Healthcare Reform During the past two decades, all of the industrialized nations have enacted some form of healthcare reform. America is no exception. Just a few years ago, the U. S. was consumed by a vigorous public debate about healthcare. In the end, the debate reaffirmed that the U. S. would retain its essentially market-based system. Instead of reform imposed from the top down, 3 the American healthcare system underwent some rather profound self-reform, driven by powerful market forces. The market—not the government—managed to wring inflation out of the private healthcare market. 4 Today, it appears that U.S. healthcare costs are again on the rise. At the same time, American patients—like patients elsewhere—are becoming more vocal5 about the restrictions many face in their healthcare plans. Talk of government-led reform is once again in the air. 6 We must think twice, though, before embarking on “reform” if that means imposing further restrictions on our healthcare markets. The more sensible course is to introduce policies that make the market work better—that is, to the advantage of consumers. I base this argument on our company’s decades of experience in healthcare systems around the world, which has given us a unique global perspective on the right and wrong way to reform healthcare. The wrong way is to impose layer after layer of regulation and restrictions. We have seen this approach tried in many countries, and we have always see it fail—fail to hold down costs, and fail to provide the best quality care. Medicine is changing at so rapid a pace that no government agency or expert commission can keep up with it. Only an open, informed and competitive market can do that. This lesson holds true for the U. S., and for all countries contemplating healthcare reform. Free markets do what governments mean to do—but can’t. The right approach10 is to foster a flexible, market-based system in which consumers have rights, responsibilities, and choices. Healthcare systems do not work if patients are treated as passive recipients of services: 11 they do work if consumers are well-informed about quality, costs, and new treatments, and are free to act responsibly on that knowledge. Of course, reform should never be driven purely by cost considerations. Instead, we ought to devise new ways of funding healthcare that will make it possible for all patients to afford the best care. Ideally, these new approaches would not only reward individuals and families but also encourage innovation, which can make healthcare systems more efficient, more productive, and ultimately of greater value for patients. The path we choose will have enormous implications for all of us. We are in a golden age of science, and no field of scientific inquiry holds more promise than that of biomedicine. 13 Not only can we look forward to the discovery of cures for chronic and acute disease, but also to the development of enabling therapies that can help people enjoy more rewarding and productive lives.14 New drugs are already helping people who would once have been disabled by arthritis or cardiovascular disease stay active and mobile.15 More effective anti-depressants and anti-psychotics are beginning to relieve the crippling illness of the mind, allowing sufferers to function normally and happily in society. The promise is quite simply—one of longer, healthier lives. 16 What is at issue are the pace and breadth of discovery, and how quickly we can make the benefits of our knowledge available to the patients who need them. Therefore, the policy environment the biomedical industry will face in the next century may make or break the next wave of biomedical breakthroughs. 17 Will that environment include protection for intellectual property, freedom for the market to determine price, and support for a robust science base? 18 Will healthcare systems nurture innovation, or remove incentives for discovery? Will they give consumers information and options, or impose stringent rules and regulations that limit access and choice? For the U. S., as for the
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Globalization What exactly does globalization mean? Concepts related to globalization include “internationalization”, “multidomestic marketing”, and “multinational or transnational marketing”, suggesting that the basic criterion is transactions across national boundaries. In the marketing and strategic management literature, globalization is conceptualized as a means to gain competitive advantage by locating different stages of production in different geographic regions according to the particular region’s comparative advantage. This conceptualization focuses only on the economic aspects of globalization; social, cultural and political factors are only considered in the context of achieving economic advantage. Thus, being “culturally sensitive” in global markets is being able to sell one’s product with enough ingenuity to avoid possible pitfalls arising from the seller’s ignorance of local customs. International marketing textbooks discuss such cultural pitfalls in great detail; however, the cultural contest of globalization is always framed by the economy. Broader conceptualization of globalization can be found in other disciplines such as sociology and anthropology. Waters defined globalization as “a social process in which the constraints of geography on social and cultural arrangements recede and in which people become increasingly aware that they are receding.” This conceptualization with its much broader scope, allows for the examination of a number of consequences of globalization, not jut economic but social, cultural and political ones. While there are a few different conceptualizations of globalization, researchers seem to be in agreement that there are at least three dimensions of globalization: economic, political and cultural. The economic aspects of globalization stem from the spread of the capitalist world economy and the resulting expansion of goods and services. The need for cheap raw materials, cheap labor and new markets saw the expansion of the capitalist world economy from one that was primarily Eurocentric to one that encompassed the entire world. This process was achieved by various means and often involved overcoming political resistances in the new markets. The political aspects of globalization involved establishing control over markets and raw materials through either the use of direct military power or the establishment of international institutions that control such markets. The rise of the nation-state is an example of the political aspect of globalization, although it is argued that advances in telecommunications and information systems and the resulting constructions of institutions that transience territorial boundaries are making the nation-state obsolete. If the economic and political aspects of globalization involve material and power exchanges, the cultural of globalization involves the expression of symbols that represents facts, meanings, beliefs, preferences, tastes and values. In fact, these symbolic exchanges are increasingly displacing economic and political exchanges in the spread of global mass culture. Traditional barriers of language pose no problems to modem means of cultural production such as satellite television and film. However, the new “global culture”, despite its manifestations through consumption of global products and symbols in different part of the globe, is essentially the culture of dominant groups centered in the West.
