George Weisz, McGill University

What is Global Health?George Weisz, McGill University

Why does ”Global Health Explode in the 1990s and 2000s?

Why did it take the form it did and what was the role of the research community?

What happened in the 1990s to make GH a growth enterprise?

Before Global Health-1: International Cooperation

• . Epidemics: International Sanitary Commission 1851; followed by 10 international conferences by 1893

• Led to Office international hygiène publique 1907 (Paris)

Created to disseminate information and supervise international quarantine measures. Continued until 1950 with about 60 members when taken over by WHO

Before Global Health 2:Mortality Statistics: International Classification of Disease 1900

• Private initiative: International Statistical Institute. Nations become involved.

• 1893 First International Conference for the development of International List of Causes of Death. Delegates from 26 countries.

• International classification adopted 21 August 1900. Revised at roughly 10 year intervals.

Before Global Health: 3 Colonial/Tropical Medicine

US Military commission. Walter Reed proves mosquito as source of disease 1900

The League of Nations malaria commission in Palestine, 1925.

Second International Conference on Biological Standardization of certain remedies,

1. League of Nations Health Committee and Health Section1.

International Health-Interwar Years

Representatives from the Rockefeller Foundation and the Rockefeller Institute visited Peking Union Medical College in the early 1920s.

Counting hookworms in prisoners in Asuncion, Paraguay

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2. Philanthropic Foundations

3. Missionary and Charitable Societies

Albert Schweitzer, Gabon

Albert Schweitzer (1875 -1965) Lambarene, French Equatorial Africa, 1950s.

Women's Foreign Missionary Society 1923

International Health: Post WW2

• UN Organizations• World Health Organization (WHO)1948• UNICEF• United Nations Development Fund (1970s)• World Bank (from 1980s)

• Governments (bilateral agreements, USA, Scandinavia, Canada-IDRC)

• Philanthropies and NGOs (Rockefeller F. Médecins Sans Frontières, 1971, etc.)

definition of health “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity.”

WHO Special Program for Tropical Disease Research (TDR) 1976

• Sponsored by WHO, World Bank, United Nations Development Program

• Received large proportion of funds from outside sources

• Work with pharma companies to produce new products

• Devote quarter of budget to developing research capacity in client countries

• Research includes social science work to understand wider social conditions

• Develops unique culture within WHO

Adetokunbo O. Lucas

Tore Godal

Patricia L. Rosenfeld

TDR

Things change 1990s: 1-Research

1990

1996

Things change from 1990- 2.

• Crisis at WHO-financial, political, bureaucratic; calls for reform of institutions

• WHO Responds with Plans for Reform; works closely with World Bank

3. World Bank Becomes Activeoverall GH strategy

• Health central to development; spending

• Cost-benefit economic view of how to spend money. Develop metrics.

• Neo-liberalism?• Alliance between

international institutions, states private philanthropies, NGOs and multi-national corporations to deal collectively with global threats.

Dean Jamison

New

Chris Murray

Alan Lopez

Evidence based action-Global Burden of Disease; morbidity as well as mortality: DALY. (disability-adjusted life year)

Revival of WHO under Gro Harlem Brundtland 1998-2003

4. Aids epidemic, fear of emerging pandemics

Joshua Lederberg

5.HIV/AidsActivism

5bis: anti-globalization protests at G8 meetings (2001)

• 6.Rich people develop interest in global health issues

3 major strategic alliances

• Global Forum (1996)- research

• GAVI- The Vaccine Alliance (2000)

• The Global Fund to Fight AIDS, Tuberculosis and Malaria (2002)

Results

Hoffman, S. J., Cole, C. B., & Pearcey, M. (2015). Mapping Global Health Architecture to Inform the Future. Centre on Global Health Security.

Growing Interests of Students and Donors leads universities to GH

The Consortium of Universities for Global Health (CUGH) is a rapidly growing Washington, DC based organization of over 153 academic institutions and other organizations from around the world engaged in addressing global health challenges. CUGH was established in 2008 with generous funding from the Bill & Melinda Gates Foundation and The Rockefeller Foundation.MISSION: To build interdisciplinary collaborations between universities and other sectors to facilitate the sharing and implementation of knowledge to address global health challenges. CUGH works across education, research, and service. It is dedicated to creating equity and reducing health disparities, particularly in low-income settings. CUGH promotes mutually beneficial partnerships between universities other sectors in developed and developing countries to strengthen human capital and institutional capabilities. It is committed to translating knowledge into action.

Towards a common definition of global healthJeffrey P Koplan, T Christopher Bond, Michael H Merson, K Srinath Reddy, Mario Henry Rodriguez, Nelson K Sewankambo, Judith N Wasserheit,for the Consortium of Universities for Global Health Executive Board* Lancet 2009

“global health is an area for study, research, andpractice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasises transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population based prevention with individual-level clinical care.”

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1966 1970 1974 1978 1982 1986 1991 1994 1998 2002 2006 2010 2014

WoSPubMed% retrieved

Global Health Articles Published in PubMed and WoS

Tensions within Global Health

• Political: Right vs Left• Temperament: Pragmatic vs Idealistic• Strategic: Short term vs long term

• Medical vs socio/environmental solutions• equity vs effectiveness (how you allocate)• Disease specific programs vs health system

development (vertical vs horizontal)• Funders vs local communities (decision-making)

Tensions within Global Health 2

• Public vs private sector (role of markets, profit)

• Priorities: Infectious vs non-communicable illness, injuries etc.

• Best criteria for deciding priorities (metrics about greatest numbers or desires of people being helped)

• Issues of Bio-ethics for research• What do rich countries and private

industry owe poor countries used for testing new products

Final Thought• GH has a lot of problems. But a lot of good and

useful things are happening on the ground.

The End

Thank you for listening