Overview of Global Health

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (1/09/2023)

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

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". It transcends geographical, national and cultural boundaries by targeting populations in all countries. The goal of global health is to protect the world's population from health threats while delivering cost-effective services. 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.

History of Global Health

As outlined by the Canadian Institutes of Health Research (CIHR)'s Framework for Action on Global Health Research, our terminology around global health has changed over time.

• 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. It was conceived as "Protection of colonial representatives from tropical diseases".
• 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.
• Finally, we currently have what is termed Global Health 3.0 where there is "Collective action to address shared risks and responsibilities".

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 Health – emergence, hegemonic trends and biomedical reductionism
• Dismantling and reimagining global health education

Defining Global Health

There has been extensive debate around a common definition for global health in recent years. Salm et al. attempted to create a common definition of global health based on a systematic review of the literature and identified the following themes:

• Global health can be considered "a multiplex approach to worldwide health improvement taught and pursued through research institutes"
  • It is a domain of research, healthcare and education
  • It is multifaceted ("disciplinary, sectoral, cultural, national")
• Global health can be considered an "ethical initiative that is guided by justice principles"
  • It has its roos in values like equity and social justice
• Global health can be considered "a form of governance that yields national, international, transnational and supranational influence through political decision-making, problem identification, the allocation and exchange of resources across borders"
  • It is a political field that includes power relations at multiple scales
  • It is determined by globalisation and international interdependence
  • Issues related to global health cross national borders
  • It is problem oriented
• Global health has many meanings with "historical antecendents and an emergent future"
  • It is "dis/similar" to public health, international health and tropical medicine
  • The definition for global health remains vague

Determinants of Health

As stated above, the goal of global health is to promote health, improve health equity and reduce health disparities. 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.

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. 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. 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:

• Racism, xenophobia, discrimination, and the determination of health
• Racism, xenophobia, and discrimination: mapping pathways to health outcomes
• Intersectional insights into racism and health: not just a question of identity
• Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems

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
  • 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
• 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
  • 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

Sustainable Development Goals

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

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. The intention of these goals is to provide sustainable development by 2030.

Resources

• The Role of Physiotherapists in Global Health
• Measuring Global Health