Global Health

An Introduction to Current and Future Trends

Kevin McCracken, David R. Phillips

• Publisher: Taylor & Francis
• Year: 2017
• eBook ISBN: 9781317431213
• Edition: 2
• Topic: Medicine
• Subtopic: Health Care Delivery

Global Health continues to provide readers with a comprehensive, up-to-date and thought-provoking outline and understanding of the constantly evolving global health landscape. In this new edition the authors have maintained the successful structure and organisation of the previous edition to examine and explain recent health changes and consider likely future patterns. New or expanded topics covered include:

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• emerging and re-emerging infectious disease threats
• increasing awareness of, and interest in, antimicrobial resistance and superbugs
• terrorism, global conflict and health
• the new UN 2030 Agenda for Sustainable Development
• the drive for Universal Health Coverage (UHC)
• the use of information technology in global health
• substance abuse
• palliative and end-of-life-care
• ethical issues in global health.

Using clear and original explanations of complex issues, this text makes extensive use of boxed case studies and international examples, with discussion questions posed for readers at the end of each chapter. Readers will also be able to take advantage of the new website that was designed to complement this book.

Global Health is essential reading for students and researchers of global health, public health and development studies.

Part I
Concepts, data, measurement, explanations

1 Global health

An introduction

Keywords

global health, international health, global, globalization, Sustainable Development Goals (SDGs), Millennium Development Goals (MDGs), epidemiological transition, ageing, international assistance, business and philanthropy, corruption, ethical issues

The genesis of global health (GH)

In 1624 Donne meditated ‘no-one is an island, entire to themselves’, words that have become prescient for modern global health. We are now increasingly aware of the commonalities and yet differences in health and health status in different places. Never a day goes by without news of a new health threat – perhaps a new, reappearing or deadlier variant of an infection, or warnings about the ‘epidemics’ of dementias, obesity, diabetes or cancers that we are consistently alerted to. This is clearest perhaps with respect to infectious conditions. In Donne's day it would have taken months to cross the ocean; today, a round-the-world flight routing can take just over two days. So wherever we are, someone incubating a severe infection can cross continents and be in a new, unsuspecting and possibly unprepared community within hours. Definitely we need to be aware of the reality of global reach in health.

Terminologies change, enter and exit fashion, and nowhere more so than in health. As a concept, global health (GH) is gaining popularity and momentum yet, as the term has emerged from many perspectives and disciplines, it has been varyingly interpreted by different people and will continue to be. To some scholars and policy-makers, GH refers generally to emerging global shifts in health status and apparent convergences of health experience across the world. Others apply GH more technically in relation to particular diseases or conditions: for example, the attainment of specific health-related objectives, the reduction, prevention or elimination of specific, often infectious, diseases (such as HIV, malaria, polio, schistosomiasis) or groups of chronic conditions (heart disease, cancers or wider non-communicable diseases), or in the reduction in incidence and extent of specific health problems, such as maternal or infant mortality.

BOX 1.1 An interconnected world

‘The fact is, no matter where we live, our well-being depends on how health issues are managed around the world.’

(Source: GHEC – Global Health Education Centre htt­ps:­//g­lob­alh­eal­the­duc­ati­on.­org­/wh­ygl­oba­lhe­alt­h)

‘… an outbreak anywhere is potentially a threat everywhere …’

(Source: The Lancet, January 2016, p. 96)

Others see GH as implying some sort of generality in evolution and variation in human behaviour, such as drug and alcohol misuse, under- or over-nutrition and obesity, or behaviour leading to the spread of sexually transmitted diseases. Yet others see GH in the context of policies for widespread targeting of particular groups or geographical areas: the young, women, refugees, migrants, victims of disasters, or older people. ‘Although universities, government agencies, and private philanthropies are all using the term in highly visible ways, the origin and meaning of the term “global health” are still unclear’ (Brown et al., 2006, p. 62). However, it has a huge and critical reality, as former Director of the World Health Organization (WHO) Gro Harlem Brundtland (2003) noted over a decade ago.

Where, then, can the researcher or student start? Many, including the Journal of Public Health Policy, will refer to Wikipedia, which has an array of useful indicators and measures of health and health status but relatively few concrete references and definitions, the nearest being from Koplan et al. (2009) which we examine later. Systematic searches likewise reveal a range of interesting but not always globally relevant issues. What of the international, academic and policy literature? There is a rapidly growing number of academic papers with the term in the title, although still as yet relatively few books specifically using it.

Among current books, for example, in Introduction to Global Health Kathryn Jacobsen (2008, 2014) adopted a structured approach to specific issues. She asked a number of epidemiological and problem-focused questions, such as: ‘What are the key diseases and health conditions that cause death and disability in different parts of the world? What are the theories and methods that allow us to study population health? What can be done to create a healthier global population?’ Her text is a useful starting point as it looks at possible ways forward in global health as well as focusing on problems. Skolnik (2008; 2012) provides a helpful discussion on health-development links and the health needs of developing countries and poor and disadvantaged groups. Crisp (2010) is more visionary, seeing the search for ‘global health’ as something requiring radical policies, as health systems everywhere appear practically and financially inadequate and unable to deliver adequate care. New ways of thinking are required, with much greater co-development and learning. His book emphasizes interdependence, rich countries learning from poor as well as the usual vice versa, introducing some novel potential socio-economic and geopolitical approaches. Birn et al. (2009) use the two terms ‘global health’ and ‘international health’ in the title of their book and provide a useful discussion of the distinctions. Muennig and Su (2013) consider an age of global health policy, particularly needed because of the large number of people on the planet now, and the consequences of epidemiological transition. They feel that the focus should move to why people get sick and what can be done about it and look at this through a series of national case studies, including the role of the healthcare delivery systems. Others look at more specific themes such as global infections and global health law (Gostin, 2014).

