Dr. Abdulaziz Saddique Pharm.D.

,
CPHQ,CSSMBB

7th Arab Conference “New Trends in Hospital Administration”

“Performance improvement and cost containment in light of current national &
International Changes”
Growing liberalization of trade (in goods and services and in
money), and accelerated integration into a global economy
Growing dominance of Western forms of political, economic,
and cultural life
Proliferation of new information technologies, intensification
of and acceleration of global communication
Weakening of local and national boundaries in many areas of
human endeavour
Weakening of the role of the State relative to the role of the
Market
“The State has become too small for the big problems and
too big for the small problems” (Wade Davis)
Dr. Saddique 2
 Globalization is associated with “time and space
contracting”:
The Shrinking Globe
1500-1840

Is Distance Dead?

Best average speed of 1850-1930

horse-drawn coaches and
sailing ships, 10mph.

Steam locomotives average

65mph. Steamships average
1950s
36mph.
 The cost of information
transfer decreased by 98% Propeller
in the last 40 years. aircraft 300- 1960s
400 mph.
 The cost of Goods Jet passenger
aircraft 500-
transport is reduced by
700mph.
50 %in the last 40 years.

Dr. Saddique 3
Bretton Woods Institutions: World Bank,
IMF and World Trade Organization.
 “Washington consensus”: Rules imposed by
World Bank, the IMF, in consultation with US
to encourage deregulation, privatisation, free
trade, export oriented growth
Transnational corporations (TNCs/MNCs)
Leaders of the G-7, now G-8
 Canada, France, Germany, Italy, Japan,
Russia, UK, US

Dr. Saddique 4
Drive for Change
•WTO
Globalization •IMF
•WHO
•World Bank
•Economic
developments
effects all
Citizens / Industry Governance
•Laws
•Rules
•Regulations
•Guidelines

•Implementation
Local Governance
•Performing
•Execution
Dr. Saddique 5
 “We have global governance without global
government, one in which a few institutions – the
World Bank, the IMF, the WTO, and a few players –
finance and trade ministries, closely linked to
certain financial and commercial interests –
dominate the scene, but in which many of those
affected by their decisions are left almost
voiceless”
Joseph Stiglitz, 2002
(author of “Making Globalization Work” and
“Globalization and its Discontents”)

Dr. Saddique 6
South-South linkages to reduce dependency on
Northern markets:
 Brazil, India, China, South Africa (BRICs)
 Shanghai Cooperation Organisation: China, Russia,
Kazakhstan and other former Soviet territories
Rise of social movements in the Civil Society
sector to protest unequal benefits and promote
“alter-globalism”
 World Social Forum, 2001 Porto Allegre, calling for a fair
system of trade, full employment, guaranteed basic
goods such as education and health, local prosperity,
sustainable growth

Dr. Saddique 7
 Globalization and the
World’s Poor
Critics argue that globalization
has not helped poor
 1870: per capita income of 17 richest nations was 2.4x that of all
other countries.
 1990: it was 4.5x larger.
Other factors may have
influenced the gap
 Totalitarian governments.
 Economic policies that destroyed wealth creation.
 Little protection of property rights.
 Expanding populations.
 War. Dr. Saddique 8
Internationalization-
interaction &
interdependence of people
in different countries
Globalization-worldwide,
universal
Universalization-spread
of people & cultures
worldwide
Westernization-values,
behaviors of Western Dr. Saddique 9
 • Inevitable

• Universal

• Pro-active pays

• Uncertainties

• Stressful
What are the pros and cons of globalization on health care?
(Herhock et al., 2007)
Globalization is:
The product of the emergence of a
global economy, expansion of
transnational linkages between
economic units creating new forms of
collective decision making,
development of intergovernmental and
quasi-supranational institutions,
intensification of transnational
communications, and the creation of
new regional and military orders
(Hershock, Mason & Hawkins, 2007, p. 30).
Dr. Saddique 11
 Liberal arts
Language
Flexibility
Attitude Acceptance
Communication

Dr. Saddique 12
Client centered (CC): Treating person as a whole. CC entails:
advocacy, empowerment, respect, self-determination &
participation.

Steps to CCC Attitudes for CCC

Self awareness Individual respect &
Knowledge acceptance of differences
Communication Inclusive

Q What is the stand of the JCAHO re: client centered &

cultural competent care?
Dr. Saddique 13
….. "health problems that transcend
national boundaries, that may be
influenced by circumstances or
experiences in other countries, and that
are best addressed by cooperative
actions, and solutions; whether they
occur in developing countries, countries
in advanced transition, or industrialized
countries" (UNC-CH, 2007, p.3).

Dr. Saddique 14
 Access: Sheer numbers
Who pays?
Use of ER/hospital care
Communication-interpreters
Need for client centered care
Use of CAMS
Adherence/compliance

Q What is the impact of immigration globally?

(Brush, 2008, 40(1):20-25; www.ilo.org;public/english/dialogue/sector/papers/health/wp209.pdf)

Dr. Saddique 15
 % of
pop

2000 2050
Q What demographic shifts are occurring globally?
Dr. Saddique 16
Mass communication
Sharing media
Global traveling
Advancements

Dr. Saddique 17
Caring Economics: A Global Agenda

CARING is big business!

