Towards a common definition of global health by A022oSp

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									    Towards a common definition of
            global health
Koplan, J. P., Bond, T. C., Merson, M. H., Reddy, K. S.,
 Rodriguez, M. H., Sewankambo, N. K., & Wasserheit,
 J. N. (2009). Towards a common definition of global
 health. The Lancet, 373(9679), 1993-1995.
 doi:10.1016/S0140-6736(09)60332-9
   Contributors
The Consortium of Universities for Global Health
  (CUGH) Executive Board developed the definition and
  reviewed and edited the manuscript


                                             (Kolpan et al., 2009)
         What is Global Health?
   An area for study, research, and practice
      Improving health and achieving equity in
     health for all people worldwide.
   Emphasizes transnational health issues,
determinants, and solutions
   Involves many disciplines within and beyond
the health sciences and promotes interdisciplinary
collaboration
   A synthesis of population-based prevention
with individual-level clinical care.

                                       (Kolpan et al., 2009)
                Global Health

Can be thought of as
     A notion (the current state of global health)
   An objective (a world of healthy people, a

    condition of global health)
   A mix of scholarship, research, and practice

    (with many questions, issues, skills, and
    competencies)



                                         (Kolpan et al., 2009)
           What is Public Health?
The science and art of
   Preventing disease

   Prolonging life

   Promoting physical health and efficacy

Through organized community efforts for
   Sanitation of the environment

   Control of communicable infections

   Education of the individual in personal hygiene

   Organization of medical and nursing services

   Development of social machinery




                                             (Kolpan et al., 2009)
                  Public Health
 Emerged in the mid 19th century
 The discipline on the basis of four factors:

(1) decision making based on data and evidence (vital
statistics, surveillance and outbreak investigations,
laboratory science)
(2) a focus on populations rather than individuals
(3) a goal of social justice and equity
(4) an emphasis on prevention rather than curative care.
All these elements are embedded in most definitions of
public health.


                                             (Kolpan et al., 2009)
       What is International Health?
   Defined by Merson, Black, and Mills as
“the application of the principles of public health to
problems and challenges that affect low and middle-
income countries and to the complex array of global and
local forces that influence them”.
It was the term used for health work abroad, with
a geographic focus on developing countries and
often with a content of infectious and tropical
diseases, water and sanitation, malnutrition, and
maternal and child health.

                                            (Kolpan et al., 2009)
        Comparison: Global Health
Geographical reach           Focuses on issues that directly or
                             indirectly affect health but that can
                             transcend national boundaries

Level of cooperation         Development and implementation of
                             solutions often requires global
                             cooperation

Individuals or populations   Embraces both prevention in
                             populations and clinical care of
                             individuals

Access to health             Health equity among nations and for
                             all people is a major objective


Range of disciplines         Highly interdisciplinary and
                             multidisciplinary within and beyond
                             health sciences

                                                     (Kolpan et al., 2009)
  Comparison: International Health
Geographical reach           Focuses on health issues of countries
                             other than one’s own, especially those
                             of low-income and middle-income

Level of cooperation         Development and implementation of
                             solutions usually requires binational
                             cooperation

Individuals or populations   Embraces both prevention in
                             populations and clinical care of
                             individuals

Access to health             Seeks to help people of other nations



Range of disciplines         Embraces a few disciplines but has not
                             emphasized multidisciplinary


                                                    (Kolpan et al., 2009)
        Comparison: Public Health
Geographical reach           Focuses on issues that affect the
                             health of the population of a particular
                             community or country

Level of cooperation         Development and implementation of
                             solutions does not usually require
                             global cooperation

Individuals or populations   Mainly focused on prevention
                             programmes for populations


Access to health             Health equity within a nation or
                             community is a major objective


Range of disciplines         Encourages multidisciplinary
                             approaches, particularly within health
                             sciences and with social sciences

                                                    (Kolpan et al., 2009)
    How does global health relate to
           globalization?
•   The spread of health risks and diseases
    across the world often linked with trade or
    attempted conquest.
•    The rapid increase in speed of travel and
    communication, as well as the economic
    interdependency of all nations has led to a
    new level and speed of global
    interconnectedness or globalisation.
•   Global health uses the resources, knowledge,
    and experience of diverse societies to address
                                         (Kolpan et al., 2009)
    The health impacts of globalisation:
         a conceptual framework
Huynen, M. MTE., Martens, P., & Hilderink, H. BM.
   (2005). The health impacts of globalization: a
   conceptual framework. Globalization and Health,
   1(14). doi:10.1186/1744-8603-1-14
•     Describes a conceptual framework for the effects of
      globalisation on population health.
       –   Serving as 'think-model'
       –   Providing a basis for the development of future
           scenarios on health

