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== Defining Global Health ==
== Introduction ==
Global health is a broad term. Essentially, global health aims "to promote health and prevent and treat diseases for all people in all countries across the globe".<ref name=":0">Chen X, Li H, Lucero-Prisno DE, Abdullah AS, Huang J, Laurence C, Liang X, Ma Z, Mao Z, Ren R, Wu S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136700/ What is global health? Key concepts and clarification of misperceptions]. Global health research and policy. 2020 Dec;5(1):1-8.</ref> It transcends geographical, national and cultural boundaries by targeting populations in all countries.<ref name=":0" /> The goal of global health is to protect the world's population from health threats while delivering cost-effective services.<ref name=":2">De Cock KM, Simone PM, Davison V, Slutsker L. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739536/ The new global health]. Emerging Infectious Diseases. 2013 Aug;19(8):1192.</ref> Global health is focused on finding broad solutions, which may include partnerships, frameworks, policies, regulations and laws that can be implemented through government, communities and other methods.<ref name=":0" />
Global health is a broad term. Essentially, global health aims "to promote health and prevent and treat diseases for all people in all countries across the globe".<ref name=":0">Chen X, Li H, Lucero-Prisno DE, Abdullah AS, Huang J, Laurence C, Liang X, Ma Z, Mao Z, Ren R, Wu S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136700/ What is global health? Key concepts and clarification of misperceptions]. Global health research and policy. 2020 Dec;5(1):1-8.</ref> It transcends geographical, national and cultural boundaries by targeting populations in all countries.<ref name=":0" /> The goal of global health is to protect the world's population from health threats while delivering cost-effective services.<ref name=":2">De Cock KM, Simone PM, Davison V, Slutsker L. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739536/ The new global health]. Emerging Infectious Diseases. 2013 Aug;19(8):1192.</ref> Global health is focused on finding broad solutions, which may include partnerships, frameworks, policies, regulations and laws that can be implemented through government, communities and other methods.<ref name=":0" />


Distinguishing between global health, international health and public health can be difficult. The following points highlight the key differences between these three areas of health:
== History of Global Health ==
Our terminology around global health has shifted with time, from initially being focused on "tropical medicine" to "international health" and now "global health". Global health is seen as the health of an interdependent global population, while international health was a more narrow view of health problems in the world’s poorest countries.<ref>Gichane MW, Wallace DD. [https://pubmed.ncbi.nlm.nih.gov/36285634/ Dismantling and reimagining global health education.] Global Health Action. 2022 Dec 31;15(1):2131967.</ref><ref>Holst J. [https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00573-4 Global Health–emergence, hegemonic trends and biomedical reductionism]. Globalization and health. 2020 Dec;16(1):1-1.</ref>


# '''Global Health''':<ref name=":1">Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, et al. Towards a common definition of global health. Lancet. 2009 Jun 6;373(9679):1993-5. </ref>
These shifting concepts are outlined by the Canadian Institutes of Health Research (CIHR)'s Framework for Action on Global Health Research.<ref name=":1">Canadian Institutes of Health Research, Instituts de Recherche en Santé du Canada. Global Health 3.0. 2021-2026. Framework for Action on Global Health Research. 2021. Available from: https://cihr-irsc.gc.ca/e/52503.html [Accessed 1 September 2023]. </ref>
#* issues that transcend national boundaries
 
#* focus on prevention and clinical care and
* Initially, we had what could be termed '''Global Health 1.0''' or "tropical medicine". This area of health was very much connected with the legacy of colonialism and imperialism.<ref name=":6">Lai D. Global Health for Rehabilitation Professionals Course. Plus, 2023.</ref> It was conceived as "Protection of colonial representatives from tropical diseases".<ref name=":1" />
#** health equity among nations
* Over time, this concept morphed and changed into what has been termed '''Global Health 2.0'''. In this model, the focus was on wealthier countries helping those with less.<ref name=":1" /> It relates to the concept of "international health", which was very much concerned about the physical boundaries limited by the physical presence of diseases when they cross borders.<ref name=":6" />
#* highly interdisciplinary and multidisciplinary
* Finally, we currently have what is termed '''Global Health 3.0''' where there is "Collective action to address shared risks and responsibilities".<ref name=":6" />
#* global cooperation
 
