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The impact of globalisation of health and education policy

发布时间:2017-05-02
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Globalisation (impact of globalisation on health, education in social policy

Introduction

Giddens (1991) maintains that social structures are both constraining and enabling and thus they advantage some people and disadvantage others. The onset of what has come to be known as globalisation has had effects in almost every country in the world. At a global level this may appear to be something that enables greater co-operation and inclusion, while at a local level it tends to disadvantage those who are already on the margins of society.

The processes of globalisation began with the aftermath of World War Two when western states attempted to forge closer links with each other. Numbers of theorists (eg Stiglitz 2002) maintain that this formed the basis of what has come to be known (especially since the 1980s) as globalisation. This coupled with increasing industrialisation has resulted in financial and social changes in many countries. This paper will assess whether and in what ways the processes of globalisation have had an effect on policy making within the arenas of health and education.

Globalisation

Globalisation should not be seen as a neutral concept, it has all kinds of implications for a country’s social policy. Spending and types of welfare provision will differ from country to country, but in many cases will include housing, pensions, education and health. Giddens (2001) argues that as society changes, due to the effects of industrialisation and globalisation so must the nature of the welfare state. There is a growing opposition to the forces of globalisation as many people argue that these forces have a tendency to exclude as much as they include, and this has brought about greater imbalances in society. The increasing stresses of modern life, advances in technology and patterns of work have affected all areas of people’s lives and in many instances this has had repercussions on people’s health. Policy changes in response to what is going on in the global market mean that there has been an increase in health inequalities in recent years. This paper will assess the impact of globalisation on health and education policy in Britain in recent years.

Walsh et al (2000) have argued that in Britain there has been a growing tendency for governments to take a positive view of both physical and mental health and relate it to lifestyle. In this way governments place the responsibility for health firmly on the shoulders of those who suffer from ill health, whether this be physical or mental.

It has been said that health practitioners and health services in many countries face a growing challenge from the impact of globalisation. The free movement of both capital and people has brought social and economic changes to most developed countries, not all of these changes have been beneficial. There is no clear agreement as to how these processes affect health provision and policy making but Woodward et al (2001) maintain that there is:

however, an increasing tension between the new rules, actors and markets that characterise the modern phase of globalisation and the ability of countries to protect and promote health (Woodward et al, 2001).

As global economic competition has increased large companies have raised questions as to the cost of welfare services. This is because a big part of such services are paid for through company wage bills and contributions (Moore, 2002). Thus policy making, both within the UK and across Europe as a whole, is heavily influenced by trading patterns across the world economy. As Moore (2002) points out this in turn relies on the fact that people are employed and paying their taxes and this is a result of foreign investment setting up businesses where people can work. The World Trade Organisation was set up in 1995 with the agreement of 134 countries, and as a result trading now operates on a global scale and affects all of us. It has particular repercussions on health policy because the agreement, for example has had an effect on the price of pharmaceuticals and the WHO maintain that this affects treatment across the globe. Recent news in Britain has highlighted the fact that Britain has become a postcode lottery with regard to health with some NHS trusts refusing treatment to patients because the drugs are so expensive. This has certainly affected numbers of women suffering from breast cancer because their trusts will not pay for the treatment!

Transnational and multinational companies are assuming increasing importance, particularly in the developing world as countries rely on these companies to locate their business within their borders to facilitate job and wealth creation. Moore (2002) points out that some theorists argue that a division in the global economy has occurred between the poorer nations where manufacturing is carried out and richer nations in the west who rely more on the service industries. However, due to the fact that companies have relocated to developing countries some commentators are of the opinion that this has resulted in greater unemployment in the developed world. This has influenced policy making across the globe because rising unemployment means less revenue for the Government who have to find ways of offsetting this loss. The most obvious way is a change in policy making.

Welfare and Policy Making

By the late nineteen seventies it was argued that the full employment envisaged in the 1942 Beveridge Report would never happen and the idea that people could be reliant on the state from the cradle to the grave was no longer feasible. Rising unemployment and the spiralling costs of social care meant that the incoming Tory Government headed by Margaret Thatcher introduced radical changes into both health and education policies and there was a shift from welfare to market based provision of social care (Giddens, 2001). In theory introducing market concepts into aspects of welfare provision such as health and education should result in greater choice and an improvement in services. Stiglitz (2002) has argued in this context that such policies also allow a Government more control over people’s lives in that improvement in services means Government monitoring of service take up and provision, and also how the money is spent.

The measures that the Thatcher Government introduced meant that there was a roll back of the welfare state so that they could more easily control expenditure. At the same time the Government also embarked on a programme of privatisation as they believed that public ownership of services undermined the market forces that guided Government policy making. .Giddens (2001) maintains that this was an essential part of the Government’s strategy because it was difficult to finance the changes in any other way, thus he points out that:

…the momentum of Thatcherism in economic matters was maintained by the privatising of public companies…..(this)..is held to reintroduce healthy economic competition in place of unwieldy and ineffective public bureaucracies, reduce public expenditure and end political interference in managerial decisions (Giddens, 2001:434).

