Global Health

• Health problems, issues, and concerns that transcend national boundaries, which may be influenced by circumstances or experiences in other countries, and which are best addressed by cooperative actions and solution.
• It is the health of populations in the worldwide context
• Area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide
• Not to be confused with international health (the branch of public health focusing on developing nations and foreign aid efforts by industrialized countries)
• Examples
• Include infectious diseases: COVID, SARS, HIV, TB, avian influenza, malaria, Ebola
• Non infectious diseases: cardiovascular diseases, hypertension, DM, cancers, mental health, maternal health, child health.
• Major health risks: global warming, conflict, nuclear power, sedentary lifestyle, tobacco smoking, drug use, alcohol intake, salt intake, trans-fat

The main consideration to all these is “INEQUALITIES”

‘Everyone has the right to a standard of living adequate for the health and wellbeing of himself and his family, including food, clothing, housing and medical care.’

— Universal Declaration of Human Rights, 1948

The idea that health is a human right was articulated in the United Nation’s Universal Declaration of Human Rights, created over 50 years ago at the inception of the organization.

Read the quote. Notice how the wording reads, “standard of living adequate for health”: as you read through this note, I want you to remember this phrase and ask yourself what kind of standard of living much of the world is experiencing?

The Point of this Venn diagram is to demonstrate that the right to health is dependent upon the realization of other human rights, including economic and other sociopolitical rights! For example, one cannot protect themselves from sexually transmitted disease unless the right to education and information about their transmission is disseminated.

Thus in order to understand why the right to health in much of the world remains unfulfilled, we need to take a look at the economic and social inequities which cause people to suffer from abysmal living conditions.

• According to the Human Development Report, 2003 published by the UNDP “More than 1.2 billion persons survive on less than a dollar a day” which is the definition of extreme poverty. That’s roughly 1 in 5 people on the earth!
• The “dollar a day” definition is based on purchasing power parity, meaning that it’s a dollar in U.S. terms. For example, if a person from Cambodia came to the US right now, the wage they earn in Cambodia would translate into one dollar every day here in the United States. Just think of how much (or rather, how little) you can buy trying to survive on one dollar a day in today’s society?
• Notice that South Asia has the highest percentage of their population living on less than a dollar a day, with 43%; Sub-Saharan Africa comes in an unenviable close second with 24.3% of its population living on less than a dollar a day.
• Can you guess how much of the planet is trying to make it on less than $2 a day? Half the world, about 3 billion people live on less than 2 dollars a day.

• Yellow depicts regions of the world where there is a high prevalence and high depth of undernourishment.
• Olive green depicts regions where there is a high prevalence yet lower depth of undernourishment.
• Notice, that this map could be the map for the prevalence of TB, malaria, HIV/AIDS or poverty.
• It’s the same map, because it’s the same cycle of poverty, and poor health which helps keep these people hungry and susceptible to infectious diseases.

• 10/90 Rule
• Less than 10% of the world’s research budget is spent on conditions that account for 90% of the world’s diseases!
• 90% of all research dollars are spent on merely10% of the global burden of diseases.

• AIDS Kills 3 million a year
• TB kills 2 million a year
• Malaria kills 1 million a year

“Tuberculosis was, in that time, known as consumption, from the Latin, consumere, meaning to waste away.”

Despite the fact that effective cheap treatment for TB exists, over 2 million people die of this disease every year.

How effective and cheap is the therapy for TB? Directly Observed Therapy Short-Course (DOTS), which is 95% effective in curing TB, cost as little as US $10 for a 6-month course of treatment

This bar graph illustrates the percentage of total deaths on the y axis.

As you can see communicable disease, (a.k.a. infectious diseases) that are readily curable or treatable conditions in the rich world are still a death sentence for many, causing 70% of deaths in the poorest 20% of the globe.

Just remember 3-2-1-

• AIDS Kills 3 million a year
• TB as we said, still kills 2 million individuals every year!
• Malaria kills 1 million a year

• The predominant agency associated with global health (and international health) is the World Health Organization (WHO).
• Other important agencies impacting global health include UNICEF and World Food Program
• Others are multinational (Bill and Melinda Gates) bilateral (USAID, UKAID, DFID)
• The United Nations system has also played a part with cross-sectoral actions to address global health and its underlying socioeconomic determinant with the declaration of the Millennium Development Goals and the more recent Sustainable Development Goals

• The health of people everywhere must be a growing concern for all
• Diseases do not respect boundaries. HIV–spread worldwide. A person with tuberculosis can infect 15 people a year, wherever they are.
• There is an ethical dimension to the health and well-being of other people. Many children in poor countries get sick and die needlessly from malnutrition or from diseases that are preventable and curable.
• Many adults in poor countries die because they lack access to medicine that are customarily available to people in rich countries. Is this Just? Are we prepared to accept such deaths without taking steps to prevent them?
• Health is closely linked with economic and social development in an increasingly interdependent world.
• The health and well-being of people everywhere have important implications for global security and freedom.

• Small pox eradication 1979
• Vitamin A supplementation in Nepal prevents 200,000 child deaths
• Polio eliminated from western hemisphere 1991
• Reduction of infant death due to diarrhea by 82% from 1982 to 1987 in Egypt
• Dramatic reduction in Guinea Worm –reduced by 99% in 20 countries
• Fertility reduction in Bangladesh from 7 to 3 children per woman
• Overall improvements in IMR 126 to 56/1000, CMR 197 to 82/1000, from 1960 to 2002.
• Under 5 child mortality decreased by 60% from 1990 thru 2010 Between 1990 and 2010, life expectancy increased by years for men and women
• Burden due to HIV and Malaria is falling Announce that Levine is coming to visit.
• Ebola in Congo
• COVID worldwide

• Adopted by the United Nations member nations in 2000 and aim to significantly reduce global poverty by 2015
• Health considerations were major components
• Evaluation strategy
• 8 goals
• 18 targets
• 48 indicators
• Different UN agencies (e.g., World Bank, WHO, UNICEF) were in charge of evaluating different indicators

MDG Uses and Successes

Importance

• Shape direction of development and investment
• Development agencies use MDGs to evaluate activities

Successes

• Encourage global political consensus
• Provide focus for advocacy
• Improve flow of aid
• Improve monitoring of development projects

MDG Challenges

• May not be an adequate prioritization of development needs
• Use targets that are easier to monitor
• Goals may be too specific – considerable gaps in coverage of developmental ideals
• Lack of synergy in implementation (e.g. among education, health, poverty, and gender)
• Lack of ownership of some goals by international agencies
• May encourage focus on easiest to reach groups