BOX 1.2 Global challenges need global solutions

‘The reality is that public health is, as never before, a priority on the global agenda, for the simple reason that so many of the challenges we face now have a global impact, requiring global solutions and a global response.’

(Source: Brundtland, 2003, p. 8)

Butler (2014) edits a collection of chapters on climate change and global health, including direct effects such as heatwaves, the changing distribution of vector-borne diseases and indirect or consequential effects of climate change such as famine, population dislocation and conflict. This view accords with a more recent approach, planetary health (Horton, 2013, 2015a,b; Horton et al., 2014). This ‘situates human health within human systems … (and) the natural systems within which our species exists’ (Horton and Lo, 2015, p. 1921). Following the Rockefeller Foundation-Lancet Commission on the topic (Whitmee et al., 2015), they define planetary health as ‘the achievement of the highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the human systems—political, economic, and social—that shape the future of humanity and the Earth's natural systems that define the safe environmental limits within which humanity can flourish. Put simply, planetary health is the health of human civilisation and the state of the natural systems on which it depends' (Horton and Lo, 2015, p. 1921).

The emergence of global health as a term

Many academic and policy writers have noted that a common definition of global health will be useful. If not, used shorthand, the term might overlook important differences in philosophies, strategies and priorities among the various parties (including policy-makers, practitioners, funders, researchers, the media and the public). Koplan et al. (2009, p. 1993), working towards such a common definition, contend that GH has at least three facets:

• as a notion (the state of global health);

• as an objective (aiming for a condition of global health, a world of healthy people); and

• as a mix of scholarship, research and practice (with multidisciplinary issues, questions and participants).

Definitions will need to set GH apart from earlier related approaches. Koplan, Jacobsen and others note that GH evolved from, and often alongside, a century-old tradition of public health, which was then and is now a broad and largely comprehensible concept, through to the more recent conceptualization of international health. ‘International health’ (IH) also has a long history and has tended to focus mainly on the control of epidemics in developing countries, especially across boundaries between nations (Brown et al., 2006; Birn et al., 2009; Garrett, 2013). Birn et al. (2009) provide a third-edition update of Basch's classic Textbook of International Health, originally published in 1990. IH as a term is retained by many teachers, researchers and practitioners and today probably focuses, validly, as much on differences as similarities between health policies, practices and systems in different countries. Merson et al. (2006), in a text combining the terms – International Public Health – stress the practical and very interdisciplinary origins of public health and the application of its principles, particularly in low- and middle-income countries. However, over the past decade or more the term ‘global health’ – to be defined – has been overtaking international health, especially given a greater understanding of global interrelatedness and connectedness, and an awareness that the health and wellbeing of people and groups in all nations and regions are increasingly interdependent, probably through a popular conception of globalization. The US Global Health Council was an interesting multi-sectoral policy and research initiative that, until it ceased operation in 2012, focused on US and international health issues, including communicable diseases, NCDs, maternal and child health and HIV/AIDS. It published the magazine Global Health.

BOX 1.3 Global health predecessors

‘Global health is a comparatively new multilateral enterprise, built atop a far less ambitious, poorly funded set of mid-20th Century programs that fell under the rubrics of “tropical medicine” and “international health”, largely overseen or guided by the WHO.’

(Source: Garrett, 2013, p. 2)

‘Global health’, to Brown et al. (2006, p. 62), in general ‘implies consideration of the health needs of the people of the whole planet above the concerns of particular nations’. They view ‘global’ as ‘associated with the growing importance of actors beyond governmental or intergovernmental organizations and agencies, including, for example, the media, internationally influential foundations, non-governmental organizations and transnational corporations’.

Koplan et al. (2009) usefully compare and contrast the characteristics of global health, international health and public health (Table 1.1). All are population-based, though the first two can include clinical care for individuals; they have a preventive focus, and tend to concentrate on poorer, vulnerable and underserved populations. They are generally multidisciplinary, and global health is particularly interdisciplinary. All place health as a public good involving the participation of many stakeholders. They see global health focusing on issues that directly or indirectly affect health but which can transcend national boundaries. Public health, meanwhile, is seen as tending to focus more on the health of particular communities or a country, while international health tends to concentrate on countries other than one's own, and especially the health issues of low- and middle-income countries. Koplan et al.'s paper (pp. 1994–5) identifies several key issues to be resolved in reaching a definition of global health, which we consider below:

• What is global?

• Does a health crisis have to cross national borders to be defined as a global health issue (geographical reach)?

• Is global health aimed principally at infectious diseases and maternal and child issues, or does it also address chronic diseases, injuries, psychological health and the environment?

• Does GH relate to globa...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Table of Contents
• List of figures
• List of tables
• List of boxes
• About the authors
• Preface
• List of abbreviations
• Part I Concepts, data, measurement, explanations
• Part II Global health and health transition – past and present – places and groups
• Part III Global health futures: future transitions and health planning
• Glossary
• References
• Websites
• Index