Despite the initial buzz created by Fukuyama’s idea that history died, and with it, the divisions among countries, others disagreed and identified emerging distinctions that seemed no less divisive. Samuel Huntington, for example, divided countries by culture and proposed the “big cultural divide.” Robert Kaplan focused on regions with ethnic strife and those without. Barnett and Gaffney divided the world into the functioning core of globalization (including Western democracies, Russia, and Asia’s emerging economies), and the nonintegrating gap (including countries that remain disconnected from globalization due to political cultural rigidity, such as the Middle East, or because of poverty, such as Central Asia, Africa, and Central America).
This is similar to Thomas Friedman’s division of countries into those that buy into the flat world and those that do not. Countries have even been divided according to their membership in a world trade club (such as Birdsall and Lawrence’s modern trade clubs that include multilateral associations such as the UNWTO and regional ones such as NAFTA, MERCOSUR, and APEC).
Each of these post–Cold War concepts of the world share an acknowledgment of globalization and its tendency to tie countries in a complex set of economic relations. Such globalization entails a large increase in economic, social, and cultural interdependence between countries of the world. While countries have been linked to the international economy for centuries (witness the role of global trade in eighteenth century imperialism, dependency relations in the twentieth century, export promotion policies of the 1980s and 1990s, etc.), what is new in the current era of globalization is the volume and the nature of international economic interaction. Another new factor in globalization is the predominance of services.
Indeed, Prestowitz claims that contemporary globalization is different from previous ones because it is less driven by countries or corporations and more by people. People are the providers of services. Moreover, the world economic environment of the twenty-fi rst century is characterized by the international trade of those services. Globalization, the growing importance of services, and the increased international trade of those services are all discussed below with special reference to tourism, health care, and medical tourism
Medical Tourism and the Problem of Dependency
