Intro to Global Health

Demystifying Global Health

Definitions, Players, History and Current Day Realities

Outline Defining ‘global health’ The Big Players History and evolution of global health Current day reality

What is global health? Cross-disciplinary view Evolved from concern over infectious

disease control in industrialised world and in colonies

‘Social determinants’ approach

Social determinants of health

Social determinants of health Conditions in people grow, live, work

and age have powerful influence on health

Vast majority of inequalities in health are avoidable and, hence, inequitable

International Public Health

“the application of the principles of public health to health problems and challenges that transcend national boundaries and to the complex array of global and local forces that affect

them”

“Improving the health status of these populations requires an understanding

of their social, cultural and economic characteristics”

Merson, Black and Mill (2001)

What’s global about it? The determinants circumvent,

undermine or are oblivious to the territorial boundaries of states and, thus, beyond the capacity of individual countries to address through domestic institutions’ (Lee and Collins, 2005)

Three principal concerns:(1) The global distribution of health and

disease and their determinants;(2) The impact of globalisation on health(3) The changing nature of global health

governance(Kickbusch, 2002)

So what? Self-interest: Migration and

infectious disease; human ‘security’ Trade: Impact on economic growth Social justice: Moral concern for

fellow human beings“In a globalised world, we all swim in a single microbial sea”Gro Harlem Brundtland, 2001

The ‘Big Players’ Bretton Woods Institutions

World Bankaims to “reduce poverty and improve living standards by promoting sustainable growth an investment in people”

International Monetary Fund (IMF)Set up to ensure smooth running of the global economy

World Health Organisation/UN Philanthropic organisations World Trade Organisation NGOs

A short tour of global health1945United Nations

1948 World Health Organisation; UDHR

1978Declaration of Alma Ata

1970s+80sGlobal economic recession & ‘Structural adjustment

2000Millennium Declaration and MDGs

2000‘Drop the debt’ campaign

2001Global Fund

The United Nations Created 1945 Purpose was to maintain international

peace and security International economic and social

cooperation 50 nations signed Charter of the

United Nations


1948 World Health Organisation





2001Global Fund

World Health Organisation“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”

health as “complete physical, psychological, and social wellbeing” is achieved only at the point of

simultaneous orgasm, leaving most of us unhealthy diseased) most of the time.

The World Health Organisation International efforts to

monitor/combat infectious diseases Development and distribution of

vaccines, medicines and diagnostics Successes

Smallpox ?Polio Tobacco convention







2001Global Fund

Health for All by 2000

Alma Ata – Kazakhstan – September 1978

Declaration of Alma Ata: “Primary health care is essential

health care…made universally accessible…at a cost that the community and country can afford…”

Health for All by 2000 Components of primary health care:

Education Promotion of food and nutrition Water and sanitation Maternal and child care Family planning Immunisations Prevention, control and treatment of local and

common diseases Provision of essential drugs

Health for All by 2000 Involves related sectors:

Agriculture Animal husbandry Food Industry Education Housing Public works Communications

“Coordinated efforts of these sectors”

Selective vs Comprehensive Care ‘Counter-revolution’ World Bank challenges comprehensive

approach Costs of $5.4-9.3 billion by 2000 Proposed to fight against limited number of

diseases: Vaccinations Breast feeding Anti-malaria activities Oral rehydration

‘Selective Primary HealthCare’







2001Global Fund

Structural Adjustment Policies Oil crisis of 70s and 80s Global economic recession Period of crisis, increased poverty and

debt for developing countries World Bank, International Monetary

Fund and US imposed restrictive policies

Structural Adjustment Policies Cuts in public spending and

consumption Social services such as health and

education hit Privatisation and decentralisation Fee payments for health services







2001Global Fund

A declaration with a difference? Millennium Development Goals

#1 Eradicate extreme poverty and hunger

#2 Achieve universal primary education

#3 Promote gender equality and empower women

#4 Reduce child mortality

#5 Improve maternal health

#6 Combat HIV/AIDS, malaria and other diseases

#7 Ensure environmental sustainability

#8 Develop a global partnership for development







2001Global Fund

Pressure on governments to relieve debt$83 billion in debt cancellation

Spending on public services increased by 20%http://youtube.com/watch?v=gFfIIW_xQq4

http://youtube.com/watch?v=gFfIIW_xQq4









2001Global Fund

The Global Fund To fight AIDS, Tuberculosis and

Malaria Financing agency (>90% funds from

governments) Claims that by Jan 2007 had saved

1,146,000 lives (3,000 a day) BUT has it neglected other health

areas?

Current state of global health Aid vs Trade - $79 billion in 2004 “some thirty official donors in addition to

several dozen international NGOs…through over a thousand distinct projects and several hundred resident foreign experts”

Ongoing focus on disease-specific interventions (‘vertical approach)

Immense power imbalance

Final remarks Inequality and injustice widespread Principles of primary care still

neglected Global health affects us all “The greatest single challenge facing

our globalized world is to combat and eradicate its disparities”Nelson Mandela

Intro to Global Health

Documents

Transcript of Intro to Global Health