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Globalization and Health

Work in the globalization area focused primarily on the global neoliberal economic era (post 1980) and its far-reaching effect on health and access to the social, economic, and environmental resources needed for health. Domestic economic policy and regulatory measures figure prominently, as does trade and investment liberalization’s impacts on economic development, labour markets, debt and taxation, wealth and income distribution, and health systems access. Excess consumption of environmental resources and high levels of toxic emissions are imperilling planetary health.

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As one of the key publication notes, globalization may be driven by how it is determined by, and determines, economic relations of power, but it also has more nuanced outcomes in terms of peoples’ experiences of time, space, and knowledge. As a sociopolitical phenomenon it predates the contemporary neoliberal era, and even the post-feudal rise of capitalism, and was manifest as empires in earlier historic periods. (see: Health equity in a globalizing era: past challenges, future prospects, Oxford University Press. 2019.)

Books

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  • Labonté, R., and Ruckert, A. Health equity in a globalizing era: past challenges, future prospects, Oxford University Press. 2019. https://academic.oup.com/book/34974 

    • Summarizes almost 30 years of research; awarded 2021 Book of the Year by the British Medical Association

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  • Labonté, R., Schrecker, T., Sanders, D., Meeus, W. Fatal Indifference:  The G8 and Global Health. Cape Town: University of Cape Town Press/IDRC Books. 2004. Access at: http://hdl.handle.net/10625/31263

    • One of the first critical texts interrogating how the different facets of globalization influence health outcomes.

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Publications and Presentations

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Many of the articles were published in the open access BMC journal, Globalization and Health (https://link.springer.com/journal/12992). I have been involved with this journal since its founding in 2005 and one of its lead editors since 2014.  

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Global Health Diplomacy

Since the 1990s health has risen as an international policy concern for many states. For some (the donor nations) it is an aspect of their foreign aid, which could have multiple goals ranging from the 1970 UN General Assembly resolution that developed countries allocate 0.7% of their gross national income to development assistance, to exerting ‘soft power’ influence over nations with which it which it wishes to trade or invest. With the eight Millennium Development Goals adopted by the UN in 2000, and the more extensive seventeen Sustainable Development Goals similarly adopted in 2015, health as a foreign policy issue gained increasing prominence in the diplomatic affairs of many nations. As two key publications in this section argue, there are several differing frames by which health can enter foreign policy discourse: as security, development, global public goods, trade, human rights and ethical/moral reasoning (Labonté 2008; Labonté and Gagnon 2010). Each frame has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. 


Research on this theme involved theory and concept development, and historic and comparative country case studies (2015-2021) on how health is conceptualized (if at all) in countries’ foreign policies or evident in their international actions. 

Publications and Presentations

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Political Economy of Health

Political economy is an interdisciplinary field that studies the relationship between political forces and economic systems. It examines how politics, public policy, and economics influence each other, considering factors like government (governance), social structures (class, race, gender and other systems of stratification), and historical context (path dependency, ideology) in economic analysis. This field argues that it is not possible to understand one without the other, and it draws from economics (classical, heterodox, feminist, ecological, and radical), sociology (interrogating how power defined relations between state, market, and civil society), and political science (the study of systems of government and governance). Political economy of health, in turn, examines how these different pathways manifest as health outcomes, via social/societal determinants of health. While a political economy analysis permeates much of my past research and scholarship, two themes are highlighted on this page: neoliberalism, and tobacco control.

Neoliberalism is considered a recent (post-1980) extension of classical economic liberalism as theorized by 17th and 18th century European writers, such as Jeremy Bentham, John Stuart Mill and Adam Smith. As one of the key publications argues, the formulation of contemporary neoliberal economics is largely credited to the Austrian/America economist, Friedrich von Hayek, and became the dominant international order when the rise of conservative politics in the USA, the UK and Germany merged with one of capitalism’s intermittent crises, in this instance the oil price shocks of the 1970s and the ensuing developing country debt crisis (Labonté and Stuckler 2016). This confluence of forces created space for neoliberalism’s theoretical arguments to gain political traction, and then spread globally via the imposed financial rescue packages of the World Bank and International Monetary Fund. There is recent (post 2025) argument that the second US Trump administration has ended neoliberalism as the dominant global economic order, although many of its market fundamentalist and government minimalist practices remain (see Global Health Watch 7 2025).

