Global Health is now widely recognized as an important issue of our time. Global health is particularly important in the delivery of health services in developing countries as international public, private and philanthropic support continues to evolve and the role of host nations become better defined. In post conflict countries such as Liberia, Sierra Leone and Rwanda, global health programs represent significant outlays in the healthcare delivery system. All G-8 nations have global health programs. The G-20 nations address global health issues in their meetings. The Gates Foundation and other philanthropic organizations have committed billions of dollars to global health. Thousands of professional organizations and civil society entities are actively engaged in global health. In this article, I briefly define global health, review emerging trends in global health in the 21st Century and discuss enduring problems.  In particular, I discuss the significant role of global health in developing countries.

What is Global Health?

Experts struggle to define global health. For this article, I will focus on three broad definitions. The US Institute of Medicine (IOM) defines global health as health problems, issues and threats that transcend national boundaries and can be best addressed by cooperative action. The IOM in 2008 further added that global health represents a widely held goal of improving the health status of individuals and their families worldwide. The European Foundation Center defines global health as issues that transcend national boundaries, requiring a deliberate set of actions and new governance structures at national and international levels to improve the health of defined populations. 

For the minister of health, permanent secretary or district medical officer in Africa and other regions of the world with large numbers of poor nations, global health may simply represent support by external donor agencies and organizations, including the bilateral agencies of rich nations, technical assistance and funding from multilateral agencies such as the World Health Organization (WHO), the World Bank and UNICEF or support from external philanthropic organizations.

Is there a difference between global health and international health? Again, the difference is not so clear cut. A recent edition of the Journal of Public Health Policy concluded that international health is widely believed to represent health across national borders and regions focused heavily on the relationships between governments.  The WHO is widely regarded as the premier force in international health with its extensive relationships with governments worldwide. The Africa regional office of the WHO and similar offices in other regions with low income countries are also influential. International health also includes specific roles for non governmental organizations. 

The definition of global health has several implications. Global health is “borderless health” requiring cooperation between nations, continents and institutions. There are donors and recipients in global health with the inevitable inequalities in the relationship, including concerns about sovereignty by recipient nations and the focus on accountability by donor nations and agencies. 

Voluntary action is critical in global health, since in theory, external donors and host nations need to agree on how to increase the efficiency and effectiveness of supported programs.  In reality, poor nations may come under heavy pressure to accept donor assistance. The donor assistance may or may not address pressing national health priorities.

Civil society organizations in both donor and host countries have become important stakeholders in global health, keeping governments in rich and poor nations on their toes and accountable. However, in Africa the role of civil society organizations on global health issues is still evolving as these organizations build up relevant technical expertise and organizational reach.

What are Traditional Global Health Issues?

The prevention, identification and treatment of infectious diseases remain the traditional concerns of global health. Preventing, identifying, treating and rehabilitating non infectious health problems are also important. Deliberate actions to scale up the technical expertise of national health agencies, regional health organizations and multilateral agencies are important issues. Timely access to ‘global public health goods’ in such a way that no one is excluded, irrespective of cost or logistical difficulties is another traditional concern. Global efforts against polio, tuberculosis and childhood preventable diseases and recent global attempts to increase access to HINI influenza vaccine are examples of global public health goods.

Global health, however, continues to evolve, as nations and institutions work closely together, across national and continental boundaries, to address global health challenges. Global health has become a big tent for various disciplines and professions. It unites clinicians with public health experts, lawyers, development experts, engineers and other professions. Global health also brings together policy makers in the public and private sectors. It has also attracted the generous financial support of billionaires and philanthropists.

Current Overarching Issues in Global Health

Global health issues continue to have significant impact in Africa and other regions with large numbers of poor countries. Some of these issues cut across disciplines and themes. Human rights issues of individuals and vulnerable communities are now important overarching issues in global health. The fight against HIV/AIDS highlights the need for a robust response to human rights transgressions based on health conditions or gender. Human security is another overarching issue, with special focus on the impact of poverty on health outcomes, the role of public safety on quality of life and the impact of government health policies on the poor. The impact of globalization and global trade on vulnerable populations is another overarching issue, with global health supported services playing critical roles in extending health care coverage to vulnerable populations. The World Trade Organization has spent considerable time on health issues since its inception, including technical deliberations on the rights of poor nations to have access to lifesaving medicines for their citizens.  
 
Global health is now recognized as an important part of coordinated, timely response to   natural disasters and conflicts. In affected communities, the restoration of health services is of the highest priority and global health organizations are often among the first to be on the ground.  The emergence of dedicated public/private/civil society alliances to fight specific health condition is another hallmark of global health. These alliances come into existence to dismantle financial, technical and logistics obstacles that facilitate the destructive impact of specific health conditions. Global alliances against TB, Malaria and Neglected Diseases are well known. These alliances are active in Africa.

Governance and judicious use of scarce resources is another important overarching issue in global health. Accountability, transparency and ethical provision of services are important governance issues in global health. Governance issues are now as important as fundraising in global health.  An inherent tension exists between the focus on accountability by external donors and the priority of host nations to address huge unmet needs. Governance concerns in global health can simultaneously reduce the impact of programs in host nations and erode support in donor countries.

To be continued.

By Dr. Chinua Akukwe.