What is global health?

Author: Nashwinder Kaur

Whether you work with health or are simply interested in health, you may be curious about recently emerged health disciplines. Like any new kid on the block, global health appears to have captured the attention of many. Despite choosing to study it at Master’s level, it’s a challenge to give a concise answer when people ask me “What is global health?”

Global health emerged as a field of study during the 1970s (1) and has since become one of the most prominent health disciplines in the world (2). This might be a result of the focus it places on human health issues which transcend national borders (1). It is also more holistic in incorporating both prevention on the population level as well as clinical care on the individual level (3).  Finally, a key feature of global health is its use of inter-disciplinary approaches to improve the health of people globally (3). Despite the many versions, a commonly used definition in global health is the one proposed by Jefferey Kaplan (4)

“Global health is an area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes 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.”

But is this how global health is practiced in reality?

The field has come a long way, but certain limitations of the discipline cannot be disregarded. Let’s have a closer look.

1. “…an area of study, research and practice that places a priority on improving health… […] …global health emphasizes transnational health issues, determinants, and solutions…”

Global health professionals and academics have emphasised pressing issues such as the rise in non-communicable diseases (5), the double burden of diseases (5), mental health (3), and migrant health (3).

However, a major gap lies in the lack of practical solutions for the health issues identified by global health professionals and researchers. Also, most of the research is available in journals, which are realistically accessible to academics, not health workers, suggesting a lack of dissemination of findings for translation to practice (6).

Some of the greatest achievements in global health have saved millions of lives, such as the use of vaccines for many childhood preventable diseases (7) and antiretroviral medicines for treating HIV/AIDS (8). However, many global health solutions continue to focus mainly on the biomedical aspects of health (9), failing to incorporate the social, behavioural, and ecological determinants of health. Clever scientific solutions that don’t account for challenges in delivery suggest that life-saving solutions still do not reach the people that need them most.

2. “…achieving equity in health for all people worldwide.”

A key goal of global health is to reduce the health disparities between wealthier and poorer populations. Yet, this is the one aspect of the discipline that has not made much progress and may in turn, be increasing disparity in some contexts (3).

One of the reasons for this remaining a challenge is the way we define who is poor and who is rich. For instance, the over reliance on classification of high-income, upper middle-income, lower middle-income and low-income countries using GDP (gross domestic product) is important for understanding a country’s relative economic position. But these measures may not be the best for understanding which groups of individuals are poor or rich, since that varies within and between countries (11). More recent measures such as the Human Development Index (HDI) attempt to quantify development using a more holistic system (12).

Similarly, terminologies like “Global North” and “Global South” undermine the vulnerable groups present in the more developed world, while overlooking the advantaged groups in the less developed world. The UK and the US are classified as developed and high-income but have consistently displayed huge disparities in health equity (10). Scholars in development studies may have recognized these issues (13), but it is problematic when outdated terminology promoting a Eurocentric perspective is used in global health today.

Furthermore, global health organisations can often end up participating in the power structures they criticize. The lack incorporation of civil society and community organisers (9) into the discipline can often lead to agendas being dominated by billionaire philanthropists, pharmaceutical corporations, and corrupt political agendas. An increasingly de-politicised global health narrative fails to challenge the root causes of inequalities and poses a major challenge to achieving health equity (11).

3. “…involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration…”

Indeed, there has been an increase in various sectors’ contributions to the improvement of health around the world (2). Economics, finance, political science, pharmaceutical science, social sciences, anthropology, engineering, medicine, biological sciences, international relations: one could find a professional from almost any sector working in global health today.

What remains is the opportunity to collaborate between these disciplines to truly create a “whole-approach” in human health issues globally (3). In reality, it may look more like multiple disciplines contributing their perspective but continuing to work in silos for solutions (11). We need to be better communicators of the importance of continued investment in global health efforts and collaboration to improve health by sharing not only problems and setbacks of global health but also its successes.

Overall, the discipline of global health still has a lot of growing to do. Each one of us can contribute to its development by recognising current problems with the field, and the wider sociopolitical structures that shape its responses. Only then can we aim to find truly creative solutions to present and future challenges.

 

Now, what about you…

What does global health mean to you?

What do you think are the current successes in the discipline?

What do you think are the current challenges in the discipline?

How do you think we can overcome them?

 

REFERENCES:

[1] Cemma M. What’s the Difference? A Primer on Evolving Health Disciplines [Internet]. Global Health NOW. 2017. Available from: https://www.globalhealthnow.org/2017-09/whats-difference-primer-evolving-health-disciplines

[2] Shaikh A. Global health is growing in prominence – now what? [Internet]. the Guardian. 2012 [cited 4 January 2019]. Available from: https://www.theguardian.com/global-development-professionals-network/2012/dec/03/global-health-alanna-shaikh

[3] Merson M, Black R, Mills A. Global Health: Diseases, Programs, Systems and Policies. 4th ed. Jones & Bartlett Learning; 2018.

[4] Koplan J, Bond T, Merson M, Reddy K, Rodriguez M, Sewankambo N et al. Towards a common definition of global health. The Lancet [Internet]. 2009;373(9679):1993-1995. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960332-9/fulltext

[5] Bygbjerg I. Double Burden of Noncommunicable and Infectious Diseases in Developing Countries. Science [Internet]. 2012;337(6101):1499-1501. Available from: https://pdfs.semanticscholar.org/2c44/b4126818def768e35086e79c4d72d12e0fac.pdf

[6] Tham C, Offeddu V, Teck C, Sundaram N. Public health needs an injection of genuine impact [Internet]. Times Higher Education (THE). 2018. Available from: https://www.timeshighereducation.com/opinion/public-health-needs-injection-genuine-impact

[7] Greenwood B. The contribution of vaccination to global health: past, present and future. Philosophical Transactions of the Royal Society B: Biological Sciences [Internet]. 2014;369(1645):20130433-20130433. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024226/

[8] Piot P, Quinn T. The AIDS Pandemic – A Global Health Paradigm. New England Journal of Medicine [Internet]. 2013;368(23):2210-2218. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777557/

[9] McCoy D. Critical Global Health: Responding to Poverty, Inequality and Climate Change Comment on “Politics, Power, Poverty and Global Health: Systems and Frames”. International Journal of Health Policy and Management. 2017;6(9):539-541.

[10] Globalization Knowledge Network. Towards Health-Equitable Globalisation: Rights, Regulation and Redistribution [Internet]. University of Ottawa; 2007. Available from: https://www.who.int/social_determinants/resources/gkn_report_06_2007.pdf

[11] Benatar S. Politics, Power, Poverty and Global Health: Systems and Frames. International Journal of Health Policy and Management. 2016;5(10):599-604.

[12] United Nations Development Programme (UNDP). Human Development Report 2010 [Internet]. UNDP; 2010. Available from: http://hdr.undp.org/sites/default/files/reports/270/hdr_2010_en_complete_reprint.pdf

[13] Palat R. Dependency Theory and World-Systems Analysis. A Companion to Global Historical Thought,. 1st ed. John Wiley & Sons, Ltd; 2014.

[14] Mochrie E. Rich man, poor man [Internet]. 2016. Available from: https://www.inspire360.co.uk/rich-man-poor-man/

[15] Laundry Slum in Mumbai, India [Internet]. [cited 9 January 2019]. Available from: https://pixabay.com/en/laundry-slum-india-mumbai-1414566/?fbclid=IwAR2r6-VwU3EBY8OfL0lPqaJ5iKEZiB60-9YorG9sxVEFUsAPpAag5KJALF0

[16] Illustration of inequities [Internet]. The Economist.  North American Edition. December 7th,  2018.