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Along with the positive or negative consequences of the globalization of health, we can consider global health as a goal, responding to human rights and to common interests. History tells us that after the "microbial unification" of the world, which began in 1492, over three centuries elapsed before the recognition of common risks and attempts to cope with them in a cross-boundary effort. In the 19th and 20th centuries, the struggle against epidemics united countries, world health became a common goal, and considerable results were achieved. However, in recent decades the notion of health as a cornerstone of economic development has been replaced by the idea that public health and health services are an obstacle to the wealth of nations. Meanwhile, new common threats are growing: among them, the exacerbation of old infections and emergence of new ones, the impact of environmental changes, drug traffic on a world scale, and destructive and self-destructive violence. New and stronger empirical motives relate the interests of peoples to universal rights and to global health. The author concludes with some proposals for policies.

ALA-SE MUITO HOJE em globalização. As finanças, a informação simultânea, as migrações de povos, o crime organizado, os conhecimentos científicos, a tecnologia, os sistemas de poder, a produção e o trabalho humano, tudo isso se globaliza.Pode-se exaltar a globalização como oportunidade de crescimento econômico e cultural dos povos. Pode-se ainda criticá-la em razão dos que a conduzem, ou de como a conduzem, ou dos rumos que toma. Mas ela é irrefreável, sobretudo por corresponder a muitas exigências dos seres humanos.Essa afirmação pode sofrer duas objeções: uma vem sustentar que a globalização da economia corresponde hoje à acumulação de capital e de poder em poucas mãos e ao predomínio das finanças internacionais sobre qualquer outro interesse; outra, é que o conceito e a natureza da globalização foram criados e difundidos por forças neoliberais, com a intenção de levar os povos a crer que não há alternativa e, assim, de negar a função da polí-tica e da democracia.Ambas as objeções baseiam-se em fatos reais. Pode-se acrescentar que o ganho de capital em nossos dias passou a não respeitar nada (a vida, a saúde e até mesmo as partes do corpo humano vão se transformando em mercadoria) e que o credo neoliberal é imposto aos povos com as regras do fundamentalismo monetário, que não admite dissidências. É o que se evidencia quando o Banco Mundial e o Fundo Monetário Internacional subordinam sua ajuda ao compromisso dos governos de desmantelar os sistemas de saúde pública e previdência social. As conseqüências dessa opção (e ainda mais, dos crescentes desníveis de renda, de educação e de poder entre as classes e entre os povos) traduziram-se por quase toda a parte, nos últimos 20 anos, em aumento das desigualdades de níveis de saúde, documentadas por estatísticas eloqüentes, que se podem traduzir em milhões de existências humanas truncadas ou prejudicadas.Deve-se acrescentar, contudo, que nos últimos anos as reações a essa situação e as iniciativas pela igualdade na saúde (a partir do lançamento do Globalização e saúde globlal

