Course description
Is globalization good for health? How does globalization affect sustainable well-being? What are the main institutions implementing globalization and health policies? What is the role of globalization in creating possible conditions increasing the risk of pandemics like COVID-19? How can we make globalization healthier and more sustainable?

The course Globalization and Health brings all these questions together to investigate the multiple effects of globalization policies, including those implemented by the International Financial Institutions (IFIs) such as the World Bank, the International Monetary Fund (IFM) and the World Trade Organization (WTO) and supported by the G-7 countries and Transnational Corporations (TNCs). These reforms, that dominated the policy agenda of most governments in the last four decades, include financial deregulation, trade liberalization, privatization of state enterprises, flexibilization of the labour market, and stabilization of state budgets (including the introduction of user fees for healthcare and education.)

These reforms, heavily criticised by a large number of non-governmental organizations (NGOs) and academic scholars, have produced important effects on the social determinants of health. Using an evidence-based approach, globalization policies will be scrutinized in terms of their ability to promote or deteriorate health, wellbeing and the environment. Students will be encouraged to explore their own views on globalization and contrast such views against the actual scientific evidence in the literature.

In the first part of the course, participants will learn about the historical context of globalization and the main institutions that have designed these policies. They will also get familiar about the health effects of economic crises that followed financial deregulation, the debt crisis, the rise of economic inequality between and within countries and poverty reduction strategies in different parts of the world. In the second part, the course will analyse the impact of structural adjustment policies on different health outcomes such as HIV/AIDS and malnutrition as well as health sector reforms including the introduction of user fees for healthcare and education. This part will also concentrate on trade liberalization and privatization of state assets and the potential effects of globalization on the predisposing factors of global pandemics. Particular attention will be paid to the impact of globalization policies on obesity, the environment and wellbeing. In the last part of the course, students will be encouraged to know more about the application of scientific knowledge to advance globalization reforms that promote health and reduce health inequalities. Students will examine alternative proposals for globalization and the role of the global justice movement in altering the structures of power and policies that can make globalization healthier.

Course aims and objectives
By the end of the course, students will be able to:

• Provide different definitions of global health and critically discuss the role of international financial institutions such as the IMF, the World Bank and the WHO, the G-7 countries and TNCs;
• Describe and critically examine the specific components of globalization policies such as financial liberalization, trade liberalization, privatization, deregulation of the labour market and stabilization;
• Describe scientific evidence on the effects of globalization policies on economic growth, macroeconomic stability, inequality and poverty reduction;
• Articulate some of the major causal pathways linking globalization policies and health-related outcomes;
• Describe scientific evidence on the multiple effects of globalization on health, wellbeing and the environment;
• Describe proposals to make globalization healthier and critically analyse the role of the global justice movement in advocating for policy changes at the national and global level

Assessment methods

Participation: students are expected to come prepared to actively engage with the topic at hand as well as classmates, faculty, and guest lecturers. If you miss a class due to illness you are responsible for catching up on all material before the next class. Participation grades are based on your willingness to voice your opinions, your ability to listen closely to others without interruption, and to treat each other with respect even when disagreeing strongly.

Reading Presentation: Students are expected to critically discuss peer-reviewed articles describing major evidence on the effects of globalization on health. In order for this approach to work, we must all be committed to reading carefully and critically, to making a detailed synthesis of the observations and questions relevant to the subject, and to participate fully in class discussions. During some of the lectures for this course, groups of students will collaborate to lead a presentation of that week’s readings. Each group will prepare for circulation a one-page reading guide consisting of:
· a summary of the article(s)/chapter(s) assigned (2-3 paragraphs) that shows careful reading;
· 2 critical comments (3-5 sentences each) on each author's argument or 2 country-specific examples that illustrate the argument;
· 2-3 thoughtful discussion questions that connect the author's argument to previous readings or an experience in the field or in another class.

At each presentation, the group will be responsible for presenting a joint summary and analysis of the readings and getting discussion started. We do not expect formal oral presentations, just a well-organized summary and analysis of the readings and some thoughtful questions to animate discussion.