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Tourism, Globalization and Sustainable Development Tourism is one of the fastest growing sectors of the global economy and developing countries are attempting to cash in on this expanding industry in an attempt to boost foreign investment and financial reserves. While conceding that the uncontrolled growth of this industry can result in serious environmental and social problems, the United Nations contends that such negative effects can be controlled and reduced. Before getting into the cold facts of global economics, let me begin with another story to warm up. I was perplexed when I recently read in the newspaper that Thailand’s forestry chief had said: “Humans can’t live in the forest because human beings aren’t animals. Unlike us, animals can adapt themselves to the wild or any environment naturally.” This was to legitimatize the government’s plan to remove hundreds of thousands of rural and hill tribe people from protected areas. This man, who is in charge of conserving the forests, is at the same time very strongly pushing to open up the country’s 81 national parks to outside investors and visitors in the name of “eco-tourism”. Can we conclude, then, that the forestry chief considers developers and tourists as animals that know how to adapt to the forest and behave in the wild naturally? While authorities want to stop the access to forest lands and natural resources of village people, another group of people—namely tourism developers and tourists with lots of money to spend—are set to gain access to the area. While authorities believe that local people, who have often lived in the area for generations, are not capable of managing and conserving their land and natural resources—under a community forestry scheme for example—they believe they themselves in cooperation with the tourist industry can properly manage and conserve “nature” under a national eco-tourism plan. Taking the above quote seriously, cynics may be tempted to say there is obviously a gap between “human rights” and “animal rights”. How is this story linked to globalization? First of all, that humans cannot live in the forest is—of course—not a Thai concept. It is a notion of Western conservation ideology—an outcome of the globalization of ideas and perceptions. Likewise, that eco-tourism under a “good management” system is beneficial to local people and nature is also a Western concept that is being globalized. In fact, Thailand’s forestry chief thinks globally and acts locally. A lesson that can be learned from this is that the slogan “Think Globally, Act Locally” that the environmental movements have promoted all the years, has not necessarily served to preserve the environment and safeguard local communities’ rights, but has been co-opted and distorted by official agencies and private industries for profit-making purposes. The tourism industry is demonstrating this all too well Many developing countries, facing debt burdens and worsening trade terms, have turned to tourism promotion in the hope that it brings foreign exchange and investment. Simultaneously, leading international agencies such as the World Bank, United Nations agencies and business organizations like the Word Travel & Tourism Council (WTTC) have been substantially involved to make tourism a truly global industry. However, tourism in developing countries is often viewed by critics as an extension of former colonial conditions because from the very beginning, it has benefited from international economic relationships that structurally favor the advanced capitalist countries in the North. Unequal trading relationships, dependence on foreign interests, and the division of labor have relegated poor countries in the South to becoming tourism recipients and affluent countries in the North to the position of tourism generators, with the latter enjoying the freedom from having to pay the price for the meanwhile well-known negative impacts in destinations.
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Working Together Against the Infectious Diseases There is another area that really may sound like it’s outside the range of politics and Iraqi people where we’re cooperating together, but it’s an area that is vital to the well-being of the Chinese people, the American people, the people in the world, and it’s now we’re working together to deal with the dangers inherent in infectious diseases. China’s sobering experience with SARS stands as a lesson to all countries on the challenge of infectious diseases. I have called HIV/AIDS the world’s greatest weapon of mass destruction today. It threatens to kill tens of millions of men, women and children—in the Caribbean, in Latin America, in the subcontinent, especially in Africa—and yes, it is a danger to China as well. And China’s government is facing up to this crisis, working with us. The United States has told China we are ready to help. Last month, our Health and Human Services Secretary Tommy Thompson spoke in China of President Bush’s interest in furthering our practical cooperation on HIV/AIDS and other health issues. Specialists from our Centers for Disease Control are working on the ground with their Chinese counterparts. Our National Institute of Health has granted $14.8 million to help China upgrade its health care infrastructure. My friends, it is upon such concrete forms of cooperation on issues of regional and global importance that a 21st century US-China relationship will be built, issue by issue, experience by experience, challenge by challenge, initiative by initiative, program by program. As China participates more actively in world affairs, we will extend our welcome. Building and sustaining a healthy overall relationship is good for America, it is good for China, it is good for the region, and good for the international community.
