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Module 8

This document covers the study of global demography, including key concepts such as population composition, migration, and the implications of overpopulation. It discusses the importance of demographic data, the elements of demography, and the stages of demographic transition, highlighting the causes and effects of population growth. Additionally, it emphasizes the challenges related to food security and the need for effective social planning to address these demographic issues.

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0% found this document useful (0 votes)
12 views25 pages

Module 8

This document covers the study of global demography, including key concepts such as population composition, migration, and the implications of overpopulation. It discusses the importance of demographic data, the elements of demography, and the stages of demographic transition, highlighting the causes and effects of population growth. Additionally, it emphasizes the challenges related to food security and the need for effective social planning to address these demographic issues.

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elyjahbayanban
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ly/3fSFXyx

UNIT 8
Unit Outcome:
GLOBAL
DEMOGRAPHY At the end of this unit, the learners must have:
1. articulated key concepts and contemporary
issues related to global demography, global
migration and global citizenship.

Introduction

Demography or the study of population is extremely important to sociologists


and other social scientists. The study of population and its trends would give
direction towards the formulation of plans for education, employment, housing,
transportation and communication, health, recreational needs and other forms of
social services. Vital information on the composition of population would provide
information to the business and industrial firms regarding the demands for products
and services. Policy makers will also be able to formulate guidelines in meeting the
needs of the various sectors of the society.

A population’s composition may be described in terms of basic demographic


features – age, sex, family and household status – and by features of the population’s
social and economic context – language, education, occupation, ethnicity, religion,
income and wealth. The distribution of populations can be defined at multiple levels
(local, regional, national, global) and with different types of boundaries (political,
economic, geographic).

A population that grows too slowly faces the danger of extinction while a
population that grows too rapidly may result to mass migration, cultural diffusion or
displacing population in other territories. The different issues related to population
are important because they help shape the quality of life in a given society and the

128
world as a whole; thus, the study on global demography.

Lesson 1. Global Demography

Lesson Outcomes:
At the end of this lesson, the learners must have:
1. articulated important terms and concepts related to demography;
2. evaluated sources of demographic data, elements of demography and
stages of demographic transition and causes of rapid population growth;
3. assessed impacts of overpopulation to different aspects of society.

Fun Quiz!

Let us activate your minds by listing down as many ideas/concepts that you
can relate to the photos above.

1. 6.
2. 7.
3. 8.
4. 9.
5. 10.

129
Demography – The Scientific Study of Population

Since you have successfully listed ideas and concepts related to demography
and population, it is now the high time to acquire more information about the topic.

The roots of statistical demography may be found in the work of the


Englishman John Graunt who was regarded as the founder of demography. He
was one of the first demographers and perhaps the first epidemiologist, though by
profession he was a haberdasher.
John Graunt
https://www.britannica.com/biography/John-Graunt

In search of statistical regularities, Graunt made an estimate of the male-


female ratios at birth and death-birth ratios in London and rural communities. He
was also able to construct the first mortality table.

Demography is the scientific study of population. It comes from the Greek


word demos and graphone, meaning “measuring people.” A demographer or a
person who engaged in social planning, market research, insurance forecasting,
labor market analysis, economic development and so on conducts studies on human
population which is defined as follows: (1) the area of sociology that includes the
size, growth, demographic characteristics, composition, migration, changes and
quality vis-a-vis economic, political and social systems; (2) the number of persons
occupying certain geographic area, drawing subsistence from their habitat and
interacting with one another.

He also communicates population facts using information on birth and


death, the basic elements of life.

Demography studies the population’s size, composition and distribution


across space – and the process through which populations change. Births, deaths
and migration are the ‘big three’ of demography, jointly producing population
stability or change.

For most of the 19th century, demographic studies continued to emphasize


the phenomenon of mortality; it was not until demographers noted that a considerable
decline of fertility had taken place in the industrialized countries during the second
half of the 19th century, that they began to study fertility and reproduction with
as much interest as they studied mortality. During the period between the two
world wars, demography took on a broader, interdisciplinary character. In 1928 the
International Union for the Scientific Study of Population was founded.