Final Paper: Students will be responsible for a 12 page (double-spaced) interdisciplinary paper to deepen their thinking about a particular health-related issue within each country. This assignment will also be a chance for the students to integrate their learning across courses. At the beginning of the course, students are expected to pick a health-related problem (topic) and explore different aspects of the same problem. The final paper tackles a specific research question that includes:
a) a particular health outcome, or wellbeing, or behavioural outcome (e.g. happiness, suicide, crime, quality of life, infant mortality, life expectancy, obesity, eating disorders, tobacco smoking, alcohol consumption, inequalities in access to cancer screening);
b) a selected determinant of health o policy (e.g. stress, migration, socioeconomic status, income inequality, unemployment, the financial crisis, laws and regulations on tobacco control, free trade agreement, cultural globalization, consumerism) affecting the health and/or behavioural outcome;
c) the proposed causal pathways/mechanisms linking the selected determinant of health with the selected health outcome, or wellbeing, or behavioural outcome;
d) population or community of interest (e.g. global, OECD nations, sub-Saharan Africa, low-income countries, Italian regions).
e) list of implications for health promotion interventions and policies that can reduce the impact of the determinant of health and the prevalence of the health outcome, or wellbeing, or behavioural outcome in the population or community of interest;

The final paper should be structured around the following areas covering a research paper on a health/wellbeing research topic:

Title & Abstract (200 words summary of the proposal)
- the title of your paper should reflect its contents and can be stimulating and provocative.
- the abstract is a short summary of the major parts of your paper
Research question
- specify the aim of your paper, or research question. Define a specific hypothesis between a selected determinant of health and health outcome. Make sure your hypothesis is specific and possibly, but not necessarily, measurable. Examples of research questions are the following: has the financial crisis increased suicides worldwide? Is fast food consumption associated with obesity? Is stress higher in people of lower socioeconomic status? Why? How does unemployment affect quality of life in young adults? Is income inequality a determinant of crime?
- carry out a literature search of published articles from international peer-reviewed journals, book chapters as well as reports and other articles and commentaries addressing your research question. Always include and use references to support and develop arguments of your paper;
Selected health outcome, or wellbeing, behavioural outcome
- briefly describe the selected population or community of choice by examining potential information of interest such as demographic characteristics, historical and socioeconomic circumstances as long as they are relevant for your research question;
- describe the selected health outcome, or wellbeing or behavioural outcome in terms of epidemiological background (e.g. diffusion of a health problem in your population/prevalence) and specify the potential health consequences related to your problem in terms of mortality and morbidity and quality of life.
- analyse time trends of your health outcome where is possible or necessary.
- include figures, tables or any evidence that may be important to highlight the significance of the health outcome (either create them or use published work citing the source).
Selected health determinant
- describe the selected determinant of health capable of influencing the selected health outcome, wellbeing or behavioural outcome in terms of its diffusion in the chosen population;
- analyse time trends of your determinant of health where is possible or necessary;
- include figures, tables or any evidence that may be important to highlight the significance of the health determinant of choice (either create them or use published work citing the source).
Causal pathways between health determinant and health outcome
- describe the main causal paths or mechanisms or explanations connecting selected determinant of health with selected health outcome;
- include a discussion of competing pathways or complementary health determinants capable of influencing your health outcome, but your paper must stay focussed on your hypothesis of interest;
- to help yourself with the elaboration of the paper, you can draw a simple conceptual framework containing health determinant, causal pathways and health outcome.
- Include figures, tables or any evidence that may elucidate how causal pathways operate (either create them or use published work citing the source).
Implications for health promotion and policy
- In the last part of the paper, provide some recommendations/suggestions to improve your health outcome and health determinant at the same time. It is important to look at the health problem in context, and you can provide recommendations for action in connection with the overall structure of society, not only the population most affected by the health determinant.

