In order to plan for health communication effectively, we cannot ignore three more concepts: globalization, urbanization, and sustainable development.
Globalization
Globalization depicts how people from different states, nations, or territories are becoming more interconnected and interdependent on one another. Manifestations of globalization are in different areas: economic, political, cultural, technological, social, and ideological (Lie and Servaes 2008). Globalization involves develop- ment, progress, and disparity. For some, it may be the future of opportunities and wealth accumulations but for others it may cause unequal access to information, opportunities and wealth and that leads to economic disadvantages, exploitation, distraught and unhappiness, and sickness. It cannot be denied that communication technology in the dominance of capitalism, influenced by neo-liberal ideologies, is the propelling factor of globalization so that there exists worldwide exchanges in labor, trade, technology, production, and capitals.
According to Lee (2005), globalization encompasses three dimensions of global change: spatial, temporal, and cognitive. Globalized interactions make us perceive an extension of our space perception—that is the spatial dimension. We also per- ceive and experience the compression of time for global interactions—that is the temporal dimension. Lastly, by exchanging ideas, values, ideologies, policies, or knowledge via the global interactions, we form our own postmodern identities and worldviews—that is the cognitive dimension. This leads to social change and its health consequences. With the growth of cultural globalization, which is mostly westernization, we experience changes of lifestyles: eating, recreating, dating, arts, sports, games, clothing; sexuality and media consumption. With more sedentary lifestyles, chaotic life, and fast food consumption, we witness the rise of chronic
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non-communicable diseases such as obesity, type 2 diabetes, cardiovascular dis- ease, cancer, and mental illnesses. Spatial globalization brings more problems of migration and that enhances the outbreaks of communicable diseases in the twenty- first century such as HIV/AIDS, SARS, and H1N1 pandemics. These communi- cable and noncommunicable diseases display the negative side of globalization.
Urbanization
Urbanization is by no means a symbolic representation of globalization. Nearly half the world’s population now lives in urban settlements. Cities offer the lure of better employment, education, health care, and culture; and they contribute dis- proportionately to national economies. However, rapid and often unplanned urban growth is often associated with poverty, environmental degradation, and population demands that outstrip service capacity. These conditions place human health at risk.
Low- and middle-income countries are the most affected by demographic changes, bearing 80 % of the world’s burden of disease and the highest attrition rates of doc- tors and nurses to other parts of the world. Inarguably, these trends influence the accessibility, quality, and cost of long-term health care in urban and rural communi- ties, alike.
The distinction between urban and rural is not merely a distinction based on the nature of settlements, it is a distinction rooted in the economic structure and social relations of production and reproduction, and in the processes of social and political consciousness and its articulation. Therefore, urbanization is often taken as a proxy for the level of development in general.
Data that are available indicate a range of urban health hazards and associated health risks: substandard housing, crowding, air pollution, insufficient or contami- nated drinking water, inadequate sanitation and solid waste disposal services, vec- tor-borne diseases, industrial waste, increased motor vehicle traffic, stress associat- ed with poverty and unemployment, among others. Local and national governments and multilateral organizations are all grappling with the challenges of urbanization.
Urban health risks and concerns involve many different sectors, including health, environment, housing, energy, transportation, urban planning, and others (Moore et al. 2003).
Globalization and urbanization make us think of development in the global-local perspective. The term global village is a cliché because disparities have always existed. There are always differentiations in the level of development internation- ally or within a nation. Take the US as a good example. The United States is the only developed nation that has no national health insurance that guarantees rights to healthcare access for all (Morone 2008, p. 1). In 2005, more than 45 million Americans still had no health insurance at all (Leichter 2008, p. 173). In the United States there remains a big gap in development level according to ethnic groups.
White Americans, who are the majority, enjoy the wealth and privileges of better education and employments more than the Hispanics or the African-Americans.
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White Americans live longer and suffer less from diseases than the other ethnic groups (Allen and Easley 2006, pp. 48–50). One explanation of this is that the other ethnic groups have no inheritance or accumulation of assets, because the African- Americans started from being slaves in agricultural regions in the South of the United States and the Hispanics arrived as cheap migrant workers. Poverty affects health and life courses in terms of disease prevention, nutrition, recreation, safety and security in workplace, etc. This leads us to think of development in a global perspective—the modernization paradigm, the dependency paradigm, and the mul- tiplicity paradigm (see more details in Servaes 1999, 2008)—and raises the ques- tion of sustainability.
Sustainable Development
Sustainable development is also a discourse. One meaning is from a “Western” per- spective represented by the Brundtland Commission, and the other is an “Eastern”
Buddhist perspective as represented by the Thai philosopher and monk Phra Dham- mapidhok (Payutto 1998).
For the Western perspective, the World Commission on Environment and Devel- opment (WCED), also known as the Brundtland Commission, defined sustainable development in 1987 as “development which meets the needs of the present without compromising the ability of future generations to meet their own needs” (Elliott 1994, p. 4). The WCED emphasizes core issues and conditions such as population and development, food security, species and ecosystems, energy, industry, and the urban challenge. All of these issues have an impact on environmental health, food- borne diseases, mental health, injuries, and accidents as major concerns for public health.
Phra Dhammapidhok (Payutto 1998), a famous Buddhist monk and philosopher, points out that sustainable development in a Western perspective lacks the human development dimension. He states that the Western ideology emphasizes “com- petition.” Therefore the concept of “compromising” is used in the above WCED definition. Compromising means lessen the needs of all parties. If the other parties do not want to compromise, you have to compromise your own needs and that will lead to frustration. Development will not be sustained if people are not happy.
From a Buddhist perspective, sustainability concerns ecology, economy, and evolv- ability. The concept “evolvability” means the potential of human beings to develop themselves into less selfish persons. The main core of sustainable development is to encourage and convince human beings to live in harmony with their environ- ment, not to control or destroy it. If humans have been socialized correctly, they will express the correct attitude toward nature and the environment and act accord- ingly (Servaes and Malikhao 2004). This perspective ensures the last dimension of health: spirituality.
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