# '''International Health:'''<ref name=":1" />
To read more about the framework outlined by the CIHR, please see: [https://cihr-irsc.gc.ca/e/52503.html Global Health 3.0. CIHR's Framework for Action on Global Health Research 2021-2026].
#* issues outside of one's own country
 
#* focus on prevention and clinical care
To find out more about the history of global health in general, please read:
#* helps other nations
 
#* embraces a few disciplines
* [https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00573-4 Global Health – emergence, hegemonic trends and biomedical reductionism]
#* bi-national cooperation
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9621231/ Dismantling and reimagining global health education]
# '''Public Health''':<ref name=":1" />
#* focus on specific communities or countries
#* prevention driven
#* health equity within a nation or community
#* multidisciplinary, particularly with health and social science
#* national cooperation
<nowiki>**</nowiki> The terminology has shifted from international health to global health. Global health is seen as the health of an interdependent global population, while international health was a more narrow view of health problems in the world’s poorest countries.<ref>Gichane MW, Wallace DD. [https://pubmed.ncbi.nlm.nih.gov/36285634/ Dismantling and reimagining global health education.] Global Health Action. 2022 Dec 31;15(1):2131967.</ref><ref>Holst J. [https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00573-4 Global Health–emergence, hegemonic trends and biomedical reductionism]. Globalization and health. 2020 Dec;16(1):1-1.</ref>


== Global Impact and Solutions ==
== Global Impact and Solutions ==
Line 67: Line 61:


== Determinants of Health ==
== Determinants of Health ==
As stated above, the goal of global health is to promote health, improve health equity and reduce health disparities.<ref name=":0" /> However, achieving these goals is difficult as many interconnected factors impact health and health outcomes. These factors are referred to as determinants of health and can be categorised into the following groups:
As stated above, the goal of global health is to promote health, improve health equity and reduce health disparities.<ref name=":0" /> However, achieving these goals is difficult as many interconnected factors impact health and health outcomes. These factors are referred to as determinants of health. Examples of determinants of health can include genetics, behaviour, environment and physical influences, medical care, social and structural determinants. 
 
'''Social determinants of health (SDH)''' are the circumstances in which we are born, develop, live, earn, and age. SDH include economic conditions, housing, nutrition, the environment, transportation, and education.<ref>World Health Organization. Social Determinants of Health. Available from: https://www.who.int/health-topics/social-determinants-of-health (last accessed 1 September 2023).</ref> <blockquote>WHO defines social determinants of health as “complex, integrated, and overlapping social structures and economic systems that include the social environment, physical environment, and health services; structural and societal factors that are responsible for most health inequities. Social determinants of health are shaped by the distribution of money, power and resources at global, national, and local levels, which are themselves influenced by policy choices."</blockquote>
[[File:WHO-framework-of-social-determinants-of-health.jpg|thumb|500x500px|Figure 1. Solar O, Irwin A, Figure A. Final form of the CSDH Framework. From: World Health Organization. A Conceptual Framework for Action on the Social Determinants of Health. Social Determinants of Health Discussion Paper 2 (Policies and Practice). 2010, p.6. ]]
'''Structural determinants''' are upstream root causal factors that influence downstream determinants and health conditions. Examples include, but are not limited to, power, education, economic system, land policies and social positions.<ref name=":6" /> The WHO Conceptual Framework illustrates the relationship between structural and intermediary determinants of health and their impact on health equity (image 1).
 
Given the ongoing health pandemic, recent social movement and the increasing discussion on diversity, equity and inclusion initiatives across all sectors, it is important to understand how racism, xenophobia and discrimination are structural determinants of health.<ref name=":6" /> The Lancet recently published a series of papers illustrating how these determinants intersect with systems of power, such as politics, education, scientific knowledge production, that continue to impact health equity across minority groups. It is important as rehabilitation professionals to recognise and examine how these social constructs influence many levels of our healthcare system, spanning leadership research, biases and patient contact.
 
