Global health. The current scenario and future perspectives

11 First Prologue 1 Ronald Labonté 2 After twenty years of working as a community health promoter, first in Canada and then internationally, I bumped into what became known as ‘globalization’. In country after country, I heard public health practitioners complain of program cutbacks, staff retrenchment, and a retreat from the idealism of the 1986 Ottawa Charter for Health Promotion (WHO, 1986). The year was 1994. I reasoned that the ubiquity of these complaints suggested that there must be something above the level of nations getting in the way of an empowering public health practice. In 1995 the World Trade Organization came into existence and my attention made a sudden shift from catalyzing community level health activism to understanding how a globalizing political economy was constraining our generation’s ‘health for all’ optimism. My emergent knowledge would have been laughable to many people living in Africa and Latin America, the early global regions to be adversely affected by what we now short- hand as ‘neoliberalism’, a market- fundamentalist capitalism on ideological steroids. Chile was one of neoliberalism’s earliest policy laboratories following the violent overthrow of the social medicine and social democracy of the Allende government. Today, with its efforts to create a new human-rights focused constitution that addresses our ever more urgent health crises of inequalities, climate change, and xenophobic exclusions, Chile is again witness to the political struggles between progressive and reactionary populism that have become a defining feature throughout Latin America and many other regions of the world. These ‘struggles for health’, as the sorely missed late Prof. David Sanders liked to remind us, are the ‘struggle for a more equitable, just, and caring world’ (Sanders, 2020). The Covid-19 pandemic (subdued but still with us) highlighted the increasing fragility of our entwined sociopolitical and ecological systems upon which our health depends, and the pressing need for a volte face from many of our global economy's tacit and unjust imperatives. As one example, this new collection notes, the incursion of private capital and publicly funded private providers in many countries’ health systems left them 1 Editor's Note: Given the relevance of this prologue in English, the native language of its author, it is maintained as such. 2 BA MA Ph.D. Professor Emeritus. Ronald Labonté is Distinguished Research Chair in Globalization and Health Equity and Professor in the School of Public Health and Epidemiology, University of Ottawa. He has enjoyed a 45-year career in public health spanning government positions, international consultancies, and universities. For the past 25 years his research has focused on the health equity impacts of diverse globalization processes. He is Editor-in- Chief of the BMC journal, Globalization and Health, active with the People’s Health Movement, a frequent contributor to its flagship publication Global Health Watch.