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Brief analytical summaries or syntheses #11

The impact of global processes on health systems in Europe


The relationship between globalization and health systems is a complex one, where both positive and negative influences are reported. This unsystematic literature review explores the impact of globalization on European health systems and emphasizes the need for national policy-makers and leaders to consider global processes when designing national health systems.


The world is changing rapidly with increasing life expectancies and improving child survival rates. Globalization has contributed to economic growth. In addition to global economic integration, globalization entails the mobility of capital, goods, services and labour, and can be said to be part of an ideological process justifying neo-liberal economic policies. Globalization is also a dynamic process of global interconnectedness influenced by a number of driving and constraining forces such as technological developments, political influences, economic pressures, changing ideas, and greater awareness of social and environmental concerns. Inherent to globalization is the phenomenon of cross-border flows and, in health care, this includes the cross-border movement of people (both as health consumers and healthcare providers) as well as the cross-border movement of pharmaceuticals, technology and health-related information. Health is now high on the political agenda, and health-related issues are gaining increasing attention at the global level. Distinctions made between domestic (national) and international health problems are therefore losing utility within the global forum.

Analysis and results

The context of globalization presents a number of challenges to European health systems.

The phenomenon of innovative developing countries

The emergence of rapid healthcare innovation in China, India and Brazil creates a need for Europe to develop new types of partnerships with these countries. Demand for health care in these countries is increasing as citizens move into higher income brackets. Europe has a major opportunity to establish links, especially as these countries are investing heavily in health research.

Health workforce migration

Growing migration sees healthcare professionals moving from poorer to richer parts of the world, and from Eastern European countries to Western European countries in particular. Some European countries facing health workforce shortages are recruiting personnel from abroad. European countries must focus their efforts on developing and maintaining health workforce policies in order to limit the exodus of professionals from poorer countries.

Medical tourism

Low airfares combined with the high-cost of medical interventions (where consumers need to pay these out-of-pocket) have led to medical tourism, with people flying across the globe for medical treatment.

Microbial traffic

Globalization has increased the movement of people around the world, and with this comes the spread of infections and anti-microbial resistance via large-scale air transportation. The report cites the example of a new antibiotic-resistant super bug, NDM-1, that has the potential to cause major global health problems.


The process of globalization will continue to produce important changes in Europe over the coming decades. These will be apparent in a number of sectors — communications, transport, migration, politics and culture — that will have a significant impact on the health sector. The transformations underway highlight the importance of engaging in political dialogue on healthcare systems, including the importance of universal coverage for care. European healthcare systems can, in this way, contribute to improvements in global health.

Implications and recommendations

The values that underpin European healthcare systems must be taken into account alongside measures of efficiency and cost-effectiveness when evaluating health system performance. European Ministers of Health need to think about the type of health system they want to create for the future. System design must take the interactions between the health systems of different countries into account, as these will only increase with globalization.


The impact of global processes on health systems in Europe. Fichier PDF.