130
Sources of Demographic Data

1. Census - a census is a population count where the demographic,


economic and social data of every individual of a given time are collected,
tabulated, compiled and published. It provides the statistics of population
data for sample surveys and studies and guides the government and
nongovernment administrations in economic and social planning.

2. Vital Statistics System – refers to events that deal with an individual’s life
from birth to death and those in between, such as marriage annulment,
adoption, separation, divorce and other events and changes in his/her
status.

3. Sample Surveys – conducted by private and public institutions to obtain


data and information on matters not covered by the census or vital
statistics system.

Elements of Demography

1. Birth rate – the yearly count of live births per 1000 population; gives data
on a society’s reproductive patterns.

2. Total fertility rate – the average count of children conceived; can project
a society’s future population growth.

3. Death rate - the yearly count of deaths per 1000 population; gives data
on a society’s mortality patterns.

4. Life expectancy – the average number of years a person is expected to


live.

5. Growth rate – differences between births and deaths plus the differences
between immigrants and emigrants per 1000 population.

Global Demographic Transition

Demographic transition pertains to an observed pattern in changing vital


statistics (birth rate and death rate).

131
Stages of Demographic Transition

1. Pre-transition Stage – is the first stage of demographic transition which


occurred in the 18th century. It is characterized by high birth and death
rates with minimal population growth.

2. Transition Stage – is the second stage which took place in the 18th and
early 19th centuries. It was the stage of declining death rate and the era
of the Industrial revolution and population explosion.

3. Post-transition stage – is the third stage which took place in the late 19th
century. It is characterized by low birth and death rates with minimal
population growth.

After World War II, another demographic transition occurred with Asia, Africa
and Latin America experiencing population explosion. There was “baby boom” in
the developing countries and in the West. During this stage, there was increase in
food production as a result of “Green Revolution” and improved public health care.
Infant mortality declined and life expectancy increased.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781829/

Figure 4

The global demographic transition began in the nineteenth century in the


now economically developed parts of the world (the North) with declines in death
rates. Large reductions in birth rates followed in the early part of the twentieth
century. These transitions are now more or less complete. But, as shown in Table
1, trends for the two principal regions in the North are expected to diverge between
2005 and 2050: an increase from 0.33 to 0.45 billion in Northern America, and a
decline from 0.73 to 0.66 billion in Europe. In fact, several countries in Europe (e.g.

132
Russia) and East Asia (e.g. Japan) face significant population declines as birth
rates have fallen below death rates.

Causes of Rapid Population Growth

Population change in a country is caused by three basic components: birth,


death and migration. Birth rate is the ratio between births and individuals in a
specified population and time. It is directly affected by fertility which refers to the
actual number of children born to a woman or group of women. If high fertility is not
matched with mortality, overpopulation is bound to happen.

On the other hand, the ratio between deaths and individuals in a specified
population and time is known as death rate. A decline in mortality and a more
stable birth rate means a rise in population.

Migration which is another cause of population growth refers to the


movement of people from one place to another with the intention of finding a
permanent residence.

It was observed that most people migrate because of economic reasons.


A person usually leaves his locality to look for a better and higher paying job that
would improve his economic status.

The Perils of Overpopulation

Urbanization and industrialization are considered by development planners


as indicators of a developing society but they disagree on the role of population
growth or decline in modernization.

A British scholar, Thomas Malthus, wrote “An Essay on the Principle of


Population” in 1798, where he warned that population growth will inevitably exhaust
world food supply by the middle of 19th century.

Malthus’ prediction was off base but in 1960s,an American biologist, Paul
R. Ehrlich. and his wife Anne, revived it when they wrote “The Population Bomb,’
which argued that overpopulation in the 1970s and the 1980s will bring about global
environmental disasters that would lead to food shortage and mass starvation. In
addition, they proposed that United States should work on reducing the population
growth rate to zero by taking the lead in the promotion of global population control
through chemical castration, through implementation of policy that would demand
tax for an additional child and luxury tax on child-related products, giving of
monetary incentives to men who would agree to be sterilized after two children

133
and by building a powerful Department of Population and Environment.

The global population increase was at its height at 1.8% per year between
1955 and 1975, peaking at 2.06 percent annual growth rate between 1965 to 1970.
This happened when nations were finally able to recover from the devastations
brought by the World War II.