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Transformation of St Kilda Seventy-five years ago, the residents of a group of islands off the northwest coast of Scotland packed up and left for good. Their home—St Kilda—-now has World Heritage status but with the departure of the St Kildans in August 1930, a way of life that had existed for thousands of years, vanished. St Kilda was years for years known as the most remote settlement in the entire British Empire, but actually it is not so far away—-around 200 km west of the nearest point of the Scottish mainland. Seventy-five years ago, at the end of August 1930, the last 36 islanders banked up their turf fires, opened their Bibles at Exodus, put some oats on the table, then left forever, bringing to an end a habitation and a way of life that stretched back at least two thousand years. St Kilda is an archipelago of sea stacks, skerries and four islands, of which only one, Hirta, was permanently inhabited. It was remote in ways other than geography. The people, who never numbered more than a couple of hundred, spoke not English but a distinctive form of Gaelic. Their economy, their whole culture, revolved round seabirds—fulmars, gannets and puffins. They ate them and exchanged their feathers and precious oil for goods such as tea and sugar from the mainland. In the Victorian era, at the height of Britain’s imperial adventure, this self-sufficient life held a strange fascination. St Kilda became a fashionable tourist destination and steamers regularly dropped anchor in Village Bay. But the visitors could not comprehend the St Kildans they gawped at. There is an astonishing recording in the BBC’s archives of an islander saying that her mother, in payment for a bale of tweed which had taken all winter to weave, was given an orange. She didn’t know what it was. There had been worse traumas: St Kilda’s graveyard is one of the most heartrending places. It is full of tiny hummocks, where infants are buried. Newborn babies were all anointed where the cord had been cut with a concoction of fulmar oil, dung and earth and 8 out of 10 of them died of neonatal tetanus. The minister finally put a stop to this in 1891 and after that the babies lived, but it was too late. Add to this grief, emigration and harsh religion and it’s no wonder that the St Kildans lost heart. By the 1920s there were no longer enough people to do all the work. In 1930 they planted no crops and petitioned the government to take them off the island. St Kilda is now owned by the National Trust for Scotland. There are tow National Trust wardens and in the summer volunteer work parties come to maintain the buildings. There’s a resident archaeologist. A century on St Kilda has become a chic destination once again. There were 15,000 visitors last year. Recently one of the wardens found the first piece of litter; a plastic water bottle wedged between the stones of a wall.
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The Truth about Genetically Modified Food At almost every public lecture I give, someone asks me my opinion on genetic modification—whatever be the topic of the lecture. Genetic modification (GM) has the power to save lives through its use in medicine, such as the production of insulin for diabetics or the treatment of genetic disorders. The current outcry comes when it is used to produce food. Some of these public concerns reflect real problems, but others are fuelled by misinformation and overdramatisation. There is nothing new about crop modification; plant breeders have been doing it since agriculture began. The wonderful range of apples or potatoes we now enjoy is the result of crossing different varieties. Cabbages, Brussels sprouts, cauliflower, kohlrabi, kale and broccoli all originated from one botanical species. Modern molecular biology has enabled us to go much further. We can now isolate the gene for a particular characteristic of an organism and transfer it to another species. It is this practice of transforming a plant with alien genes—perhaps from an animal or bacterium—that is causing all the controversy. There are three main concerns. Scientists can now take a gene for resistance to a particular herbicide and transfer it to a crop: when these plants are sprayed with weed-killer, the weeds are destroyed while the crop is unharmed. A prime concern is the harmful effect this could have on the biodiversity of farmland, where so many insects, birds and other animals depend upon “weed” species. Another fear is that alien genes from a GM plant could escape into a wild population of a related species. Since plants are fertilized by pollen that is carried through their, often for great distances, this is entirely possible. A wild species modified in this way with pesticide resistance could become a “super-weed”, while a species that becomes unnaturally resistant to animals that feed on it could disrupt the food chain. The third worry concerns a proposal to produce seeds for cereals that cannot germinate to produce next year’s seeds. This “terminator technology” would be of obvious advantage to seed companies, since farms would be forced to buy new weed annually. But the same technology could be devastating to some farmers in the developing world who depend upon saving some seeds for next year’s crop. Fortunately this technology is not yet in use and there has been strong pressure to abandon it. I would not hesitate to eat a GM vegetable—it is most unlikely that the current modifications are harmful to the consumer, despite what we read in the press. However, the introduction of animal genes into food plants presents considerable ethical difficulties to vegetarinsarians and member of religious that forbid the eating of certain animals. This is one of the reasons people are demanding that tall genetically modified food products be clearly labeled. The public have a fight to know what they are eating and a fight to choose. I believe that in my own nation GM is well regulated, but this cannot be said for some other countries. One of the problems is that at the moment this technology is commercially motivated. Because the compositions developing GM food want to introduce it as quickly as possible, in my opinion, it is being rushed into without adequate research or precautions. Genetic’ modification is here to stay, and there is no doubt it will save lives. But ,like so many other scientific discoveries, such as splitting the atom, it can be seriously misused. Instead of condemning the technique, we, should ensure it is used wisely. We need to evaluate each application carefully, from environmental and ethical standpoints, and we must urge governments and companies to use it for good rather than for greed.