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Year : 2018  |  Volume : 27  |  Issue : 2  |  Page : 308-310  Table of Contents     

Geopolitical determinants of health

1 Department of Psychiatry, Queen Mary's School of Medicine, London, England
2 Department of Psychiatry, AFMC, Pune, Maharashtra, India
3 Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
4 Department of Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England

Date of Web Publication14-Jun-2019

Correspondence Address:
Dr. Pookala Shivaram Bhat
AFMC, Pune - 411 040, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ipj.ipj_71_18

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How to cite this article:
Persaud A, Bhat PS, Ventriglio A, Bhugra D. Geopolitical determinants of health. Ind Psychiatry J 2018;27:308-10

How to cite this URL:
Persaud A, Bhat PS, Ventriglio A, Bhugra D. Geopolitical determinants of health. Ind Psychiatry J [serial online] 2018 [cited 2020 Dec 5];27:308-10. Available from: https://www.industrialpsychiatry.org/text.asp?2018/27/2/308/260417

It is not an exaggeration to say that the world is facing a number of crises at the geopolitical level. From an increase in population to climate change, human-made and natural disasters and ongoing conflicts leading to mass migration and increase in refugees and asylum seekers to the impact of droughts and floods, geopolitical factors are being recognized. However, often their impact on mental health of individuals is not taken into account at all. Even with spread of infectious disease spread, often the focus remains on the control of infection without taking into account the impact of survivor guilt, loss, and grief resulting from such loss, etc., on an individual's mental health and well-being. Mental health is integral to health.

There is no doubt that the world population is getting bigger but also doing so at an unprecedented rate. Whereas over 200 years ago in 1800, it was around 1 billion and currently it stands at over 7 billion people (a seven-fold increase) and is expected to reach 8 billion in 2024 and 9 billion by 2038. It is estimated that it will take further 18 years to reach 10 billion in 2056 and another 29 years to reach 11 billion in 2088 and approximately 11.2 billion by 2100.[1] And yet, the increase in population is not uniform and in many countries, the population growth is indeed negative thereby bringing about additional stressors to the older individuals who are living with increased multiple complex comorbidities.

The planet is getting hotter; the science and our own personal lived experience testify to this. There is little doubt that global climate change results in wide economic, social, health, and environmental changes and disparities with higher temperatures itself bringing direct and indirect health risks with rates of suicide being the strongest and most consistent link.[2] Like most of the disasters, low-income countries are being impacted first and most damaging with hurricanes, floods, and crop failure, creating large movements of people not only within the country but also across countries and continents.

The world of geopolitics is changing rapidly moving from a phase of relative stability to one, that is, unsettling and unstable which in addition to social, and personal instability is also bringing about political changes which are more inward looking not only nationalist but also isolationist and xenophobic. Democracy is being chipped away in many countries, with leaders consolidating their authority. Seventy-one countries suffered net declines in political rights and civil liberties, with only 35 registering gains, this marked the 12th consecutive year of decline in global freedom. The United States is retreating from its traditional role as both a champion and an exemplar of democracy amid this accelerating decline in global political rights and civil liberties. Over the period since the 12-year global slide began in 2006, 113 countries have seen a net decline and only 62 have experienced a net improvement.[3]

Some 3.3 billion people in the world currently live under autocratic regimes, whereas 4.2 billion live in democracies. In 2003, only 2.3 billion lived in nondemocratic countries; the number of autocracies among the 129 nations has increased from 55 (two years ago) to 58 (today). “More and more people are living not only in less equal but also in more repressive environments.”[4]

Continuing conflicts, associated with terrorism, public health crises like Ebola together with major natural disasters such as earthquakes and tsunamis, carry with them largely invisible, often crippling, mental health scars that have an impact on millions of lives and often create large numbers of refugees, asylum seekers, and internally displaced people.[5] By the end of 2017, the number of forcibly displaced people in the world grew to a record 67.7 million with >4.1 million people displaced in the Democratic Republic of Congo alone.[6]

The public and political perception of migrants remains a kaleidoscope of conflicting views. This is particularly true with the rhetoric in Europe with populism offering superfluous answers. In this climate, state-sponsored hate threatens to normalize discrimination against the minority groups. Xenophobic slogans at nationalist marches across many countries and sweeping crackdowns on minority communities showed how the open advocacy of intolerance is increasing.[7]

Political and social corruption and social inequality are closely related and provide a source for popular discontent. There is no doubt that corruption itself leads to an unequal distribution of power in the society which, in turn, translates into an unequal distribution of wealth and opportunity thereby creating a vicious cycle. The top 1% of income earners worldwide captured 27% of total growth between 1980 and 2016 and increased their share of global income from 16% in 1980 to 22% in 2016 with 10% of the richest households owning 88% of global assets.[8],[9]

Over the past decade, the number of violent political conflicts worldwide has increased dramatically, destroying lives, cities, history and cultural artifacts, and forcing millions to flee. According to the UN, there are now 402 conflicts taking place around the world, a terrifying 25-year peak in global violence.[10] Security risks threatening significant loss of human life around the world have become more immediate, numerous, and interlinked, failed states, and ungoverned spaces provide potential breeding grounds for new configurations of terror group or similar structures. However, the fight against terror has to be as much about stabilizing the failed geographies that provide the context for these movements, as it is about eliminating the actual mechanisms of terror.[11]