See these articles here:


# genetics
* [https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(22)01972-9.pdf Racism, xenophobia, discrimination, and the determination of health]
# behaviour
* [https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(22)02484-9.pdf Racism, xenophobia, and discrimination: mapping pathways to health outcomes]
# environment and physical influences
* [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02304-2/fulltext Intersectional insights into racism and health: not just a question of identity]
# medical care
* [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01989-4/fulltext Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems]
# social
Social determinants of health (SDH) are the circumstances in which humans are born, develop, live, earn, and age. SDH include economic conditions, housing, nutrition, the environment, transportation, and education. According to the World Health Organization's Commission on Social Determinants of Health, focusing on SDH is "the most successful means of enhancing all people’s well-being and raising disparities".<ref>Chelak K, Chakole S. [https://www.cureus.com/articles/119651-the-role-of-social-determinants-of-health-in-promoting-health-equality-a-narrative-review#!/ The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review.] Cureus. 2023 Jan 5;15(1).</ref>


All determinants of health can have a positive or negative impact on health outcomes:
All determinants of health can have a positive or negative impact on health outcomes:

Revision as of 03:26, 1 September 2023

Original Editor - Robin Tacchetti based on the course by Derek Lai
Top Contributors - Jess Bell, Robin Tacchetti and Kim Jackson


Introduction[edit | edit source]

Global health is a broad term. Essentially, global health aims "to promote health and prevent and treat diseases for all people in all countries across the globe".[1] It transcends geographical, national and cultural boundaries by targeting populations in all countries.[1] The goal of global health is to protect the world's population from health threats while delivering cost-effective services.[2] Global health is focused on finding broad solutions, which may include partnerships, frameworks, policies, regulations and laws that can be implemented through government, communities and other methods.[1]

History of Global Health[edit | edit source]

Our terminology around global health has shifted with time, from initially being focused on "tropical medicine" to "international health" and now "global health". Global health is seen as the health of an interdependent global population, while international health was a more narrow view of health problems in the world’s poorest countries.[3][4]

These shifting concepts are outlined by the Canadian Institutes of Health Research (CIHR)'s Framework for Action on Global Health Research.[5]

  • Initially, we had what could be termed Global Health 1.0 or "tropical medicine". This area of health was very much connected with the legacy of colonialism and imperialism.[6] It was conceived as "Protection of colonial representatives from tropical diseases".[5]
  • Over time, this concept morphed and changed into what has been termed Global Health 2.0. In this model, the focus was on wealthier countries helping those with less.[5] It relates to the concept of "international health", which was very much concerned about the physical boundaries limited by the physical presence of diseases when they cross borders.[6]
  • Finally, we currently have what is termed Global Health 3.0 where there is "Collective action to address shared risks and responsibilities".[6]

To read more about the framework outlined by the CIHR, please see: Global Health 3.0. CIHR's Framework for Action on Global Health Research 2021-2026.

To find out more about the history of global health in general, please read:

Global Impact and Solutions[edit | edit source]

Global health issues have a global impact, and the goal is to find a global solution.

More health issues are having a global impact because of economic growth, rapid and unevenly paced globalisation and technological development. Some examples of global health issues include health disparities, internet abuse, increased sedentary lifestyle, lack of physical activity, substance abuse, obesity, depression and mental health issues.[1] Global solutions to these issues tend to be policies, frameworks, laws and regulations rather than medical interventions or procedures.[1]

According to the Institute for Health Metrics and Evaluation,[7] the top current issues within global health are:

  1. Long COVID
  2. Mental health
  3. Impact of climate change
  4. Cardiovascular disease
  5. Lower respiratory infection
  6. Role of poverty in health
  7. Health systems strengthening
  8. Diabetes
  9. Road injuries
  10. Dementia
  11. Population ageing[7]

Low-Resource Countries or Settings[edit | edit source]

Global health tends to focus on low-resource settings. Research shows that socioeconomic position is related to health outcome - "the lower the socioeconomic position, the worse the health."[8] Low-resource countries are constantly battling with malnutrition, access to health care services, and a lack of clean water and sanitation. In addition, these countries might be affected by war or conflict.