The argument which states that “by limiting the population, vital resources
could be used for economic progress and not to feed more mouths” became the
government’s basis for “population control” programs worldwide.

Population Growth and Food Security

It is estimated that by 2050, global population will reach 9.5 billion and will
increase to 11.2 billion by 2100. Ninety-five percent of this population growth will
happen in the developing countries, with demographers predicting that by middle
of this century, several countries will have tripled their population. Considering the
given scenario, feeding the population will be an immense challenge.

The Food and Agriculture Organization (FAO) warns that for the countries
to mitigate the impact of population growth, food production must be increased
by 70%. FAO also recommends that countries increase their investments in
agriculture, craft long-term policies aimed at fighting poverty and invest in research
and development.

The United Nations (UN) also suggests that countries develop a


comprehensive social service program that includes food assistance, consistent
delivery of health services and education especially for the poor.

Interesting facts about Philippine Population:

* The current population of the Philippines is 109,698,807 as August 1, 2020, based


on Worldometer elaboration of the latest United Nations data.
* The Philippines 2020 population is estimated at 109,581,078 people at mid-year
according to UN data.
* The Philippines population is equivalent to 1.41% of the total world population.
* The Philippines ranks number 13 in the list of countries (and dependencies) by
population.
* The population density in the Philippines is 368 per Km2 (952 people per mi2).
* The total land area is 298,170 Km2 (115,124 sq. miles)
* 47.5 % of the population is urban (52,008,603 people in 2020)
* The median age in the Philippines is 25.7 years.

134
Summary

Global demography is a complex discipline that requires the integration of


various social scientific data. Demography is the scientific study of population. It
comes from the Greek word demos and graphone, meaning “measuring people.”
A demographer or a person who engaged in social planning, market research,
insurance forecasting, labor market analysis, economic development and so on
conducts studies on human population.

Demography studies the population’s size, composition and distribution


across space – and the process through which populations change. Births, deaths
and migration are the ‘big three’ of demography, jointly producing population
stability or change.

Population change in a country is caused by three basic components: birth,


death and migration.

The different issues related to population such as rapid population growth,


overpopulation, migration and food security are important because they help
shape the quality of life in a given society and the world as a whole; thus, the study
on global demography.

135
Name: Score:
Curriculum and Section:
Subject:
Unit No.: Date:

Let’s Do This!

Let us try to apply what you have leaned from the topics discussed.

1. Identify three couples with the most number of children within your
barangay. If possible, conduct a short interview as to their way of living
and other issues and concerns related to their family size.

2. Showcase you creativity by making your very own family tree. Interview
your parents and try to trace your family connections as far back as you
can. Try also to trace if your family of the family or your parents have
moved from one place to another. Ask for their reasons of moving.

Note: These requirements are due 2 weeks after the lecture.

Let us assess your opinion and writing skills by doing the following activity.

The U.N. Population Fund (UNFPA) projected that the pandemic-driven


disruptions in access to contraception could lead to millions of unplanned
pregnancies.

With the above projection, write an essay (not more than 300 words)
discussing the effects of unplanned pregnancies to Philippine population and
economy.

Note: Please use Arial 12 and observe 1.5 spacing. Deadline of submission
via email: 3 days after the lecture.

136
Lesson 2. Global Migration

Lesson Outcomes:
At the end of this lesson, the learners must have:
1. explained the reasons for the migration of people;
2. discussed the effects of global migration on the economic and well-being
of the state;
3. described the characteristics of a global citizen;
4. determined the challenging issues on integration and citizenship.

Fun Quiz!

I. Are you fond of travelling? Let us activate your minds by answering the
questions below:

1. What can you say about the pictures above?


2. What places have you visited within the province of Iloilo? Within or
outside the country?
3. How would you compare it to your place of origin?