A relação entre o trabalho e a saúde se coloca na interface entre a biologia humana e a economia, isto é, entre dois campos nos quais se manifesta um crescente interesse pela ética. No campo biológico, na onda deste interesse, nasceu uma nova disciplina, a bioética, como era previsível devido aos extraordinários mas também perturbadores progressos da ciência biomédica. No entanto, era pouco previsível que Mr. John Shad, presidente da SEC, o órgão de controle dos mercados financeiros americanos, doasse trinta milhões de dólares para a Harvard Business School criar uma nova disciplina no ensino: Ética e negócios. G. Rossi, que é o homólogo italiano a Mr. Shad, escreveu no "Corriere delia Sera", jornal que pertence à Fiat: "O problema da relação entre a ética e a atividade econômica sempre esteve no centro das mais angustiantes reflexões do pensamento antigo e moderno. Isto torna-se atual cada vez que se apresentam períodos de crise ou de transformação...Conclamar à ética é sinal de que no mundo da economia ocidental o direito apresenta problemas ou está em crise, e que portanto estão amadurecidos os tempos para reformas radicais no ordenamento" 1 . Se isto é O outro texto é a Declaration on Worker's Health, editada em Washington em 6 de fevereiro de 1.992, por importantes personalidades do mundo da economia, da política e da ciência, reunidas por iniciativa da Organização Panamericana de Saúde no ano que a OPS dedicou à segurança e à higiene no trabalho. Após ter enfatizado "the high cost of disabilities and lost lives resulting from work-related pathologies, unhealthy working conditions, and serious occupational risk factors which could be eliminated and controlled", a declaração enfatizou dois aspectos éticos da relação entre trabalho e saúde:"The aims of the economic progress are only justified to the extent that concern is focused on human beings and their social well-being, and that in order to ensure viable and sustained development it is essential that workers enjoy good levels of health"."Knowledge is available about the strategies and techniques for eliminating, reducing, and controlling occupational risk factors; the application of this knowledge is not only beneficial for workers, but also leads to the attainment of a more equitable, stable, and productive society". O último documento diz respeito diretamente àqueles que se ocupam do problema como profissionais. Em 1.992 a International Commission on Occupational Health (ICOH) publicou, após amplas consultas, um International Code of Ethics for Occupational Health Professionals, que consta de 26 parágrafos. O ICOH resumiu o conteúdo dessa publicação em três pontos: 1. Occupational health practice must be performed according to highest professional standards and ethical principles. Occupational health professionals must serve the health and social wellbeing of the workers, individually and collectively. They also contribute to environmental and community health. 2. The obligations of occupational health professionals include protecting the life and the he...

This chapter explores the concept of globalization and makes an assessment of its potential influence on health and equity. It considers growing concerns about the impact of globalization on inequities in health. The chapter does not argue whether globalization is intrinsically good or bad or whether we should nurture or impede it. Rather, it accepts that globalization is a reality, not a choice. A more pertinent question concerns the direction of globalization. What type of globalization is good or bad for human health? How are the globalizing processes that are underway to be confronted and used for, rather than against, the promotion of health equity?

Giovanni Berlinguer argues that the analysis of inter-relations between globalization and health has often considered health as a by-product or as a spontaneous consequence of globalizing forces. He proposes instead that health must be tackled as a global problem and a global goal and that globalization is an asset for health, deserving purposeful and well-planned effects. Development (1999) 42, 17–21. doi:10.1057/palgrave.development.1110076

Throughout history, the relationship between employers and workers has been subject to the equilibrium of power, to legislative norms, to ethical considerations, and more recently to scientific knowledge. The authors examine the ethical conflicts that arise from the application of scientific knowledge to preventive health policies in the workplace. In particular, they discuss the ethical conflicts in the application of screening practices, in the setting of "allowable limits" of harmful work exposures, and in the right of workers to be informed about work hazards. Ethical problems are also created by conflicting interests in the protection of the environment, the health of the general public, and the health of the working population, and by conflicting interests among workers, and even within the individual worker, as in the case of "fetal protection" policies. The authors emphasize the positive use of scientific information and respect for human dignity in resolving these conflicts.

A review of the five centuries since Columbus discovered America helps us understand the mutual contributions of the Old and the New Worlds to the history of diseases and their treatment. It also shows the consequences of this "mutual discovery" as they are currently emerging in the fields of health, culture, and the environment. To evaluate the multiple aspects of the interchange between the Old and New Worlds, this article discusses the following: the causes of the rapid decline of the original American populations; the diffusion of communicable diseases between the two civilizations; the health consequences of the nutritional changes on both sides of the Atlantic; drug addictions, as they developed through the centuries and as they exist today; the ways diseases were and are evaluated, prevented, diagnosed, and treated; and the mutual impact of different models of health services. Arguing that a major global change following the discovery of America was the transition from isolation of the two worlds to communication, and more recently, to global interdependence, the article also discusses some problems of bioethical relevance and the possible impact of new epidemics. Finally, it suggests that a critical analysis of the past may help stimulate future cooperation and solidarity.