Introducing Global Health: Practice, Policy, and Solutions

Peter Muennig, Celina Su

• Publisher: Jossey-Bass
• Year: 2013
• ISBN:
  9781118233993
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Introducing Global Health: Practice, Policy, and Solutions is a contemporary overview of the major issues in global public health. The book explores how population health might be maximized with the right blend of health system, education, antipoverty, infectious disease, urban development, governance, and incentive-based policies. It covers topics critical for understanding the state of the world today, including wars for natural resources, the missing women phenomenon, and whether global aid really works. The book's case studies focus on developing economies, mixed economies, and new emerging superpowers. Thematic chapters are interwoven with running motifs, such as the health risks and benefits associated with different totalitarian, capitalist, and market socialist economies. Moving beyond statistics, the book represents a major innovation in the teaching of global health by presenting technical concepts including the incidence and prevalence of disease within the context of more accessible topics such as global poverty. This helps students contextualize otherwise challenging but critical concepts, such as the burden of infectious disease.

By encouraging reflection, focusing on what works, and using activities and exercises, Introducing Global Health both teaches fundamentals of global public health and cultivates a policy perspective that is appealing and compelling for today's students.

PART ONE
The Basics of Global Health

CHAPTER 1
A Very Brief History of Global Health Policy

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Key Ideas

• Although people often think of health as a question of genetics and biology, the field of global health is now largely focused on how policies and social environments affect mortality and morbidity.
• The past century, marked by the second Industrial Revolution and economic development around the world, has brought improvements in standards of living. But industrialization in low-income countries poses new threats to human health, primarily through environmental degradation and occupational hazards.
• Better nutrition and basic infrastructure such as sanitation systems have helped many societies to experience an epidemiologic transition, when infectious diseases drops and life expectancy greatly increases.
• Global health policies are now partly shaped by intergovernmental institutions, such as the United Nations (UN), formed after World War II. These institutions are chiefly concerned with economic development, human development, and preventing war.
• Although fiscal austerity, trade liberalization, and the so-called Washington Consensus dominated many intergovernmental policies in the 1980s and 1990s, more recent policies have begun to acknowledge that multiple models for development are needed.

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Health and Public Policy through the Twentieth Century

People tend to think of health as a question of genetics and biology but our environment, more than our genetic code, probably explains why our feet would pop out of the bottom of the Renaissance-era beds you see in current museums. Over time, the environments around us have tended to improve our health prospects. New medical technologies, access to better nutrition, and fewer life-threatening hazards in our everyday work lives have helped increase global life expectancy. In the healthiest nations, life expectancy has increased from fifty years in 1900 to sixty-five years in 1950 to eighty years in 2000. In a much more extreme trajectory, Cuba's life expectancy moved from nineteen in 1900 to fifty-seven in 1950 to seventy-seven in 2000 (figure 1.1).

Figure 1.1. Changes in life expectancy from 1940 to 2009 in some of the nations that we discuss extensively in this book.

Source: World Health Organization. Rendered by Gapminder.org.

In this chapter, we give a very brief history of some of the key trends that have shaped population health worldwide in the past few hundred years. Along the way, we will introduce some of the key public health issues that we will dive into more deeply later in the book.

Communities and Health

In the days when humans lived as hunters and gatherers, the best hunters and the best gatherers were almost certainly more likely to get the hottest partner around. But for most people, eating and being eaten were probably bigger concerns than one's position in the social pecking order (Diamond, 1998). These two problems—finding food and fending off attacks—were greatly mitigated by agrarian lifestyles, introduced around ten to twelve thousand years ago (Denham et al., 2003). By keeping livestock, farming, and gathering in communities large enough to scare off predators, humans greatly increased their chances of survival.

When food could be had with less physically demanding work, a sedentary lifestyle and more rapid population growth occurred. But the agrarian life also introduced new problems. For one, there was a need for division of labor and governance. Thus, formal social hierarchies were introduced. Those at the top were more or less ensured access to food, a mate, and superior protection from threats than those at the bottom.