137
II. Identify what country does each photo below represent?

https://www.boredpanda.com/spring-japan-cherry-blossoms- https://unsplash.com/images/travel/
national-geographic/?utm_source=int.search.myway&utm_ statue-of-liberty
medium=referral&utm_campaign=organic

1. ____________________ 2. ___________________

https://unsplash.com/s/photos/eiffel-
tower

3. ____________________ 4. ___________________

https://english.visitkorea.or.kr/enu/ATR/SI_EN_3_6. https://www.freepik.com/free-vector/thailand-icons-
jsp?cid=2469608 set_3910247.htm#page=1&query=thailand%20
symbol&position=2

5. ____________________ 6. ___________________

138
4. If given a chance to migrate in one of these countries, what would be your
choice? Why?

Since you have comprehensively answered my questions and correctly


identified the different countries being asked, let us now move on and acquire
more information about our topic on global migration.

What is Migration?

Migration is the movement of people from one place to another with the
intention of finding a permanent residence.

Though the main factor for migration of people is economic consideration,


demographers also identified the push and pull factors. The push factor means that
people are pushed away from their homes due to natural calamities such as floods,
famine, loss of jobs or political oppression. The pull factors are those reasons
which invite people to a place due to promising and extensive opportunities for a
better life.

Two (2) Types of Migration

There are two types of migration. First is internal migration which refers to
the people moving from one area t another within one country while the other type
is known as international migration where people cross borders of one country to
another like:

a. those who move permanently to another country (immigrants);


b. workers who stay in another country for a fixed period (at least 6 months
in a year);
c. illegal immigrants;
d. migrants whose family members have petitioned them to move to the
destination country; and
e. refugees and vagabonds or those who are “unable or unwilling to return
because of a well-founded fear of persecution on account of race, religion,
nationality, membership in a particular social group or political opinion.”

Demographers estimate that 247 million people are currently living outside
the countries of their birth. Ninety percent (90) of them moved for economic
reasons while the remaining ten (10) percent were refugees and asylum-seekers.
The top three (3) regions of origin are Latin America (18 percent of the global total),
followed by Eastern Europe and Central Asia (16 percent), and the Middle East
and North Africa (14 percent). On a per country basis, India, Mexico and China

139
are leading, with Philippines, together with Afghanistan, ranking 6th in the world.
The top 10 country destinations of these migrants are mainly in the West and the
Middle East, with the United States topping the list.

Fifty percent (50%) of global migrants have moved from the developing
countries to the developed zones of the world and contribute from 40 to 80 percent
of their labor force.

Benefits and Detriments for the Sending Countries

Even if 90 percent of the value generated by migrant workers remains in their


host countries, they have sent billions back to their home countries. Remittances
make significant contributions to the development of small and medium-term
industries that help generate jobs. It likewise changes the economic and social
standing of migrants as shown by new or renovated homes and their relatives’
access to new consumer goods. The purchasing power of the migrant’s family
doubled and makes it possible for their children to start or continue schooling.

On the other hand, global migration may result to “siphoning” qualified


personnel and removing dynamic, young workers or often been referred to as
“brain drain.” Furthermore, the loss of professionals in certain key roles, such as
doctors and nurses, has been detrimental to the migrant’s home countries. In
2006, some 15% of locally trained doctors from 21 sub-Saharan African countries
have emigrated to the United States or Canada.

In line with this, there are many restrictions for labor migration and many
of these are related to the Westphalian conception of the nation-state. According
to Shamir (2005), the loss of the part of a country’s workforce is one of the major
reasons for the state to control migration. He added that conflicts between local
residents and migrants may surface due to influx of migrants. Moses (2006) another
concern of the state in regulating migration is terrorism.

Governments are aware of this long-term handicap, but have no choice


but to continue promoting migrant work as part of state policy because of the
remittances’ impact on Gross Domestic Product (GDP).

The Problem on Human Trafficking

Human trafficking, another – often times involuntary – form of migration,


is an important international issue. The UN defines human trafficking as, “the
recruitment, transportation, transfer, harboring or receipt of persons, by means
of the threat or use of force or other forms of coercion, of abduction, of fraud, of

140
deception, of the abuse of power or of a position of vulnerability or of the giving
or receiving of payments or benefits to achieve the consent of a person having
control over another person, for the purpose of exploitation.” (UNODC.org)

The United States Federal Bureau of Investigation listed human trafficking


as the third largest criminal activity worldwide. In 2012, the international Labour
Organization (ILO) identified 21 million men, women and children as victims of
forced labor, an appalling three (3) out of every 1,000 persons worldwide. Ninety
percent of the victims (18.7 million) are exploited by private enterprises and
entrepreneurs; 22 percent (4.5 million) are sexually abused; and 68 percent (14.2
million) work under compulsion in agricultural, manufacturing, infrastructure and
domestic activities. Human trafficking has been very profitable, earning syndicates,
smugglers, and corrupt state officials profits of as high as $150 billion a year in 2014.
Governments, the private sector and civil society groups have worked together to
combat human trafficking, yet the results remain uneven.