Conflict, populism, the erosion of human rights, climate change, inequalities, terror, and fragile security add to the global health burden and present the most fundamental global challenges. We need to take heed and pay greater attention to these and the structural issues that create them. Geopolitical determinants affect social determinants of health. Social determinants include poverty, unemployment, urbanization, industrialization, and lack of green spaces in urban areas and all of these are influenced by geopolitical determinants. The CAPE Vulnerability Index provides an analysis of where we can act proactively where effort and resources should be placed especially when aid is being distributed to poorer countries.[12] This measure, we believe, goes well beyond the WHO social determinants of health which primarily is structured to address the health inequalities.[13] However, more importantly, this measure provides an outcome related to mental health and mental well-being to help reduce the impact of various geopolitical factors; it is absolutely critical that policymakers take into account the following factors:

  • Advancing the global economy and global trade: In view of the globalization where not only the resources travel around the globe, the manufacturing takes place in a different part and consumption in another part of the world meaning that the wealth distribution is more likely to be unequal. Poverty contributes to ill-health. Policymakers at a global level need to ensure that there is a fairer distribution of the wealth so that globalization works for all and eventually helps reduce structural inequalities
  • Mitigating and adapting to climate change: It is crucial that urgent attention is paid to dealing with climate change and its impact on human beings. Furthermore, policymakers and health professionals need to work together to adapt the structure and delivery of health systems to respond to the various characteristics of climate change including the chronic emission of climate-altering pollutants
  • Promoting and achieving global health: Two things are essential if this is to succeed. One is that health-care systems need to be culturally sensitive and appropriate, and cultural relativism is taken into account and second, health, especially the mental health, needs to be a part of impact assessment of all policies. By extending mental health into foreign policy and targeting bilateral aid in the areas of the CVI, Vulnerability Index will ensure that human well-being becomes the primary target rather than simple wealth creation
  • Use and surveillance of technology: There is no doubt that telehealth and eHealth can be used to provide better and specific health interventions, provided ethical and confidential issues are kept in mind. Development of artificial intelligence, in spite of some possible job loss, is likely to benefit all, but security should be priority, especially when levels of cybercrimes are at unprecedented levels
  • Preventing and responding to violent conflict between and within countries: Critical regional alliances are required to ensure that they have a proactive role in preempting conflicts before they become intractable. This may mean that consideration needs to be given to redefining boundaries and creating more autonomy. There is a need to be forward-looking, innovative thinking rather than simply sticking to old enmities if the human race is to survive and progress
  • Combating violent extremism and terrorism: Global leaders have a moral imperative to prevent terrorism by looking at the root causes and eliminating these causes be they religious motivations or political ones. The solutions are at a global level, so joint working across geographical states and players is the need of the hour.

The world population is increasing and as a result, demands on resources are rising too. Faced with challenges such as climate change, conflicts, and cybercrimes leaders need a broader vision rather than old certainties. There has to be a real reason to hope for a better future since the world has a larger number of better educated people and more people with a desire to create a less conflicting world.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Roser M, Ortiz-Ospina E. World Population Growth; 2018. Available from: https://www.ourworldindata.org/world-population-growth. [Last accessed on 2019 Feb 06].  Back to cited text no. 1
Watts N, Amann M, Ayeb-Karlsson S, Belesova K, Bouley T, Boykoff M, et al. The lancet countdown on health and climate change: From 25 years of inaction to a global transformation for public health. Lancet 2018;391:581-630.  Back to cited text no. 2
Freedom House: Freedom in the World 2018. Democracy in Crisis; 2018. Available from: https://www.freedomhouse.org/report/freedom-world/freedom-world-2018. [Last accessed on 2019 Feb 06].  Back to cited text no. 3
Bertelsmann Foundation. Developing world faces more conflict, more repression. Available from: www.dw.com/en/bertelsmann-study-developing-world-faces-more-conflict-more-repression/a-43079308. [Last accessed on 2019 Feb 06].  Back to cited text no. 4
Persaud A, Day G, Gupta S, Ventriglio A, Ruiz R, Chumakov E, et al. Geopolitical factors and mental health I. International Journal of Social Psychiatry 2018;64:778-85.  Back to cited text no. 5
Council of Councils. 2018 Report Card on International Cooperation. Grades in Global Issues; 2018. Available from: www.cfr.org/councilofcouncils/reportcard2018/#!/. [Last accessed on 2019 Feb 06].  Back to cited text no. 6
Amnesty International Report 2017/18: The state of the world's human rights; 2018. Available from: https://www.amnesty.org/en/documents/POL10/6700/2018/En. [Last accessed on 2019 Feb 06].  Back to cited text no. 7
The World Inequality Database 2018. World Inequality Report; 2018. Available from: http://wir2018.wid.world/files/download/wir2018-summary-english.pdf. [Last accessed on 2019 Feb 06].  Back to cited text no. 8
CREDIT SUISSE Global Wealth Report; 2017. Available from: http://publications.credit-suisse.com/index.cfm/publikationen-shop/research-institute/global-wealth-report-2017-en/. [Last accessed on 2019 Feb 06].  Back to cited text no. 9
Keny-Guyer N. Conflict is reshaping the world. Here's how we tackle it. Geneva: World Economic Forum; 2018. Available from: www.weforum.org/agenda/2018/01/conflict-is-reshaping-the-world-mercy-corps. [Last accessed on 2019 Feb 06].  Back to cited text no. 10
Council of Councils. Report Card on International Cooperation 2018. Grades in Global Issues; 2018. Available from: https://www.cfr.org/councilofcouncils/reportcard2018/#!/ranking/2018. [Last accessed on 2019 Feb 06].  Back to cited text no. 11
Persaud A, Day G, Ventriglio A, Gupta S, Ramachandran P, Ruiz R, et al. Geopolitical factors, Foreign Aid and Mental Health II: Value for money. International Journal of Social Psychiatry 2018;64:786-98.  Back to cited text no. 12
WHO. Social Determinants of Health. Available from: http://www.who.int/social determinants/sdh definition/en/. [Last accessed on 2019 Feb 06].  Back to cited text no. 13


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