Introduction to Global

Health as an overview
PRESENTED BY:
NIMAL BAROYA, M. PH.
PUBLIC HEALTH FACULTY, UNIVERSITY OF JEMBER EAST JAVA INDONESIA
ADAPTED FROM: MANY SOURCE
1.

PROF. DR.SHARMEEN YASMEEN, CEO, PUBLIC HEALTH FOUNDATION OF BANGLADESH,

HEAD OF THE DEPT. OF COMMUNITY MEDICINE, BANGLADESH MEDICAL COLLEGE,
DHAKA

2.

DR YOGA NATHAN, SENIOR LECTURER IN PUBLIC HEALTH, GEMS UL

Contents

Definition of global health and global health issues

The differences between global and international health

Comparison of inequalities in health status

Global health agenda

Key concepts in relation to global health

Recognize the importance of information sharing in the area

of global health

Why should we learn global health?

As of today, global health appears as newer concept

Health is becoming a global concern with the shifting

paradigm of chronic diseases being a number one killer
around the globe

Global Health is important for all professionals and young

learners, those in health, engineering, chemistry, etc.

Professionals and students will be better equipped to face

the challenges of their unique profession

Can explore better the priority areas for research

Definition of Global Health

Health problems, issues, and concerns that
transcend national boundaries, may be

influenced by circumstances or experiences

in other countries, and are best addressed

by cooperative actions and solutions

(Inst. of Medicine-USA: 1997)

Global Health Issues

Non

communicable diseases
Emerging and remerging infections
Climate change
Urbanisation
Malnutrition under or over nutrition
Nuclear war and bioterrorism etc

From individual to Global Health

Global Health

Health problems know no boundary

Health in the interconnected
context, globalization, extends
beyond problem on and capability
of one country

International
Health

Problem and/or concern beyond

frontier
Focuses on solving health problem in
developing countries

Public Health

Health problem within national

boundary
aims to promote health of the
population through prevention and
health promotion including sanitation

Individual Health << Family Health << Community Health

Source: J P Koplan et al. Towards a common definition of global health Lancet 2009; 373: 199395

Historical Development of Term

Public Health: Developed as a discipline in the mid 19th century in UK,

Europe and US. Concerned more with national issues.

International Health: Developed during past decades, came to be more

concerned with

Data and evidence to support action, focus on populations, social justice and equity,
emphasis on preventions vs cure.

the diseases (e.g. tropical diseases) and

conditions (war, natural disasters) of middle and low income countries.
Tended to denote a one way flow of good ideas.

Global Health: More recent in its origin and emphasises a greater scope
of health problems and solutions

that transcend national boundaries

requiring greater inter-disciplinary approach

Its the Real Thing

Global health issues are closely related to

numerous other fields of policy such as;
Development,

security, trade, economics,

human rights, food, agriculture, research,
employment, education, migration, environment
climate protection, humanitarian aid.

Global health issues Vs. Global Impact

Health Issue
Cigarette Tobacco is ranked as the second
smoking major cause of death in the world

Global Perspective
Tobacco is a multinational business with
global marketing strategies. Illicit tobacco
marketing is also important

Obesity

One billion adults worldwide are

Food retailing and marketing is a
overweight; 300 million are clinically
multinational business
obese

STIs

340 million new cases of sexually

transmitted infections occur world
wide each year

Increased travel and migration contribute to

the spread of STIs; global action is required
to coordinate containment efforts

Health Issues

Global Perspective

Mental health 450 million people worldwide Conflict and poverty are major contributors;
are affected by mental illness these generally involve more than a single
country and intervention strategies require
at any one time
multinational collaboration
Alcohol

Inequities

Alcohol marketing and distribution is a global

76.3 million people worldwide
business; lessons can be learned from other
have alcohol use disorders
countries

Disparities in power and

wealth directly influence
health.

inequities in societies are great, there are much

greater disparities between countries.