Integration

Integration is the final issue as to how migrants interact with their new
home countries. Migrants unwittingly reinforce the tension by “keeping among
themselves.” The first-time migrant’s anxiety at coming into a new and often
“strange” place is mitigated by “local networks of fellow citizens’ that serve as the
migrant’s safety net from the dislocation of uprooting oneself.

Democratic states assimilate immigrants and their children by granting them


citizenship and the rights that go with it (especially public education). However,
without a solid support from their citizens may just be a formality. Linguistic
difficulties, customs from the “old country” and of late differing religions may create
cleavages between migrants and citizens of receiving countries, particularly in the
West.

Governments and private businesses have made policy changes to address


integration problems, like using multiple languages in state documents (in the case
of the United States, Spanish and English). Training programs complemented
with counselling have complemented with counselling have also helped migrant
integration in Hamburg, Germany, while retail merchants in Barcelona have bought
in migrant shopkeepers to breakdown language barriers while introducing Chinese
culture to citizens.

141
Citizenship

Citizenship is the status of a person recognized under the custom or law of


a sovereign state as a member of or belonging to the state. Each state is free to
determine the conditions under which it will recognize persons as its citizens, and
the conditions under which that status will be withdrawn. Recognition by a state
as a citizen generally carries with it recognition of civil, political, and social rights
which are not afforded to non-citizens.

In general, the basic rights normally regarded as arising from citizenship are
the right to a passport, the right to leave and return to the country/ies of citizenship,
the right to live in that country and to work there.

Some countries permit their citizens to have multiple citizenships, while


others insist on exclusive allegiance. A person who does not have citizenship of
any state is said to be stateless, while one who lives on state borders whose
territorial status is uncertain is a border-lander.

Nationality is often used as a synonym for citizenship in English although the


term is mainly – notably in international law – understood as denoting a person's
membership of a nation (a large ethnic group).

Transnationalism

The heightened interconnectivity between people and the receding


economic and social significance of boundaries between nation states paved way
to a scholarly research agenda and social phenomenon known as transnationalism,
a term popularized by the writer Randolph Bourne in the early 20th century to
describe about relationships between cultures.

With the aim of reducing costs, transnationalism as an economic process,


led to the global reorganization of the production process, in which various stages
of the production of any product can occur in various countries.

It was in the latter half of the 20th century by the development of the internet
and wireless communication, when economic transnationalism, commonly known
as globalization, spurred. During this time, there was also a reduction in global
transportation costs caused by containerization. Multinational corporations are
considered as a form of transnationalism. Multinational corporations seek to
minimize costs, and hence maximize profits, by organizing their operations in the
most efficient means possible irrespective of political boundaries.

142
Transnationalism is a part of the process of capitalist globalization for its
concept refers to multiple links and interactions between and among people and
institutions across the borders of nation-states.

What is a Global Citizen?

According to Oxfam, a Global Citizen is someone who:

• is aware of the wider world and has a sense of their own role as a
world citizen.
• respects and values diversity.
• has an understanding of how the world works.
• is outraged by social injustice.
• participates in the community at a range of levels, from the local to
the global.
• is willing to act to make the world a more equitable and sustainable
place.
• takes responsibility for their actions.

To be an effective Global Citizen, one must be flexible, creative and proactive.


He/she needs to be able to solve problems, make decisions, think critically,
communicate ideas effectively and work well within teams and groups. These skills
and attributes are increasingly recognised as being essential to succeed in other
areas of 21st century life.

