What is Global Health? What is Global Health?

Global health perceptionGlobal health perception

Global health is still often perceived Global health is still often perceived as international aid, technologies, as international aid, technologies, and interventions flowing from the and interventions flowing from the wealthier countries of the global wealthier countries of the global north to the poorer countries of the north to the poorer countries of the global south. global south.

Pandemics: H1N1, Ebola, climate changePandemics: H1N1, Ebola, climate change Non communicable diseases: Non communicable diseases: diet and diet and

lifestyle of high-income nations have lifestyle of high-income nations have “communicable” characteristics“communicable” characteristics

cross-national comparisons of health cross-national comparisons of health systems can yield useful insightssystems can yield useful insights

health workforce is becoming globalised. health workforce is becoming globalised. The traditional model of health professionals The traditional model of health professionals from the wealthy north providing care in the from the wealthy north providing care in the poor south is outmodedpoor south is outmoded..

A more nuanced and contemporary perspective emphasises interdependence and recognises the many contributions of both resource-rich and resource-scarce nations.

The origins of ’global health’The origins of ’global health’

Global Health

Public health & International health

Hygiene and Tropical Medicine

So is global health is public health?So is global health is public health?

2 schools of thought: 2 schools of thought:

YesYes

NoNo

Public healthPublic health Emerged in the mid 19th century in Europé and the US – Emerged in the mid 19th century in Europé and the US –

from medical advances and social reform movementsfrom medical advances and social reform movements

4 main characteristics4 main characteristics (1) decision making based on data and evidence (vital (1) decision making based on data and evidence (vital

statistics, surveillance and outbreak investigations, statistics, surveillance and outbreak investigations, laboratory science); laboratory science);

(2) a focus on populations rather than individuals; (2) a focus on populations rather than individuals; (3) a goal of social justice and equity; and (3) a goal of social justice and equity; and (4) an emphasis on prevention rather than curative care.(4) an emphasis on prevention rather than curative care.

Many definitions but basically these 4 tenetsMany definitions but basically these 4 tenets

Global health is public health! Global health is public health!

Global health and public health are Global health and public health are indistinguishable. indistinguishable.

Both view health in terms of physical, mental, Both view health in terms of physical, mental, and social wellbeing, rather than merely the and social wellbeing, rather than merely the absence of disease. absence of disease.

Both emphasise population-level policies, as well Both emphasise population-level policies, as well as individual approaches to health promotion. as individual approaches to health promotion.

Both address the root causes of ill-health through Both address the root causes of ill-health through scientific, social, cultural, and economic scientific, social, cultural, and economic strategiesstrategies..

International healthInternational health Developed world perspective for health work Developed world perspective for health work

abroadabroad Geographic focus on developing countries and Geographic focus on developing countries and

often with a content of infectious and tropical often with a content of infectious and tropical diseases,water and sanitation, malnutrition, and diseases,water and sanitation, malnutrition, and maternal and child healthmaternal and child health

Defn: many. “The application of the principles of Defn: many. “The application of the principles of public health to problems and challenges that public health to problems and challenges that affect low and middle-income countries and to affect low and middle-income countries and to the complex array of global and local forces that the complex array of global and local forces that influence them”influence them”

Tropical MedicineTropical Medicine

Precursor to International healthPrecursor to International health

Liverpool school of Tropical MedicineLiverpool school of Tropical Medicine identifying, preventing, diagnosing, identifying, preventing, diagnosing,

and treating diseases most and treating diseases most prominent in tropical climates. Major prominent in tropical climates. Major disciplines were entomology, disciplines were entomology, parasitology, clinical medicine, parasitology, clinical medicine, epidemiology, and community healthepidemiology, and community health

Global health, international health Global health, international health and public healthand public health

Intersections between the 3 disciplinesIntersections between the 3 disciplinesCommonalities: Commonalities: priority on a population-based and priority on a population-based and

preventive focus; preventive focus; concentration on poorer, vulnerable and concentration on poorer, vulnerable and

underserved populations; underserved populations; multidisciplinary and interdisciplinary multidisciplinary and interdisciplinary

approaches; approaches; emphasis on health as a public good emphasis on health as a public good the importance of systems and structuresthe importance of systems and structures the participation of several stakeholdersthe participation of several stakeholders

What then is global?What then is global? Must a health issue cross national borders Must a health issue cross national borders

to be deemed a global health issue?to be deemed a global health issue? No! Global health implies the scope of the No! Global health implies the scope of the

issue in trans national, the health issue issue in trans national, the health issue itself need not literally cross bordersitself need not literally cross borders

Global refers to any health issue that Global refers to any health issue that concernsconcerns

many countries or is affected by many countries or is affected by transnationaltransnational

determinants, such as climate change or determinants, such as climate change or urbanisation, climate change, economic, urbanisation, climate change, economic, food and energy crisesfood and energy crises

What is global? Contd….What is global? Contd…. Epidemic infectious diseases such as dengue, infl Epidemic infectious diseases such as dengue, infl

uenza A (H5N1), and HIVuenza A (H5N1), and HIV infection are clearly globalinfection are clearly global Tobacco control, micronutrient deficiencies, Tobacco control, micronutrient deficiencies,

obesity, injury prevention, migrant-worker health, obesity, injury prevention, migrant-worker health, and migration of health workersand migration of health workers

Thus—like public health but unlike internationalThus—like public health but unlike internationalhealth— global health can focus on domestic health health— global health can focus on domestic health

disparities as well as cross-border issuesdisparities as well as cross-border issues

Focus on Infectious diseases and Focus on Infectious diseases and MCH?MCH?