Gaps in health status worldwide

Every

second of every day, four women

around the world give birth. And every
minute, one of those women dies

In

Sweden, the life-time risk of a woman

dying during pregnancy and childbirth is 1
in 17, 400; in Afghanistan, it is 1 in 8.

Gaps in health status worldwide

Today, there is a 36-year gap in life expectancy between

countries. A child born in Malawi can expect to live for only
47 years while a child born in Japan could live for as long
as 83 years.

In Chad, every fifth child dies before they reach the age of
5, while in the WHO European Region, the under-five
mortality rate is 13 out of 1000.

There is no biological or genetic reason for these alarming

differences in health and life opportunity.

Gaps in health status within country

There are significant gaps in health outcomes within

countries, too rooted in differences in social status, income,
ethnicity, gender, disability or sexual orientation.

For example in the United States, infants born to AfricanAmerican women are 1.5 to 3 times more likely to die than
infants born to women of other races/ethnicities. American
men of all ages and race/ethnicities are approximately four
times more likely to die by suicide than females.

Key Facts-Inequality in health service

Worldwide, about 150 million people a year face

catastrophic health-care costs because of direct payments
such as user fees, while 100 million are driven below the
poverty line.

Even if they could pay, access to doctors would be a

challenge.

Low-income countries have ten times fewer physicians than

high-income countries. Nigeria and Myanmar have about 4
physicians per 10 000, while Norway and Switzerland have 40
per 10 000.

10 leading causes of death around the world (WHO)

Cause of death

Death in Millions

Percent of Death

Coronary heart disease

7.20

12.2

Stroke and other cerebrovascular diseases

5.71

9.7

Lower respiratory infections

4.18

7.1

Chronic obstructive pulmonary disease

3.02

5.1

Diarrheal diseases

2.16

3.7

2.04

3.5

1.46

2.5

Trachea, bronchus, lung cancers

1.32

2.3

Road traffic accidents

1.27

2.2

Prematurity and low birth weight

1.18

2.0

HIV/AIDS
Tuberculosis

Source: WHO statistics 2008

Source: W.H.O. Statistics

Global Governance
The

term global governance refers to

the interaction of all mechanisms and
forms of international cooperation to
solve global issues in the context of
globalization.

Global and National Health Agenda

HFA:

1981 to 2000 AD: 12 global indicators

MDGs: 2000 to 2015: 8 goals, 18 targets and 48
indicators
SDGs:

2016 to 2030 : 17 goals and 169 targets and

UN Statistical Commission will finalize around 300
indicators by March 2016

Global Goals all SDGs

Health in post-2015 development goals

17 goals & 169 targets

Ensure health lives & promote well-being

for all at all ages
Target

Description

3.1

Reduce global MMR to <70 per 100,000 live births

3.2

End preventable newborn & U5 deaths, with all countries aiming to reduce neonatal mortality to
at least as low as 12 per 1,000 live births & U5 mortality to at least as low as 25 per 1,000 live
births

3.3

End AIDS, tuberculosis, malaria & neglected tropical diseases epidemics

& combat hepatitis, water-borne diseases & other communicable diseases

3.4

Reduce by 1/3rd premature NCD mortality through prevention & treatment

& promote mental health & well-being

3.5

Strengthen prevention & treatment of substance abuse, including narcotic drug abuse &
harmful use of alcohol

3.6

Halve the number of global deaths & injuries from road traffic accidents

3.7

Ensure universal access to sexual & reproductive health-care services, including for FP,
information & education, & the integration of RH health into national strategies & programs

3.8

Achieve UHC, including financial risk protection, access to quality essential health-care
services & access to safe, effective, quality & affordable essential medicines & vaccines for all

3.9

Substantially reduce number of deaths & illnesses from hazardous chemicals & air, water & soil
pollution & contamination

Linkage between National and Global movements

Examples

Framework Convention on Tobacco Control (FCTC)

Health for All

Global Fund

MDGs

NCDs

IHR

Alcohol: Global Strategy, National Strategy,

SDGs

UHC etc
6

Key Concepts in Relation to Global Health

1.
2.