Summary

Migration is the movement of people from one place to another with the
intention of finding a permanent residence. There are many economic, social and
physical reasons why people emigrate and these can be classified into push and
pull factors. The push factor means that people are pushed away from their homes
while pull factors are those reasons which invite people to a place due to promising
opportunities. Migration can be classified into internal migration which refers to
the people moving from one area to another within one country and international
migration where people cross borders of one country and stay in the host state
for some minimum length of time. Migration has positive and negative impacts
on countries of origin and host countries. Developing countries benefit from
remittances. It also uplifts the social and economic status of the migrant’s family.
Unemployment rate decreases in the countries of origin. On the other hand, working
abroad has detrimental effect to the country’s economy because it causes brain
drain. Some of the advantages of migration on host countries are economic growth
can be sustained, job vacancies can be filled, cheap labor costs and services to

143
the elderly can be maintained. Some issues related to global migration are human
trafficking, integration, transnationalism and global citizenship.

144
Name: Score:
Curriculum and Section:
Subject:
Unit No.: Date:

Let’s Do This!

I. Let us now apply what you have learned by doing the following activity.

1. Do a survey in your neighbourhood and identify families with member/s


(parent/s, children, uncle, aunt, cousin) who are OFW or immigrants.
Make a list indicating the places where they work/migrate and for how
long they have been there. (It is advisable that the survey be conducted
online).

With your list, check how the members of the family with member/
relative abroad dress, the structure of their houses, the things/properties
they own.

In class, share the results of your survey with your classmates and
determine the differences in terms of lifestyle/standard of living of those
with family member/relative abroad with those with none.

2. Interview an OFW (former OFW or presently working abroad) using the


following guide questions:

-- How long have you stayed abroad?


-- What are the purposes of your stay there?
-- What were your most unforgettable experiences there? How will
you describe them, good or bad?
-- How will you compare the Philippines with other countries?
-- Do you want to go back abroad (for former OFWs) in the future?
-- Are you satisfied with your present employment or do you have
plans of applying in other countries?

3. Conduct a research on the top 10 multinational corporations and list


down if which among those multinational corporations have offices in the
Philippines. Identify their products/services.

145
Note: Additional questions could be asked during the course of the
interview. The interview should be done online (Skype, FB messenger).
Kindly include screenshots, videos of your interview. Outputs must be
submitted within 2 weeks.

II. Write a brief photo essay based on the photo above.

___________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________________.

146
I. Determine whether the following items belong to push or pull factors
of migration:

1. More job opportunity ___________________________


2. War/Violence ________________________________
3. The promise of a better life _____________________
4. Overpopulation _______________________________
5. Active religious persecution _____________________
6. Natural Disasters _____________________________
7. Low wages __________________________________
8. Attractive nature ______________________________
9. More jobs ___________________________________
10. Better working conditions _______________________

II. Essay

1. How does global citizenship affect our world?


2. Write an essay (not more than 300 words) about human trafficking
using the key terms from the image below.

Note: Please use Arial 12 and observe 1.5 spacing. Deadline of submission
via email: 3 days after the lecture

147
References

Aldama, Prince Kennex. Chapter 2 of the book: "The Contemporary World,"


pp. 12-13.

Aldama, K. (2018). The Contemporary World.Manila, Philippines:


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Anand SV (2013) Global Environmental Issues. 2: 632 doi:10.4172/


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Bowen, K, Cradock-Henry, N, Koch, F et al 2017, 'Implementing the


"Sustainable Development Goals": towards addressing three key
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Buddy Mantra. "Oligarchy: A few People That Hold Power." n.d. The 14 Forms of
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Burrows, Dan citing Dr. James Glattfelder. "Who Really Controls Global
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Cable, V. (1999). Globalization and global governance. London: Royal institute


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Clapp, Jennifer, and Peter Dauvergne. Paths to a Green World: The Political
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Claudio, L and Abinales, P. (2018). The Contemporary World.


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Danesi P. R., Cherif H. S., 1996. Environmental changes in perspective:


The global response to challenges.

Dallas Learning Cloud. "The Meaning of Democracy." n.d. The Roots of American
Government. 12 July 2020 <https://dlc.dcccd.edu/usgov1-1/
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Donohoe, M., 2003. Causes and health consequences of environmental


degradation and social injustice. Soc. Sci. Med. 56, 573e587.

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