Infectious diseases and MCH have Infectious diseases and MCH have dominated international health - the most dominated international health - the most attention in global health.attention in global health.

Simultaneous efforts on undernutrition and Simultaneous efforts on undernutrition and overnutrition, HIV and tobacco, malaria overnutrition, HIV and tobacco, malaria and mental health, tuberculosis and and mental health, tuberculosis and deaths due to motor vehicle accidents.deaths due to motor vehicle accidents.

Infectious diseases are communicable so Infectious diseases are communicable so are aspects of the Western lifestyle! are aspects of the Western lifestyle!

In GH, burden of disease is important in In GH, burden of disease is important in priority settingpriority setting

Globalisation and global healthGlobalisation and global health

Spread of health risks and diseases across Spread of health risks and diseases across the world,often linked with trade or the world,often linked with trade or attempted conquestattempted conquest

Small pox and measles from the old to the Small pox and measles from the old to the new world (tobacco in reverse)new world (tobacco in reverse)

Opium to ChinaOpium to China Newer unpredented levels of global Newer unpredented levels of global

interconnectedness now…new issues for interconnectedness now…new issues for the health of populationsthe health of populations

The new global context of public The new global context of public health: globalisationhealth: globalisation

Mixed public health effects Mixed public health effects accelerated economic growth and

technological advances have enhanced health and life expectancy in many populations

erosion of social and environmental conditions, the global division of labour, the exacerbation of the rich–poor income gap between and within countries, and the accelerating spread of consumerism, so life style changes

Global environmental change

Equity and global healthEquity and global health

Is equity a pursued value in GH as in Is equity a pursued value in GH as in public health and international health? public health and international health?

Yes, but in a different way….more based Yes, but in a different way….more based on a reciprocity (the notion that good on a reciprocity (the notion that good ideas are not the monopoly of the ideas are not the monopoly of the developed world!)developed world!)

Use of GH being prefered over Use of GH being prefered over international health emphasises this shiftinternational health emphasises this shift

InterdisciplinaryInterdisciplinary

the social and behavioural sciences, the social and behavioural sciences, law, economics, history, engineering, law, economics, history, engineering, biomedical and environmental biomedical and environmental sciences, and public policysciences, and public policy

Global health - evolvingGlobal health - evolving

No consensus definition of global No consensus definition of global healthhealth

No agreement on the content of No agreement on the content of coursescourses

What does it mean to work or What does it mean to work or research in global health?research in global health?

Calls for a common definition Calls for a common definition

Many definitions for Global health, Many definitions for Global health, each incorporating some of the each incorporating some of the elements aboveelements above

Will come across them over the Will come across them over the coursecourse

Some current definitionsSome current definitions

’’an area for study, research, and practice an area for study, research, and practice that places a priority on improving health that places a priority on improving health and achieving health equity for all people and achieving health equity for all people worldwide’ worldwide’

‘‘those health issues that transcend those health issues that transcend national boundaries and governments and national boundaries and governments and call for actions on the global forces that call for actions on the global forces that determine the health of people’ determine the health of people’

Current definitions contd…Current definitions contd…

‘‘health issues where the determinants health issues where the determinants circumvent, undermine or are oblivious to circumvent, undermine or are oblivious to the territorial boundaries of states, and are the territorial boundaries of states, and are thus beyond the capacity of individual thus beyond the capacity of individual countries to address through domestic countries to address through domestic institutionsinstitutions

‘ ‘worldwide improvement of health, worldwide improvement of health, reduction of disparities, and protection reduction of disparities, and protection against global threats that disregard against global threats that disregard national borders’ national borders’

Suggested readingSuggested reading Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH,

Sewankambo NK, et al. Towards a common definition of Sewankambo NK, et al. Towards a common definition of global health. Lancet 2009; 373: 1993–5. global health. Lancet 2009; 373: 1993–5.

Fried LP, Bentley ME, Buekens P, Burke DS, Frenk JJ, Klag Fried LP, Bentley ME, Buekens P, Burke DS, Frenk JJ, Klag MJ, et al. Global health is public health. Lancet 2010; 375: MJ, et al. Global health is public health. Lancet 2010; 375: 535–7. 535–7.

Macfarlane SB, Jacobs M, Kaaya EE. In the name of global Macfarlane SB, Jacobs M, Kaaya EE. In the name of global health: trends in academic institutions. J Public Health health: trends in academic institutions. J Public Health Policy 2008; 29: 383–401. Policy 2008; 29: 383–401.

Beaglehole R. What is global health?Beaglehole R. What is global health? Global Health Action Global Health Action 2010, 2010, 3:3: 5142 - DOI: 10.3402/gha.v3i0.5142 5142 - DOI: 10.3402/gha.v3i0.5142