So, what is global health?

By: Celia Mir Álvarez

A term previously unknown to most, global health is now on the top of the agenda for everyone, regardless of origin, education level, or occupation. But do we truly understand this concept? Does it mean the same to all of us?

To the general public, global health probably refers to issues affecting the entire population such as the current covid-19 pandemic that started sweeping the world around one year ago. There is no question that this is concerns global health: at the time this article was written, the virus had affected nearly 73 million people across the globe and had taken 1.6 million lives. Moreover, this pandemic has had drastic economic, social, and political consequences at the local, national, and international level that directly or indirectly affect people’s health. But is covid-19 the only relevant global health concern? Most people involved in global health would argue that this is not the case. In fact, it seems that the pandemic has exposed and highlighted other high-priority issues that illustrate the wide range of problems that relate to or concern global health, and that are usually not on the radar of the public eye.

For starters, covid-19 has shed a renewed light onto the already widely discussed topics of air pollution, climate change, and the environment. During the first lockdown, it was predicted that global CO₂ emissions could be reduced between 4 and 7% throughout 2020; perhaps more illustrating are the images of clear skies in cities like Jakarta (Indonesia) or in Manila (the Philippines), where air pollution levels are usually too high to enjoy such sights. What covid-19 brought to light, therefore, was how severe air pollution was (and continues to be) in cities across the globe. The WHO claims that already in 2016 more than 80% of cities had air pollution levels that exceed their guidelines. Furthermore, for those living in highly polluted settings, mortality rates from covid-19 have been much higher. In short, the battle against air pollution is far from over and poses a serious public and global health concern, especially for rapidly industrializing regions like West Africa, where most cities do not even monitor air quality. Although some claim that virus will dominate the agenda and will hamper progress related to climate change, others state that the pandemic has opened a window of opportunity for a greener future.

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Surely those who have followed covid-19 cases across different countries have seen how some nations have managed to keep the virus spread under control, while others have seen cases and deaths skyrocket at astounding rates. The keys to success or failure stories lie in two key global health-related terms: governance (or lack thereof) and disease surveillance. In countries like New Zealand, a combination of extremely strong, coherent leadership –translated into rapid and effective directives– and rigorous contact tracing have lead them to have one of the most successful covid-19 management strategies, now serving as a reference worldwide. Other nations, however, have faced great struggles that related to either their poor governance or their underperforming public healthcare systems – or both. The clearest example is the USA, where a fragmented public message and extremely inadequate governance have led to the country’s cases representing over a quarter of those on the entire globe. Other nations whose weak governance have directly affected their population’s difficulties in dealing with the pandemic include Brazil and Spain, the latter for which the Lancet published a public request for an independent review of the reasons behind their inability to better control the virus spread. The consequences of these nations’ insufficient leadership and surveillance capabilities are reflected in their numbers, with both countries in the top 10 countries with the highest number of confirmed covid-19 cases. It has therefore been proven how essential proper leadership and governance are when it comes to global health, especially during times of crisis.

This pandemic has also highlighted that difficulties in healthcare access disproportionately affect women. Gender inequality is an extremely relevant global health concern, and the spread of the virus has shown discrimination hotspots. Women are more likely to have lost a job during the pandemic, and women have taken on more unpaid care and have exposed themselves more to the virus because of the nature of the jobs they typically undertake. Even more concerning is the gender-based violence data that has arisen during the lockdown, shown in the spike in calls to report domestic violence across numerous Latin American countries during the months of strict lockdown. Once more, although these were concerns far before the covid-19 outbreak, the pandemic has served to highlight the severity of an issue some have unfortunately come to naturalize as a “normal” part of life.

So, what is global health anyway? This term embodies the topics mentioned above and many more: poverty and poverty-related diseases, the social determinants of health, the burden of non-communicable diseases, universal health coverage, the concept of OneHealth, the health of migrants and displaced populations… The fact that global health now has a global audience is positive, but let this serve not as a reason for celebration, but as a motivation for researchers, experts and advocates in the field to call attention to all global health matters, as well as to the interconnectedness of them all: this pandemic has highlighted, drawn attention to, and even worsened matters that global health professionals have been dealing with in the background for years. There is clearly still much, much work to be done. Hopefully, this tragic world event has opened the eyes of the public to the importance of protecting the environment, of reducing inequality, of strengthening public healthcare systems, and of strong leadership. Hopefully, we will now have more supporters to continue the global health fight, since it is now clear that it concerns us all.

Celia has a BSc in biomedical engineering from the Technical University of Madrid, as well as an MSc in Global Health from Maastricht University. She has work and education experience in the United States, Spain, Belgium, the Netherlands, Colombia, and more recently France, where she completed an internship in EHESP (Rennes) that led to the publication of an article on air pollution and health in West African countries. She currently works for a small NGO in Nantes (France) that promotes the reinsertion of low-resource youth.