Caring is marketing.
Caring & outcomes
Caring takes time.
Caring is a basic human need.

Q Is caring a business commodity?

(Eisler, R., 2007, Creating a Caring

Economics:
The Real Wealth of Nations)
Dr. Saddique 18
Health Disparities: mortality &
morbidity of poor
Infectious Diseases
More effective health care Systems
Tobacco addiction

Q What other issues can you identify?

Dr. Saddique 19
#1 France
#6 Singapore
#10. Japan
#15. Iceland
#20. Switzerland
#25. Germany
#30. Canada
#37. USA
#61. Mexico
#144. China

Dr. Saddique 20
Access to health care
Individual profile
Social:
education/economics
Environment
Infant mortality
Life expectancy

Dr. Saddique 21
USA 7.09 male deaths/1000 births
UK 5.67
Canada 5.15
Australia 5.02
Switzerland 4.84
Spain 4.76
Germany 4.56
Japan 3.58
Iceland 3.43
Sweden 2.92
(Retrieved from www. Who.org , 2007)
Dr. Saddique 22
 Male Female
UK 78.8 83.1
Australia 78.5 83.3
Japan 78.5 85.5
Iceland 78.5
Germany 77.4 84.4
Malta 77.0 81.9
France 75.9 83.1
Spain 74.5 82.0
USA 74.8 80.1 (17th.
in world)
Sweden 70.4 78.4
(www.INED.fr/en/pop_figures,
Dr. Saddique 2006; Holtz, 2008, p. 23
Cardiovascular/hypertension
Diabetes
Cancer
Obesity & nutrition
HIV/AIDS
Tobacco/alcohol addiction
Substance abuse
Injury/violence
Immunizations

Dr. Saddique 24
Universal INFECTION CONTROL

Dr. Saddique 25
Cultural competency

Diversity & Workforce

Diversity management

Equity/social justice

Dr. Saddique 26
 System Outcomes

Quality Evidence-
Improveme based
nt Practices

Performance
What are the expected outcomes
Measurement of globalization and health
Dr. Saddique 27 car
 •Advocates for health
are imperative
•Society continues to
change
•Gatekeepers are
necessary
•Learning to cope is
Q What do you predict essential
for the globalization of
health care?
Dr. Saddique 28
Global partnerships
Government’s role
Philanthropy
Engagement/participation
Transformational leadership

Dr. Saddique 29
 Health People 2015 in various countries
Eight Millennium Development Goals 1990-2015
United Nations/World Health Organization shifts
Ministries of health
Non-Government Organizations, consumer/
professional/environmental groups
Public/private partnerships & alliances

What needs to be done to activate clients in health care?

Dr. Saddique 30
 •Cultural diversity

•HCP migration

•Nursing & Medicine

shortages

•Service learning

•Health careers
Q What significant impact will globalization have on the role
of the HCP? Dr. Saddique 31
Health care systems are in reform globally.

Globalization affects every system.

Inter-professional efforts are needed to improve

health care globally.

Health care providers need to prepare, be

proactive and collaborate.

Dr. Saddique 32
In 2001, trade in goods accounted for
40% of the world’s GDP
 compared with 33% in 1990
 19% for US but over 100% for many
developing countries
In 2001, foreign direct investment totaled
746 billion dollars
 compared with 203 billion dollars in 1990

Dr. Saddique 33
Foreign trade volume increased from 48
billion dollars in 1960 to 3.6 trillion
dollars in 2006

Dr. Saddique 34
US-owned assets abroad
 457 billion dollars in 1976
 13.8 trillion dollars in 2006

Foreign-owned assets in the US

 292 billion dollars in 1976
 16.3 trillion dollars in 2006

Dr. Saddique 35
Normative theory
 What ought to be
 e.g.: “Globalization is ultimately good for poor
developing countries.”
Positive theory
 What is
 e.g.: “Globalization increases economic
inequality between rich and poor countries.”

Dr. Saddique 36
The impact of globalization on
 income inequality
 unemployment
 education
 health care
 women and children
 the environment
 homeland security, etc.

Dr. Saddique 37
Does globalization decrease levels of
government spending on social services
such as health care and education?
Yes:
 “race to efficiency” or “race to the bottom”
No:
 “race to the top” of human capital formation
How to empirically test these theories?

Dr. Saddique 38
 Social Implications

 Large technological transfer + cheap information technology: knowledge

diffusion
 Increase of skilled labor
 Leapfrog development steps: high-speed transition towards a service
economy
 Economic efficiency → economic growth → poverty reduction
 “Westernization” of governance: gender issues / democracy
 Convergence of income / labor standards
 Efficient allocation of labor between i) economic sectors ii) rural-urban
areas

Dr. Saddique 39
 Important Note
The move from Agricultural Society
into Industrial Society was a move
in the type of products and
production process.
The move from Industrial Society
into Information Society
(Globalization) is not limited to the
type of products or the process of
production but it affects people in
all their life aspects.
Dr. Saddique 40
 Globalization & Culture: The
Story So Far
 Cultural Homogenization
 Cultural Imperialism
 Mcdonaldization
 Coca-Colonization
 Americanization
 Westernization
Dr. Saddique 41
Thanks you for your
Participation