The following statistics provide perspective on these issues:

  • over 2 billion people lack access to clean water
  • over 4.2 billion people lack access to safely managed sanitary services
  • over 3 billion people lack basic handwashing facilities[9]
  • half the world's population lacks access to essential healthcare services[10]
  • approximately 800 million people are affected by hunger[11]
  • noncommunicable diseases (NCDs) are on the rise in developing countries
    • 80% of all NCDs deaths are in low-and middle-income countries[12]
    • The most common NCDs are:
      1. cardiovascular disease (17.9 million deaths annually)
      2. cancers (9.3 million deaths annually)
      3. chronic respiratory disease (4.1 million deaths annually)
      4. diabetes (2.0 million deaths annually)[13]

Determinants of Health[edit | edit source]

As stated above, the goal of global health is to promote health, improve health equity and reduce health disparities.[1] However, achieving these goals is difficult as many interconnected factors impact health and health outcomes. These factors are referred to as determinants of health. Examples of determinants of health can include genetics, behaviour, environment and physical influences, medical care, social and structural determinants.

Social determinants of health (SDH) are the circumstances in which we are born, develop, live, earn, and age. SDH include economic conditions, housing, nutrition, the environment, transportation, and education.[14]

WHO defines social determinants of health as “complex, integrated, and overlapping social structures and economic systems that include the social environment, physical environment, and health services; structural and societal factors that are responsible for most health inequities. Social determinants of health are shaped by the distribution of money, power and resources at global, national, and local levels, which are themselves influenced by policy choices."

Figure 1. Solar O, Irwin A, Figure A. Final form of the CSDH Framework. From: World Health Organization. A Conceptual Framework for Action on the Social Determinants of Health. Social Determinants of Health Discussion Paper 2 (Policies and Practice). 2010, p.6.

Structural determinants are upstream root causal factors that influence downstream determinants and health conditions. Examples include, but are not limited to, power, education, economic system, land policies and social positions.[6] The WHO Conceptual Framework illustrates the relationship between structural and intermediary determinants of health and their impact on health equity (image 1).

Given the ongoing health pandemic, recent social movement and the increasing discussion on diversity, equity and inclusion initiatives across all sectors, it is important to understand how racism, xenophobia and discrimination are structural determinants of health.[6] The Lancet recently published a series of papers illustrating how these determinants intersect with systems of power, such as politics, education, scientific knowledge production, that continue to impact health equity across minority groups. It is important as rehabilitation professionals to recognise and examine how these social constructs influence many levels of our healthcare system, spanning leadership research, biases and patient contact.

See these articles here:

All determinants of health can have a positive or negative impact on health outcomes:

  • Income and social status:
    • higher social status and high income is associated with better health[15]
    • the larger the gap between the wealthiest and poorest people, the greater the differences in health
  • Education:
    • lower education levels are correlated with poorer health, less self-confidence and more stress[16]
  • Physical environment:
    • safe water / houses / communities / roads all contribute to good health
    • clean air, healthy workplaces, and employment are associated with healthier outcomes
  • Social support networks:
    • having more support from families, friends and communities is associated with better health[16]
    • customs, beliefs and traditions affect health
  • Genetics:
    • can impact the chance an individual will develop certain conditions
  • Personal behaviour:
    • healthy eating, staying active, smoking and drinking all affect health
  • Health services:
    • access to / using services that prevent and treat disease influences health
  • Gender:
    • diseases affect men and women differently and at different stages of life[17]

Sustainable Development Goals[edit | edit source]

In 2015, all United Nations Member States adopted the Sustainable Development Goals (SDGs) to address global challenges, including improving health and education, reducing inequality and spurring economic growth. The 17 interconnected goals are listed below:

  1. No poverty
  2. Zero hunger
  3. Good health and well-being
  4. Quality education
  5. Gender equality
  6. Clean water and sanitation
  7. Affordable and clean energy
  8. Decent work and economic growth
  9. Industry, innovation and infrastructure
  10. Reduced inequalities
  11. Sustainable cities and communities
  12. Responsible consumption and prevention
  13. Climate action
  14. Life below water
  15. Life on land
  16. Peace, justice and strong institutions
  17. Partnerships for the goals[18]

As these goals are interrelated, achieving SDG 3 is only possible if other goals advance (i.e. efforts to end poverty (SDG 1), zero hunger (SDG 2), quality education (SDG 4) and clean water and sanitation (SDG 6)).

Health inequalities remain uneven, and the rate of reducing avoidable gaps is slower than anticipated. This decreased pace may be a result of:

  • environmental pollution
  • climate change
  • antimicrobial resistance
  • inequities in living conditions
  • economic disparities
  • lack of political will
  • institutional capabilities.