The papers will be assessed based on the following criteria:
• Clearly organized around a well-developed research question and conceptual framework
• Use of solid evidence, data, logical arguments to support statements
• Thoughts are clearly presented through well-constructed arguments
• Paper is well-organized with sections that logically follow each other and attempt to answer the research question
• Effective transitions between major ideas and topics are clear, and demonstrates good grammar and careful editing

Final paper presentation
During the last lectures of the course, each student will lead a presentation summarizing the major points of the final paper. After the presentation, students will lead a Q&A session or discussion where each student in the class is expected to play the role of peer-reviewer and provide suggestions for the presenter. The presentation will be assessed on the basis of the following guidelines:
Content
- Title: should reflect the content of the presentation
- Present to research question to the audience, give a clear introduction to the topic, including its relevance for health and wellbeing
- Structure your presentation in a clear, logical way – take the audience systematically through your key points
- Underpin your key points using evidence, facts, data, for example by using figures, references or concise tables
- There should be a clear conclusion which answers the research question asked and that stems from the evidence showed during the presentation.
Slides
- Ensure the slides are legible and clear – do not present too much information on a single slide
- Ensure your slides highlight the key issues that you speak about
- Leave out unnecessary information
Presentation of the slides
- Language: clarity
- Presentation style (incl. speaking to the audience rather than reading from paper; pace, use of effective communication techniques.)

Grading
Participation 10%
Reading Presentation 15%
Final Paper 55%
Final Paper Presentation 20%

Program & Reading Schedule

Session 1. Global Health: Policies and Institutions
Readings:
• De Vogli R, Schrecker T and Labonte R. Neoliberal Globalisation and Health Inequalities. In: Gabe J and Monaghan L. (editors) Key Concepts of Medical Sociology (2nd Edition). Sage Publications 2013.
• Schrecker T, Labonte R, and De Vogli R. Globalization and Health: the Need for a Global Vision, Lancet 2008:1670-76.

Session 2. Social Determinants of Global Health: Evidence and Pathways
Readings:
• World Health Organization. Closing the Gap in a Generation: Health Equity Through Action on The Social Determinants of Health. WHO Commission on Social Determinants of Health Report. Executive Summary, 2008.
• Stuckler D, Siegel K, De Vogli R and Basu S. Sick Individuals, Sick Populations: the Social Determinants of Chronic Diseases. In: Stuckler D et al. (editors) Sick Societies: Responding to the Global Challenge of Chronic Disease. Oxford University Press, Oxford 2011.

Session 3. Globalization, Inequality and Health
Readings:
• De Vogli R. Neoliberal Globalization and Health in a Time of Economic Crisis. Social Theory & Health 2011;9:311-325.
• De Vogli R, Gimeno D, Mistry R. Economic Inequality and Health in the Age of Globalization. In: Nriagu JO (ed.). Encyclopedia of Environmental Health. 2011(2): 207-214 Bulrington Elsevier.

Session 4. The COVID-19 Pandemic
Readings:
• De Vogli R. & De Falco R. Socioeconomic Inequalities and the COVID-19 Pandemic. Rivista Sperimentale di Feniatria, 2021; vol. CXLV (2).
• Matarazzo T, Bravi F, De Vogli R, Carradori T. CORONAcrisis-An Observational Study on the Experience of Healthcare Professionals in a University Hospital during a Pandemic Emergency. Int J Environ Res Public Health. 2021 Apr 16;18(8):4250.

Session 5. Globalization, Stress and Mental Health
Readings:
• De Vogli R & Cornia GA Rapid Change, Psychosocial Stress and Health in an Era of Globalization. Working Paper presented at a meeting on SES, Stress and Health. University of Florence, Faculty of Economics & MacArthur Foundation – Network on Socioeconomic Status and Health, Florence (Italy), 2004.
• De Vogli R and Owusu J. The Causes and Health Effects of the Great Recession: From Neoliberalism to “Healthy De-Growth”? Critical Public Health 2015; 25(1):15-31