 

Publications and Presentations

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Health Promotion

The Ottawa Charter for Health Promotion (1986) is one of the seminal declarations that made health promotion a commonly invoked and rapidly globalized practice in public health, displacing the earlier dominant concept of health education. The Charter defines health promotion as ‘the process of enabling people to increase control over, and to improve, their health’ a riff on the definition I coined in 1981 as ‘the process of empowering people to take control over, and responsibility for, their health’, but with an emphasis on acting on the ‘socially pathogenic issues and structures’ that determined their health. This 1981 monograph was printed by mimeo, predating any digital age, and so lives in an old office filing cabinet. But its analysis suffused my health promotion work from the mid-1970s onwards, reflecting very much the social critiques of various social movements of the era: anti-poverty, anti-racism/civil rights, feminism, environmentalism, New Left (socialism/Marxist economics), labour and human rights. At base, I understood health promotion (a term I never liked much) as an exercise in doing social justice, informed by critical theory. And only and ever in concert with the progressive local, national and (only later) global social activist groups.

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My early health promotion scholarship, generated during my almost two decades of full-time work as a health promoter for local and provincial health departments in Canada, attracted a lot of attention, including as it did a lot of practical reflection on what an ‘empowering’ health promotion practice looked like. Two key publications summarize much this work (Labonté and Laverack 2008, and Labonté 1993). As some of the publications below indicate, I have continued with some scholarly work in the health promotion area; but most of my active work on this theme began to fade in the mid-1990s. I spent much of the 1990s working internationally running workshops and contributing to research based on the empowerment models of health promotion I had developed in the 1980s. In country after country I encountered public health workers complaining of retrenchment and lack of support for the social justice underpinnings of health promotion, leading me to speculate that there must be global forces at work, if this was becoming such an international experience. I pivoted, then, to examining how globalization was affecting nation states, and hence regional and local health authorities’, resources and capabilities for the ‘radical’ health promotion on which my own work was weaned for two decades.

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As such, many of the publications here are older; in that sense, they can be considered foundational, for there is essentially nothing that I wrote on this topic over 40 years ago with which I disagree, or that I find irredeemably dated.

Books

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Publications and Presentations

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Global Health Mobilities

In broad terms global health mobilities refers to the movement of peoples, primarily cross-border movement but increasingly also internal displacement, often due to conflict or environmental conditions such as drought. Research on this theme fell into two broad categories: health worker migration, where the health equity issue is the loss of (often publicly trained) skilled health workers from underserved poorer countries to better-served wealthy ones (‘brain drain’); and ‘medical tourism’, a quixotic term coined to describe the commercialization of international patients with the lure of recovery in touristic surroundings where the health equity concern is investment and growth of private care for international private paying patients crowding out access for poorer locals to less well equipped tax-funded public facilities. The health worker migration studies began when there was a surge of active recruitment for foreign-trained doctors and nurses in the Canadian provinces in which I worked; or were suggested by research colleagues in countries where I had migration studies as the obvious obverse of the outmigration of health professionals.

Books

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Global Health Governance

Global governance processes concern the agreed upon actions and means adopted by social actors to promote collective action and deliver solutions in pursuit of common goals. In distinction to government processes, such actions are not always backed by formal authority structures and usually involve actors beyond the nation state, including many private sector entities and various nongovernmental organizations (NGOs) and wider civil society groups. Academic and policy attention has gone into studying how to strengthen ‘global health governance’, the need for which is a result of a funding chokehold on the WHO, which has king been surpassed in financial standings by the health programs of the World Bank, the Bill and Melinda Gates Foundation (the WHO’s number one funder) and other philanthropies, and the growing number of ‘global health partnerships’, many of them structured as public-private-partnerships.


A useful distinction is made between global health governance (where the focus is on health organizations and systems, much of it related to disease control), global governance for health (where non-health institutions policies or actions are interrogated for their impacts on health, addressing social/societal determinants of health), and governance for global health (see the global health diplomacy page, how health becomes a foreign policy concern). The COVID-19 pandemic generated considerable study of global health governance.


One of the key systems of health governance are human rights, of which there 9 core human rights treaties. These treaties have legally binding obligations and duties under international law, although enforcement of these rights is relatively weak. The major means of holding governments to account are intermittent reports they must present to UN Human Rights Council, where fear of being ‘named and shamed’ for slow progress in realizing rights’ obligations could incentivize countries to strengthen their own legal systems’ instantiation of these obligations. Doing so can allow individuals or groups to pursue domestic legal remedies if they believe their human rights have been impugned. 