SDG 3 provides opportunities for stakeholders to promote health, strengthen disease prevention and increase overall planetary health.[19] The intention of these goals is to provide sustainable development by 2030.[20]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Chen X, Li H, Lucero-Prisno DE, Abdullah AS, Huang J, Laurence C, Liang X, Ma Z, Mao Z, Ren R, Wu S. What is global health? Key concepts and clarification of misperceptions. Global health research and policy. 2020 Dec;5(1):1-8.
  2. ↑ De Cock KM, Simone PM, Davison V, Slutsker L. The new global health. Emerging Infectious Diseases. 2013 Aug;19(8):1192.
  3. ↑ Gichane MW, Wallace DD. Dismantling and reimagining global health education. Global Health Action. 2022 Dec 31;15(1):2131967.
  4. ↑ Holst J. Global Health–emergence, hegemonic trends and biomedical reductionism. Globalization and health. 2020 Dec;16(1):1-1.
  5. ↑ 5.0 5.1 5.2 Canadian Institutes of Health Research, Instituts de Recherche en Santé du Canada. Global Health 3.0. 2021-2026. Framework for Action on Global Health Research. 2021. Available from: https://cihr-irsc.gc.ca/e/52503.html [Accessed 1 September 2023].
  6. ↑ 6.0 6.1 6.2 6.3 6.4 Lai D. Global Health for Rehabilitation Professionals Course. Plus, 2023.
  7. ↑ 7.0 7.1 The Institute for Health Metrics and Evaluation: 11 global health issues to watch in 2023, according to IHME experts. 2022. Available from: https://www.healthdata.org/news-events/insights-blog/acting-data/11-global-health-issues-watch-2023-according-ihme-experts
  8. ↑ World Health Organization. Social Determinants of Health. Available from: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
  9. ↑ World Health Organization. Available from: https://www.who.int/news/item/18-06-2019-1-in-3-people-globally-do-not-have-access-to-safe-drinking-water-unicef-who
  10. ↑ World Health Organization. 2017. Available from: https://www.who.int/news/item/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses
  11. ↑ World Health Organization. 2022. Available from: https://www.who.int/news/item/06-07-2022-un-report--global-hunger-numbers-rose-to-as-many-as-828-million-in-2021
  12. ↑ Ndubuisi NE. Noncommunicable diseases prevention in low-and middle-income countries: an overview of health in all policies (HiAP). INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2021 Aug;58:0046958020927885.
  13. ↑ World Health Organization. Noncommunicable diseases. 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.
  14. ↑ World Health Organization. Social Determinants of Health. Available from: https://www.who.int/health-topics/social-determinants-of-health (last accessed 1 September 2023).
  15. ↑ Kontodimopoulos N. The association between social development and population health: a cross-sectional study across countries of different economic growth. Research in Health Services & Regions. 2022 Jun 22;1(1):2.
  16. ↑ 16.0 16.1 Gumà J, Solé-Auró A, Arpino B. Examining social determinants of health: the role of education, household arrangements and country groups by gender. BMC public health. 2019 Dec;19:1-9.
  17. ↑ World Health Organization. Determinants of Health. 2017. Available from: https://www.who.int/news-room/questions-and-answers/item/determinants-of-health#:~:text=Income%20and%20social%20status%20%2D%20higher,stress%20and%20lower%20self%2Dconfidence.
  18. ↑ United Nations. Sustainable Development Goals. Available from: https://sdgs.un.org/goals
  19. ↑ Menne B, Aragon de Leon E, Bekker M, Mirzikashvili N, Morton S, Shriwise A, Tomson G, Vracko P, Wippel C. Health and well-being for all: an approach to accelerating progress to achieve the Sustainable Development Goals (SDGs) in countries in the WHO European Region. European journal of public health. 2020 Mar 1;30(Supplement_1):i3-9.
  20. ↑ Sianes A, Vega-Muñoz A, Tirado-Valencia P, Ariza-Montes A. Impact of the Sustainable Development Goals on the academic research agenda. A scientometric analysis. PLoS One. 2022 Mar 17;17(3):e0265409.
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