Europe and Asia had some native plants and animals that really benefited the people there, including barley, two types of nutritious wheat, and easily domesticated goats and sheep for wool, leather, and meat. The grains could be stored for a long time without getting spoiled, unlike fruits and vegetables. European and Asian people were also lucky because their lands were contiguous on an east-west axis so they could reach one another and trade products by land. Donkeys and horses from the Middle East also helped these people trade and flourish. With luck, work, and trade, the people of Europe, the Middle East, and Asia cultivated a wide range of nutritious crops and domesticated animals. Folks in Africa, however, mostly dealt with untamable animals, such as lions and leopards; they continued to hunt and gather (Diamond, 1998).

Of course, up until relatively recently in human history, few people died of diabetes and hypertension. It is true that the automobile, television, and high-caloric food all play big roles in the predominance of heart disease as a major cause of death (Lowry, Wechsler, Galuska, Fulton, & Kann, 2002). But few people died of these conditions mostly because more often people died of infectious disease before they had a chance to get their first heart attack. Over time, the people outside of the Americas developed immunity to common pathogens. There is even evidence that they evolved by natural selection to become resistant to some diseases, such as the plague (Galvani & Slatkin, 2003). When Europeans encountered Native Americans during the colonial period, they brought diseases, such as smallpox, that cut down half or more of some tribal populations. Likewise, endemic malaria in Africa and yellow fever in parts of Asia killed many Europeans during the colonial era (Diamond, 1998).

Thus, by transitioning from hunter and gatherer lifestyles to an agrarian and feudal life, old threats to survival were conquered but new ones were introduced. These newer problems tended to require higher-scale cooperation and collective problem solving so that health policies began to evolve not just in small villages or clans but also in nation-states and civilizations.

These problems included, among many others, the need to dispose of all the feces produced by large collections of people living together and to ensure clean water to drink. Some human civilizations were able to tackle these problems quite early on. Many ancient civilizations show evidence of complex water delivery and basic sewage disposal systems. Other nations to this day cannot effectively provide these basic provisions, even though it has never been cheaper or easier to provide them. Thus, we see that a given community or nation can unambiguously benefit from new ideas and technologies only if it can govern well enough to counteract the unintended consequences of collective living and make full use of technology so that it does more benefit than harm. (See figure 1.2.)

National Policies and Health

In the late 1700s and 1800s, manufacturing technologies and processes gave rise to the first Industrial Revolution. This opened the door to the development of new medicines and life-saving goods. In the first Industrial Revolution, the development of refined coal and the steam engine helped create a new manufacturing sector, one in which machines helped with agriculture and transport. New tools and machine parts were also made. This, in turn, led to new machines that greatly facilitated the production of textiles (with cotton spinning machines), paper, and glass. Water was easier to pump out of mines. The advent of the coal-powered steam engine transformed trade and migration along new rail routes, and the rediscovery of concrete (which had been lost for thirteen hundred years) reinvigorated building construction techniques.

The second half of the nineteenth century brought the second Industrial Revolution, with assembly-line production of goods, the internal combustion engine, and electricity power generation. This era is renowned for the development of steel, chemical industries, petroleum refinement, the car industry, and hydroelectric power.

Figure 1.2. Residents live near a waterway containing raw sewage and trash in Chennai, India, 2013.

Source: Flickr/McKaySavage.

But just as agrarian living created some problems and solved others, industry posed new health threats. In England, for example, the population had remained steady at six million from 1700 to 1740. After the first Industrial Revolution, the population increased from eight million in 1800 to seventeen million in 1850 and then to almost thirty-one million in 1900 (Ashton, 1997). Yet, despite this population increase, childhood survival rates remained abysmally low. Children were not afforded the chance to receive an education, and they were expected to work. The Industrial Revolution made the hazardous conditions of child labor a lot more visible than they were before and was documented by writers such as Charles Dickens. Children died in explosions in mines; they were burned and blinded making glass. “Matchstick girls” developed phossy jaw, or phosphorous necrosis of the jaw, and then organ failure while making matches (Myers & McGlothlin, 1996). The new, dense slums brought open sewers, polluted water and air, and persistent dampness, leading to widespread ch...

Table of contents

• Cover
• Table of Contents
• Title
• Copyright
• Figures and Tables
• The Authors
• Introduction: An Overview of Global Health
• PART ONE: The Basics of Global Health
• PART TWO: Global Health and the Art of Policy Making
• PART THREE: Key Challenges in Global Health
• Index
• End User License Agreement