Globalisation, Human Genomic Research and the Shaping of Health: An Australian Perspective

Abstract

This thesis examines one of the premier "big science" projects of the contemporary era - the globalised genetic mapping and sequencing initiative known as the Human Genome Project (HGP), and how Australia has responded to it. The study focuses on the relationship between the HGP, the biomedical model of health, and globalisation. It seeks to examine the ways in which the HGP shapes ways of thinking about health; the influence globalisation has on this process; and the implications of this for smaller nations such as Australia. Adopting a critical perspective grounded in political economy, the study provides a largely structuralist analysis of the emergent health context of the HGP. This perspective, which embraces an insightful nexus drawn from the literature on biomedicine, globalisation and the HGP, offers much utility by which to explore the basis of biomedical dominance, in particular, whether it is biomedicine's links to the capitalist infrastructure, or its inherent efficacy and efficiency, that sustains the biomedical paradigm over "other" or non-biomedical health approaches. Additionally, the perspective allows for an assessment of whether there should be some broadening of the way health is conceptualised and delivered to better account for social, economic, and environmental factors that affect living standards and health outcomes, and also the capacity of globalisation to promote such change. These issues are at the core of the study and provide the theoretical frame to examine the processes by which Australian policy makers have given an increasing level of support to human genomic research over the past decade and also the implications of those discrete policy choices. Overall, the study found that globalisation is renewing and extending the dominance of the biomedical model, which will further marginalise other models of health while potentially consuming greater resources for fewer real health outcomes. While the emerging genomic revolution in health care may lead to some wondrous innovations in the coming decades, it is also highly likely to exacerbate the problems of escalating costs and diminishing returns that characterise health care systems in industrialised countries, and to lead to greater health inequities both within and between societies. The Australian Government has chosen to underwrite human genomic research and development. However, Australia's response to the HGP has involved both convergences and variations from the experiences of more powerful industrial nations. The most significant divergence has been in industry and science policy, where until the mid-1990s, the Australian Government displayed no significant interest in providing dedicated research funding, facilities, or enabling agencies to the emerging field. Driven by the threat of economic marginalisation and cultural irrelevance, however, a transformation occurred. Beginning with the Major National Research Facilities Program of the Department of Industry, Science and Technology, and then the landmark Health and Medical Research Strategic Review, support for human genomic research grew strongly. Comprehensive policy settings have recently been established to promote the innovation, commercialisation, promotion and uptake of the products of medical biotechnology and genomics. As such, local advocates of a broader model of health will be forced to compete on the political and economic stage with yet another powerful new area of biomedicine, and thus struggle to secure resources for perhaps more viable and sustainable approaches to health care in the 21st century.