Publications and Presentations

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Global Trade

An increasingly interconnected and interdependent global economy and the dynamic nature of trade across borders have important implications for health everywhere. Economic policies for the past four decades have largely embodied neoliberal agendas that are subject to increasing empirical, ethical, and theoretical scrutiny, with widely accepted concerns over their impact on inequality, poverty, and environmental damage. Economic integration and trade and investment liberalization are defining features of contemporary globalization, first creating, and now revamping, global supply chains, creating both health opportunities and risks. How trade and investment treaties impact health outcomes within and between countries continues to be politically and empirically debated. The World Trade Organization, established in 1995, has been the major intergovernmental body overseeing multiple agreements that are binding on member states, one of the best known and studied ones being the TRIPS agreement that protects intellectual property rights, mostly held by wealthy corporations in the USA and Europe, and a source of contention during the COVID-19 pandemic. Outside of the WTO system, regional trade treaties have proliferated to overcome governance gridlock within the WTO system. Bilateral or regional investment treaties (as part of regional trade treaties) grant special rights to foreign investors to sue governments for actions perceived to affect the value of their investment (such as direct expropriation or passage of new laws and regulations considered ‘tantamount to expropriation’). These treaties similarly exploded in number, dispute frequency, and the size of monetary claims. Most pf these investor state disputes involve extractive industries (mining, fossil fuels) suing governments for introducing environmental protection policies. As one of the key publications on trade and health notes, the breadth and depth of these post-1995 trade and investment treaties meant that few areas of general public health concern are untouched (Gleeson and Labonté 2020). 

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The re-election of Donald Trump to his second presidency in 2025 and his chaotic imposition of tariffs, as another key publication outlines, is re-shaping global trade in unexpected ways; although global trade will continue and, while slowing, is not demonstrably diminishing (Labonté et al 2025).

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Publications and Presentations

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Critical Public Health

Public health has long been concerned with the distribution of disease in differing publics, and in the conditions that give rise to outbreaks, epidemics, and pandemics. There is also a history of calling on health and other public officials to intervene in what we now call the social (or societal, or socioenvironmental) determinants of health. But much public health reduces to an individual or risk factor level of analysis, which led to calls for more critical approaches to understanding population health and disease: in the 1970s to ‘radical community social medicine’ and ‘new public health,’ in the 1980s to ‘health promotion’ and ‘critical public health.’ As one of the publications suggests, the implications of a critical public health research or practice is two-fold: an obligation to uncover how specific social structures condition and constrain health opportunities, and a praxis based on community/civil society engagement and an activist commitment to social change (Critical Perspectives in Public Health, London: Routledge. 2007). In 1990, the journal Critical Public Health was launched, giving voice to a distinct form of public health activist research. Although still published, in 2023 the journal editorial board resigned to protest the publisher’s insistence on fewer article rejections and profit-maximization by adopting a fully open access (author-pay) publishing model. Critical public health scholarship continues in a variety of other platforms.

Books​

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  • McLaren, L., Green, J., Labonté, R. New directions in critical public health: health in turbulent times London: Routledge (2025) https://www.routledge.com/New-Directions-in-Critical-Public-Health-Health-in-Turbulent-Times/McLaren-Green-Labonte/p/book/9781032354804 

    • An update on some of the themes presented in the edited 2007 text (below), this book draws from, and supplements, some of the analyses of articles published in the Critical Public Journal before the mass resignation of editorial board members.

  • Bourgeault, I., Labonté, R., Packer, C., and Runnels, V. (eds.) Population Health in Canada: Issues, Research & Action. (2018) Toronto: Canadian Scholars Press. https://canadianscholars.ca/book/population-health-in-canada/ 

    • This contributed volume includes papers from the Population Health Improvement Research Network (PHIRN) of Ontario and offers a focused analysis of the social and economic determinants of health that impact the health status of populations in Ontario as well as the conditions that can improve the health status of populations across Canada. The different sections address health policy theories, research methods, program interventions, and strategies for knowledge translation.

  • Green, J. and Labonté, R. (eds). Critical Perspectives in Public Health, London: Routledge. 2007. https://www.researchgate.net/publication/291842378_Critical_Perspectives_in_Public_Health 

    • An early retrospective on critical public health scholarship, featuring many of its foundational elements.
       

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Global Health Development

Development theories and development assistance have been fixtures on the global health landscape for decades, most recently with adoption of the 2015 Sustainable Development Goals (SDGs). Considerable controversies continue to surround health development assistance, including the complex forms it takes (vertical, diagonal, horizontal), the lack of consistency over time, disbursements driven by donor interests rather than need, high transaction costs of poor donor coordination, a ‘charity’ rather than ‘entitlement’ approach, the rise of global philanthropies, and the lack of coherence between donors’ aid and their international trade/macroeconomic policies. In recent years, the role of micro-financing has been advanced as a key development strategy, although it remains controversial; and ‘social impact investing’ (where private investors finance projects with global social/public good outcomes, but also with the expectation of profit) is inserting a market logic into previously humanitarian notions of assistance or obligation.  