It was believed that free markets were self-organising and that eventually the situation would stabilise itself (Stigliss, 2002). Within the healthcare arena there was a shift from patients and doctors to clients and service providers, thereby emphasising the market principles now inherent in the provision of healthcare (Walsh, 2000). Thus a two tier system of care evolved which created inequalities between hospitals and between patients. The NHS was no longer the body that it had been, the Conservatives split it into competing NHS Trust organisations and parts of the health service were privatised (Walsh et al, 2000). The NHS and Community Care Act was introduced in 1990 and as a result the state was no longer the sole provider of care. Voluntary and Charitable organisations would also play a part and care packages would be organised by local authorities. Means and Smith (1994) maintain that this meant that the term actually took on the opposite meaning of not caring thus they argue that:

the term community thus enables the continuous construction of an idyllic past of plenty and social harmony which acts as an immanent critique of contemporary social relations. Thus the call by politicians and policy makers to replace present systems of provision with community care feeds into this myth by implying that it is possible to recreate what many believe were the harmonious, caring and integrated communities of the past (Means and Smith, 1994:5).

Sears (2001) has pointed out that in a world ruled by the owners of mobile capital, along with the rising importance of market forces in the majority of nation states ideals of equality are difficult to maintain. When New Labour came to power in 1997 they did not break with Conservative policies. Tony Blair’s Government, like the Conservatives before them held to the view that the welfare state had fostered a dependency culture (Dean, 2003).

Thatcher believed, as do the current Government, that education should be guided by market forces and the need for an educated workforce. She called for an improvement in educational standards rather than equality of opportunity. The introduction of competition it was argued would increase standards and choice while being cost effective. The 1988 Education Act allowed for schools to opt out of the state system and become Grant Maintained and self governing. At the same time the National Curriculum was introduced which change the face of British education (not necessarily for the better). These policies which claim to give better services and more choice for parents and children have been carried on by the present Government. Gillborn and Youdell point out contrary to Government rhetoric, that marketisation not only creates inequalities between schools but the competitive examination system (i.e. results reflected in league tables) creates inequalities within schools. It often seems to be the case that government policy making has the effect of giving with one hand while taking it back with the other. State policies affect individuals and current educational policy making in particular tends to produce a society of winners and losers

Conclusion

The issues examined here do seem to point to the fact that the forces of globalisation tend to push countries into adopting similar kinds of policy making. Harlan (2001) has this to say:

One of the most intense debates in International Political Economy over the

past decade has revolved around the question of whether these trends in globalisation have forced nations to follow the same economic policies. Those who argue for convergence, whether they approve of it3 or not,4 maintain that powerful economic forces, combined with the ideological hegemony of Anglo-Saxon economic ideas, have forced states to adopt neo-liberal policies. Others, however, argue that a convergence towards neo-liberal economic ideas is not preordained, since other economic models can adapt to globalisation and even have advantages over neoliberalis (Harlan, 2001:3)..

Some theorists argue that convergence leads to privatisation and marketisation and could result in an American model of virtually no welfare provision. Garrett (1998) argues that those welfare states whose policies lean towards the left will have more success in dealing with the forces of globalisation than those who lean to the right. Certainly this country has been under the influence of the kind of policy making that leans to the right over the last twenty five years. Clearly Globalisation does have an effect on the way countries organise social care for their inhabitants. Whether the health and education policies that have been introduced since Thatcher’s Government came to power are solely a result of this, or whether they are, in part, the desire for those in power to return to a less egalitarian society remains to be seen. References

Dean, H. 2003 “The Third Way and social welfare: the myth of post-emotionalism” Social Policy and Administration Vol 7 Issue 7 p.695

Garrett, G. 1998. Partisan Politics in the Global Economy Cambridge, New York: Cambridge University Press

Gewirtz, S., Ball, S. & Bowe, R. (1995) Markets, Choice, and Equity in Education. Buckingham: Open University

Giddens, 2001. 4th ed. Sociology. Cambridge, Polity Press

Gillborn, D.,&Youdell, D. (2000). Rationing education. Philadelphia:Open University Press.

Harlan, C. 2001 Europe and the third way: Gerhard Schröder and Globalisation

Paper for the 51st Political Studies Association Conference

10-12 April 2001, Manchester, United Kingdom

Marsh, Keating and Eyre et al 2000 2nd ed. Sociology: Making Sense of Society Essex, Pearson Education

Means, R. and Smith, R. 1994 Community Care, Policy and Practice London, Macmillan

Moore, S. ed. 2002 Social Welfare Alive 3rd ed. Cheltenham, Nelson Thornes

Sears, M 2001 “Welfare with or without the state: British Pluralists, American Progressives, and the Conditions of Social Justice” The European Legacy Vol 6 No. 2 pp. 201-213 2001

Stiglitz, J. 2002 Globalisation and Its Discontents New York and London: WW Norton & Company

Walsh, I ed. 2000 Sociology: Making Sense of Society. Edinburgh, Prentice Hall.

Woodward, D. Drager, N. Beaglehole, R and Lipson, D.

2002. Globalisation and Health: a Framework for Analysis and Action

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