Session 6. Structural Adjustment Policies, “Shock Therapy” and Health
Readings:
• De Vogli R, Birbeck G. The Potential Impact of Adjustment Policies on Children’s Vulnerability to HIV/AIDS in sub-Saharan Africa. Journal of Health, Population and Nutrition, Jun 2005;23(2):105-120.
• De Vogli R. Mortality crises in high-income countries: evidence from the United States, the United Kingdom, Italy and Greece. Report for Dialogue for Civilization Research Institute, Berlin, Vienna and Moscow, 2019.
• De Vogli R and Gimeno D. Changes in Income Inequality and Suicide Rates in Eastern Europe After Economic “Shock” Therapy. J Epidemiol Community Health 2009;63(11)956.

Session 7. Globalization and the Ecological Crisis
Readings:
• Fioramonti L, Coscieme L. Costanza R, Giovannini E, Kubiszewski, Lovin H, Mc Glade J, Pickett K, De Vogli R and Wilkinson R. Wellbeing Economy: An Effective Paradigm To Mainstream Post-Growth Policies. Ecological Economics 2021.
• Costanza R, Giovannini E, Kubiszewski, Lovin H, Mc Glade J, Pickett K, De Vogli R and Wilkinson R. Modelling and measuring sustainable wellbeing in connection with the UN Sustainable Development Goals. Ecological Economics 2016;130:350-355.
• De Vogli R. Averting Collapse Through Equitable Development? Solutions Journal 2016;7(3):82-83.

Session 8. Global Economic Crises and Health
Readings:
• De Vogli R., Mattei G. and De Falco R. Excess Suicides due to the 2008 Global Financial Crisis: an Update. Epidemiology & Prevention 43(2-3):111 2019.
• De Vogli R. The financial crisis, health and health equity in Europe: the need for regulations, redistribution and social protection. International Journal for Equity in Health 2014;13:58.
• Glonti K. et al. A systematic review on health resilience to economic crises. PLoS One 2015 Apr. 23;10(4): e0123117.

Session 9. Globalization, Diet and Obesity
Readings:
• De Vogli R and Renzetti N. The Potential Impact of the Transatlantic Trade and Investment Partnership (TTIP) on Public Health? Epidemiol & Prev 2016;40(2).
• De Vogli R, Kouvonen A, Gimeno D. The Influence of Market Deregulation on Fast Food Consumption and Body Mass Index: A Cross-National Times Series Analysis. Bulletin of the World Health Organization (WHO) 2014;92:99-107.

Session 10. Global Pandemics, the Environment and Economic Development
Readings:
• United Nations Environment Program and International Livestock Research Institute. Preventing the Next Pandemic: zoonotic diseases and how to break the chain of transmission, 2020.
• Sparke M and Williams O. Neoliberal disease: COVID-19, co-pathogenesis and global health insecurities. EPA: Economy and Space, 2022.

Session 11. Protecting Health and Wellbeing in a Time of Global Crises
Readings:
• Leon et al. The Russian invasion of Ukraine and its public health consequences. Lancet, Apri 1, 2022
• Costanza R, Giovannini E, Kubiszewski, Lovin H, Mc Glade J, Fioramonti L, Pickett After the COVID-19 Crisis. Solutions Journal 2020
• Costanza R, Giovannini E, Kubiszewski, Lovin H, Ragnarsdottir V, Mc Glade J, Pickett K, De Vogli R and Wilkinson R. Development: Time to Leave GDP Behind. Nature 2014 Jan 16;505:283-285.

Session 12. The Global Health and Social Justice Movements
Readings:
• Green D. How Change Happens. Oxford University Press, 2016, London.
• Guise A, Woodward D, Lee P, De Vogli R, Tilman T, Mc Coy D. Letter to the Editor. Engaging the Health Community in Global Economic Reform. Lancet 2009;373(9668):987-9.
• An open letter from Russian scientists and science journalists against the war in Ukraine
https://www.eureporter.co/world/russia/2022/02/24/an-open-letter-from-russian-scientists-and-science-journalists-against-the-war-with-ukraine/