through increased communicable disease transmission and worsening problems related to social violence and community disintegration.
Good health depends on health investment and sound health policies (Milstead & Short, 2019). Technology, education, and the exchange of ideas also influence healthcare outcomes. Developing countries have limited investment in education and health due to a lack of professional human resources and financial capacity, which prevents them from meaningfully participating in international healthcare decision-making platforms. Globalization carries far-reaching consequences for healthcare, and the nursing community must do much more to bridge the professional gaps it creates.
One of the global healthcare policy issues that must change in light of globalization is the pricing of prescription drugs. The healthcare industry is a booming commercial sector. While commercial interests are important for keeping the private sector engaged in healthcare, pharmaceuticals and other medical utilities have often been overpriced for economic gain without adequate attention to affordable global healthcare. Overall, the cost of accessing healthcare in both developing and developed economies has become increasingly unaffordable. Policy interventions that introduce affordable healthcare insurance in developing countries and affordable prescription drugs for all are urgently needed. The commercialization of healthcare has undermined the ethical obligation of nursing practitioners to provide care to every person in need. Many people cannot afford costly treatments such as chemotherapy, dialysis, and cancer therapy due to high treatment and medication costs (McCracken & Phillips, 2017).
"WHO and UN lobbying to build global policy consensus"
"Evidence-based design and regulatory compliance framework outlined"
"Nurses assess affordability and patient health outcomes"
This stage involves assessing whether the new policy has had a tangible impact on patients' ability to afford prescription medicine. Nurses will be central to determining whether patients are able to follow medication instructions and afford their medications comfortably (World Health Organization, 2005). Nurses will also help determine whether the general health of patients is improving as a result of more affordable healthcare. The effectiveness of the new policies will be measured by comparing the initial costs of pharmaceutical products with costs following implementation of the regulations.
Although the healthcare industry has been excessively commercialized, leading to unrealistic healthcare costs for low-income earners, the situation can still be remedied. If commercial discipline is not restored to the healthcare industry — with particular attention to making healthcare more affordable — a time will come when healthcare services are accessible only to those with high incomes. This outcome is unacceptable, and for this reason, immediate action is required to contain escalating costs. Regulation of the pharmaceutical industry and insurance sector is one essential pathway toward achieving that goal.
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