3.
4.

5.
6.

The determinants of health

The measurement of health status
The importance of culture to health
The global burden of disease
The key risk factors for various health problems
The organisation and function of health
systems

1. Determinants of Health
Genetic make up
Age
Gender
Lifestyle choices
Community influences
Income status
Geographical location
Culture
Environmental factors
Work conditions
Education
Access to health services

Source: Dahlgren G. and

Whitehead M. 1991

Determinants of Health
PLUS MORE GENERAL FACTORS SUCH AS:
POLITICAL STABILITY
CIVIL RIGHTS
ENVIRONMENTAL DEGRADATION
POPULATION GROWTH/PRESSURE
URBANISATION
DEVELOPMENT OF COUNTRY OF
RESIDENCE

2. The Measurement of Health Status

Cause specific death rate

Life expectancy at birth

Maternal mortality rate

Infant mortality rate

Neonatal mortality rate

Child mortality rate

3. Culture and Health

Culture:
The

predominating attitudes and behaviour that characterise the

functioning of a group or organisation

Beliefs about health

e.g.

epilepsy a disorder of neuronal depolarisation vs a form of

possession/bad omen sent by the ancestors
Psychoses ancestral problems requiring the assistance of
traditional healer/spiritualist
Diversity, marginalisation and vulnerability due to race, gender and
ethnicity

4. The global burden of disease

Predicted changes in burden of disease from

communicable to non-communicable between 2004 and
2030
Reductions

in malaria, diarrhoeal diseases, TB and HIV/AIDS

Increase in cardiovascular deaths, COPD, road traffic accidents
and diabetes mellitus

Ageing populations in middle and low income countries

Trends in Global Deaths 2002-30

Source: World Health Statistics 2007

5. Key Risk Factors for Various Health

Conditions

Tobacco use
related

Poor sanitation and access to clean water

to the top ten causes of mortality world wide

related to high levels of diarrhoeal/water borne diseases

Low condom use

HIV/AIDS,

sexually transmitted infections

Malnutrition
Under-nutrition

(increased susceptibility to infectious diseases)

and over-nutrition responsible for cardiovascular diseases,
cancers, obesity etc.

6. The Organisation and Function

of Health Systems and UHC

A health system

comprises all organizations, institutions and resources

devoted to producing actions whose primary intent is to

improve health (WHO)

Most national health systems consist:

public, private,

traditional and informal sectors:

Global Health Players - More complex

and not only UN
UN: UNGA, WHO, UNICEF, UNFPA, UNAIDs, etc
WB and regional banks, and IMF, WTO
Bilateral donors: USAID, DFID, AFD, NORAD, SIDA,
CIDA, IDRC, JICA, EC and G8
Foundations: BMGF, RF, Ford, CMB, etc.
NGOs: MSF, Oxfam, Clinton foundation, etc
Global Health Partnerships: GAVI, GF, RBM, Stop TB,
PMNCH, HMN, GHWA, CORDs, etc.

10

11
4

Digital divide: gap between haves and have nots

One of the biggest global health challenges is access
to information

Potential Solution:
WWW and
Mobile Global Health

The importance of knowledge,

learning, innovation, and IT

The most fundamental resource in

modern economy is knowledge and,
accordingly, the most important process
is learning
Lundvall, Bengt-ke (1992) National Systems of Innovation. Towards a Theory of
Innovation and Interactive Learning. Pinter, London and New York, pp. 342

GloCal Health (Global to Local)

Your Patient and

Where you live

Global Health References

Skolnik R. Essentials of Global Health. Jones & Bartlett
Publishers, Sudbury MA 2008. Chapter 1
Ed. Robert Beaglehole, 2003. Global Public Health: A
new era. Chapter 1
Megan Landon. 2006. Environment, Health and
Sustainable Development
Bonder, B. Martin L. Miracle A. Culture in Clinical Care
Koplan J et al, 2009. Towards a common definition of
global health The Lancet, Volume 373, Issue 9679, Pages
1993-1995