What is Global Health?

1. What is Global Health?

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

3. Pandemics: H1N1, Ebola, climatechange Non communicablediseases: diet and lifestyle of high-income nations have “communicable” characteristics cross-national comparisons of health systems can yield useful insights health workforce is becoming globalised. The traditional model of health professionals from the wealthy north providing care in the poor south is outmoded.

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

5. The origins of ’global health’ Global Health Public health & International health Hygiene and Tropical Medicine

6. So is global health is public health? 2 schools of thought: Yes No

7. Public health • Emerged in the mid 19th century in Europé and the US – from medicaladvances and social reform movements 4 maincharacteristics • (1) decision makingbased on data and evidence (vital statistics, surveillance and outbreakinvestigations, laboratory science); • (2) a focus on populations ratherthanindividuals; • (3) a goalof social justice and equity; and • (4) an emphasis on prevention ratherthancurativecare. Many definitions butbasicallythese 4 tenets

8. Global health is public health! Global health and public health are indistinguishable. Both view health in terms of physical, mental, and social wellbeing, rather than merely the absence of disease. Both emphasise population-level policies, as well as individual approaches to health promotion. Both address the root causes of ill-health through scientific, social, cultural, and economic strategies.

9. International health • Developedworldperspective for healthworkabroad • Geographic focus on developingcountries and oftenwith a contentofinfectious and tropicaldiseases,water and sanitation, malnutrition, and maternal and childhealth • Defn: many. “The applicationof the principles of public healthto problems and challengesthataffectlow and middle-incomecountries and to the complexarrayof global and localforcesthatinfluencethem”

10. Tropical Medicine • Precursor to International health Liverpool school of Tropical Medicine • identifying, preventing, diagnosing, and treating diseases most prominent in tropical climates. Major disciplines were entomology, parasitology, clinical medicine, epidemiology, and community health

11. Global health, international health and public health • Intersections between the 3 disciplines Commonalities: • priority on a population-based and preventive focus; • concentration on poorer, vulnerable and underserved populations; • multidisciplinary and interdisciplinary approaches; • emphasis on health as a public good • the importance of systems and structures • the participation of several stakeholders

12. What then is global? • Must a health issue cross national borders to be deemed a global health issue? • No! Global health implies the scope of the issue in trans national, the health issue itself need not literally cross borders Global refers to any health issue that concerns many countries or is affected by transnational determinants, such as climate change or urbanisation, climate change, economic, food and energy crises

13. What is global? Contd…. • Epidemic infectious diseases such as dengue, infl uenza A (H5N1), and HIV infection are clearly global • Tobacco control, micronutrient deficiencies, obesity, injury prevention, migrant-worker health, and migration of health workers Thus—like public health but unlike international health— global health can focus on domestic health disparities as well as cross-border issues

14. Focus on Infectious diseases and MCH? • Infectious diseases and MCH have dominated international health - the most attention in global health. • Simultaneous efforts on undernutrition and overnutrition, HIV and tobacco, malaria and mental health, tuberculosis and deaths due to motor vehicle accidents. • Infectious diseases are communicable so are aspects of the Western lifestyle! • In GH, burden of disease is important in priority setting

15. Globalisation and global health • Spread of health risks and diseases across the world,often linked with trade or attempted conquest • Small pox and measles from the old to the new world (tobacco in reverse) • Opium to China • Newer unpredented levels of global interconnectedness now…new issues for the health of populations

16. The new global context of public health: globalisation • 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

17. Equity and global health • Is equity a pursued value in GH as in public health and international health? • Yes, but in a different way….more based on a reciprocity (the notion that good ideas are not the monopoly of the developed world!) • Use of GH being prefered over international health emphasises this shift

18. Interdisciplinary • the social and behavioural sciences, law, economics, history, engineering, biomedical and environmental sciences, and public policy

19. Global health - evolving • No consensus definition of global health • No agreement on the content of courses • What does it mean to work or research in global health?

20. Calls for a common definition • Many definitions for Global health, each incorporating some of the elements above • Will come across them over the course

21. Some current definitions • ’an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide’ • ‘those health issues that transcend national boundaries and governments and call for actions on the global forces that determine the health of people’

22. Current definitions contd… • ‘health issues where the determinants circumvent, undermine or are oblivious to the territorial boundaries of states, and are thus beyond the capacity of individual countries to address through domestic institutions • ‘worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders’

23. Suggested reading • Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, et al. Towards a common definition of global health. Lancet 2009; 373: 1993–5. • Fried LP, Bentley ME, Buekens P, Burke DS, Frenk JJ, Klag MJ, et al. Global health is public health. Lancet 2010; 375: 535–7. • Macfarlane SB, Jacobs M, Kaaya EE. In the name of global health: trends in academic institutions. J Public Health Policy 2008; 29: 383–401. • Beaglehole R. What is global health?Global Health Action 2010, 3: 5142 - DOI: 10.3402/gha.v3i0.5142