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In this context, most recently dramatically affected by the 2025 US slashing of foreign aid, emulated by many other donor countries, the SDGs still resonate as important global health targets. While pressured by increasing health care privatizations, the aims of comprehensive primary health care still drive much public health research and advocacy. And bridging the development and primary health care nexus is the longstanding global emphasis on improving maternal/child health outcomes.

Publications and Presentations

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  • Hussain, S., Javadi, D., Andrey, J., Ghaffar, A., and Labonté, R. “Health intersectoralism in the Sustainable Development Goal era: from theory to practice,” Globalization and Health (2020) 16;15: 1-5. https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-0543-1

  • Bergen, N., Ruckert, A., Labonté, R. “Monitoring frameworks for Universal Health Coverage in the Sustainable Development Goals: What about high-income countries?” International Journal of Health Policy and Management (2019) 1-7. https://www.ijhpm.com/article_3612.html   

  • Proulx, K, Ruckert, A., and Labonté, R.  “Canada’s Flagship Development Priority: Maternal, Newborn and Child Health (MNCH) and the Sustainable Development Goals (SDGs)” Canadian Journal of Development Studies /Revue canadienne d’études du développement. (2017) 38(1):39-53. http://www.tandfonline.com/doi/full/10.1080/02255189.2016.1202103

  • Labonté, R. “Development goals in the post-2015 world: Whither Canada?” Canadian Journal of Public Health 2014, 105(3):e224-e228.

Global 1HN

The Global One Health Network (Global 1HN) was a multi-year (2018 – 2023) was an interdisciplinary research-to-action network intent on strengthening Canadian leadership in improving the global governance of infectious diseases (IDs) and antimicrobial resistance (AMR). The Network brings together researchers and knowledge users from the social sciences as well as human, animal, and environmental health sciences to develop a transdisciplinary One Health approach to ID and AMR governance at global, national, and local levels. It has several objectives:

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  1. Develop and sustain a Network of local, national and international state and non-state actors to facilitate collaborative interactions among civil society, academics, industry, and policy communities.

  2. Strengthen capacity for inter- and transdisciplinary research on, and the practice of, global governance of IDs and AMR. 

  3. Facilitate evidence-informed actions through: synergistic engagement of social and health sciences approaches to OH global governance, identifying and addressing existing barriers to, and enhancing existing and potential enablers of OH governance, and developing a OH evaluation framework.

  4. Facilitate the implementation of a transdisciplinary OH approach to global governance of IDs and AMR through an integrated knowledge translation strategy.

Policy Briefs and Reports

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Publications and Presentations

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Wellbeing Economics

Public health has tended to grapple with economics only in cursory ways, as some of the publications in the section on Political Economy of Health discuss. Health economics often defaults to health (medical) care economics, using cost/benefit analyses to determine the greatest health return per level of capital (financial and/or human) expenditure. A legacy of health behavourism critiques in several of the publications in the Health Promotion section, ‘nudge’ economics attempts to use economic carrots (financial incentives) or sticks (financial penalties) to induce people to adopt healthier ‘lifestyle’ behaviours.

 

In the background, however, there has always been minority concerns with the disequalizing and toxic impacts of capitalism as an economic model. While generating growth and growth-associated health gains (albeit grossly maldistributed), capitalism relies upon consumption of natural resources, income inequalities, and profit (capital accumulation) as the prime social directive. Climate catastrophe and the increasing pace of financial crises, compounded by the rise in pandemic threats and anti-microbial resistance (discussed in many of the publications under Global1HN), has led to a number of new ‘post-capitalist’ economic models and policy prescriptions, from degrowth/postgrowth to doughnut economics to ‘wellbeing economics.’

 

This latter concept, while running the risk of performative politics with little change in ‘business as usual’ practices that are killing planet and people, nonetheless has some positive attributes that could help in a transformative shift into something other than the autocratic rule and kleptocratic greed that the recent second Trump presidency has escalated.

Reports​

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  • Labonté, R. Muhajarine, N., Winquist, B., Quail, J. Healthy Populations Domain of the Canadian Index of Wellbeing. Toronto: CIW Foundation, 2010.

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Publications and Presentations

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