                                               (Huynen et al., 2005)
       The presented framework
1) Defining the concept of population health and
  identifying its main determinants
2) Defining the concept of globalisation and
  identifying its main features
3) Constructing the conceptual model for
  globalisation and population health




                                        (Huynen et al., 2005)
               Population health
•    Human health is increasingly perceived as
    the integrated outcome of
     –   Ecological
     –   Social-cultural
     –   Economic
     –   Institutional determinants.




                                       (Huynen et al., 2005)
          What is Globalisation?
•   An extremely complex phenomenon
•   It is the interactive co-evolution of multiple
    technological, cultural, economic, institutional,
    social and environmental trends at all
    conceivable spatiotemporal scales.
•   Important features of the globalisation
    process:
     –   Global governance structures
     –   Global markets
     –                                      of
         Global communication and diffusion(Huynen et al., 2005)
Multi-nature and multi-level framework for population health
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                                                                                                                                              (Huynen et al., 2005)
    Rethinking global health research:
      towards integrative expertise
MacLachlan, M. (2009). Rethinking global health
   research: towards integrative expertise. Globalization
   and Health, 5(6). doi:10.1186/1744-8603-5-6
•    The Bamako Call for Action on Research for Health
•    The ministerial conference theme of "Strengthening
     Research for Health, Development and Equity"
•    The agenda being to change the way in which health
     research is undertaken


                                            (MacLachlan, 2009)
    Nature of research and innovation
         for health improvement
•    Not sufficiently inter-disciplinary and inter-
     sectoral, especially in the context of the United
     Nations Millennium Development Goals
•    Need to mobilize all relevant sectors (public,
     private, civil society) to work together in
     effective and equitable partnerships to find
     needed solutions
•    Need to rethink our approach
      –   To research in global and public health
      –   To complement narrow research specialization
                                          (MacLachlan, 2009)
     To enhance the likelihood of
         research utilization
•   What
    –   Content
•   Where
    –   Context
•   How
    –   Process




                             (MacLachlan, 2009)
Example: The challenges presented
          by HIV/AIDS
•   What: Content knowledge
     –   An appreciation of critical issues ranging across
         immunology, stigma and adherence to
         medication, and the different approaches to
         researching these
•   Where: Context knowledge
     –   Require understanding how HIV/AIDS is
         patterned across society, its social
         epidemiology, especially with regard to gender,
         disability, age, place, and socioeconomic status
                                             (MacLachlan, 2009)
    Global Health is a 'composite' field

•    Comprised of
      –   Biological
      –   Clinical
      –   Social health sciences
      –   Other disciplines such as engineering or
          political science




                                             (MacLachlan, 2009)
                 Conclusion
•   Need a reconfiguring of knowledge, not simply
    a diminution or expansion of it.
•   Need to know more about how things fit
    together and can be put to good use.
•   Cannot simply hope for broad-minded health
    researchers to spontaneously spring forth.
•   Research training at postgraduate level should
    stress the value of integrative expertise as
    well as recognizing depth expertise.

                                       (MacLachlan, 2009)
                 References
•   Huynen, M. MTE., Martens, P., & Hilderink, H.
    BM. (2005). The health impacts of
    globalization: a conceptual framework.
    Globalization and Health, 1(14).
    doi:10.1186/1744-8603-1-14
•   MacLachlan, M. (2009). Rethinking global
    health research: towards integrative expertise.
    Globalization and Health, 5(6).
    doi:10.1186/1744-8603-5-6
•   Koplan, J. P., Bond, T. C., Merson, M. H.,
The White Man's Burden
           •   Almost 3 billion
               people live on less
               than two dollars a
               day
           •   804 million people in
               the world don't have
               enough to eat
           •   10 million children
               die every year from
               easily preventable
               diseases
How Rich Countries Got Rich and
 Why Poor Countries Stay Poor
                   The gap between the rich
                    and the poor on this planet
                    is larger then ever before
                    and still growing
                   Even after three
                    “Development Decades”
                    that began in 1970 and
                    trillions of dollars of
                    development assistance,
                    the situation is still dismal
                    and getting worse.
                   Since 1970, the gap
                    between the richest and
                    the poorest nations has
                    only increases.

								
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