Global Health in the 21st Century

The Globalization of Disease and Wellness

Debra L. DeLaet, David E. DeLaet

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317258988
• Edition: 1
• Topic: Education
• Subtopic: Education General

Perhaps no other public policy issue has greater potential to affect some of the most significant economic, political, social, and ethical changes of the 21st century than global health. In this book, a scholar/physician team authors a comprehensive introduction to global health issues and emphasises the potential of public health intervention to improve the longevity and quality of human life across the globe. The authors have lived and worked in Africa as well as in medically underserved areas of the United States, so they write with firsthand experience and authority. Using themes of interconnectedness, globalisation, and united concern from citizens, this book encourages readers to consider the role that they might play as engaged citizens in taking on the global public health challenges of the 21st century including everything from AIDs and flu to tobacco, obesity, and threats in conflict zones.

PART I

Foundations of Global Health

CHAPTER 1

Introduction to Global Health

Introduction

Because a public health model is at the foundation of global health, this chapter examines the evolution of the discipline of public health and explains how public health differs from a medical approach to health. The chapter also provides an overview of major challenges to global health in the contemporary world and discusses why the study of global health is important not only for medical practitioners but also for policy makers and engaged citizens everywhere. The chapter introduces the concept of global governance and considers potential governing solutions available to address the challenges at stake in global health.

What Is Global Health?

Global health is grounded in the concept of public health, a broad, multidisciplinary approach to health that emphasizes the health of communities and populations, preventive care, and the socioeconomic determinants of illness. Global health also has roots in the practice of international health, a term that traditionally has been used to describe health work abroad, especially on poverty-related illnesses in developing countries. A key distinction in the usage of the terms public health and international health is that public health tends to be applied in the context of specific communities or countries, whereas international health is used to describe health work in countries, especially developing countries, outside the home country of the particular practitioner or scholar. In addition, international health tends to be used to describe health work that encompasses medical care for individuals as well as health programs for specific communities or populations, in contrast to public health, which primarily focuses on population health programs.¹

Global health represents an evolution and integration of these concepts. Rather than focusing on population health in single countries (public health) or on the health of both individuals and populations in countries other than one’s own country (international health), global health is concerned with health issues that transcend national boundaries and emphasizes both individualized medical care and public health programs for populations in developed as well as developing countries.² In this way, global health represents the broadest conception of health that spans from individual health care to public programming both within and across countries. The following definition has been offered by a group of scholars and practitioners in the field: “Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population based prevention with individual level clinical care.”³ In short, global health is a truly global conception of health.

APPROACHES TO HEALTH

Global Health: a multidisciplinary approach to health that focuses on transnational health challenges, is concerned with the broad socioeconomic determinants of health across the globe, and incorporates both individual health care and preventive, public health programming.

International Health: a term used to describe health work abroad with a particular focus on poverty-related illnesses in developing countries.

Public Health: a multidisciplinary approach to health that is concerned with the health of specific communities and populations, emphasizes the socioeconomic determinants of illness, and prioritizes preventive care.

Because the discipline of public health has played a critical role in shaping the concept of global health, it will be useful to explore the evolution of public health in greater depth. In 1920, Charles-Edward Amory Winslow, a leading figure in the development of the concept of public health, put forth the following definition:

Public health is the science and art of preventing disease, prolonging life and promoting physical health and efficacy through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of social machinery which will ensure every individual in the community a standard of living adequate for the maintenance of health, so organizing these benefits in such a fashion as to enable every citizen to realize his birthright and longevity.⁴

The core of this definition has stood the test of time. In the United States, numerous public health agencies at the state and local levels have adopted this definition, and scholars of public health still cite it as a useful definition.⁵ The World Health Organization (WHO), a permanent international health organization created within the United Nations (UN) system that serves as a primary global authority for coordinating health programs and activities, has adopted a similarly broad definition of health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”⁶

The study and practice of public health are grounded in several core assumptions. First, public health is just that—a public rather than an individualized conception of health. It deals with the health of whole communities rather than simply considering the health of particular individuals in isolation. In this way, public health is a much broader concept than medicine. The practice of medicine involves medical practitioners working in one-on-one relationships with patients to treat injuries or disease, to monitor the health of individual patients, and to promote healthy practices that contribute to wellness. In contrast, public health involves the health of entire communities.

Second, the concept of public health tends to stress the importance of preventive rather than curative approaches to health. Of course, medical practitioners recognize the importance of prevention, and routine “wellness checks” for healthy patients are an example of a preventive approach within the practice of medicine. Nevertheless, the medical model is still heavily reliant on a curative approach to health—doctors must spend a great deal of their time treating sick patients. In contrast, public health practitioners, on balance, spend a relatively much greater amount of time investigating, promoting, and implementing preventive solutions to health challenges.

Third, public health approaches recognize poverty as a major factor undermining the attainment of the highest possible standards of health. Therefore, the concept of public health engages more directly with socioeconomic determinants of health than a medical model, which, in general, is more likely to focus on genetic and behavioral determinants of health.⁷

Finally, public health approaches are concerned with almost any issue or factor that has the potential to significantly affect the health of a community. In this way, the concept of public health differs not only from the concept of medicine but also from the concept of health care. Health care involves “the financing, provision, or governance of health services,” and health care policy describes governmental actions (or inactions) in this area.⁸ Although health care policy is necessarily an important piece of the public health puzzle, public health still encompasses a broader range of issues and policy arenas. Any policy area with potentially significant health implications, including economic policy, education, employment, housing, or public infrastructure, falls under the umbrella of public health.

As these assumptions indicate, public health is a broad and complicated topic. Public health does not focus primarily on individual traits and behaviors that contribute to, or undermine, a person’s health but on the economic, political, and social determinants of health—such as education, income, and public goods (like roads, clean air, and clean water)—that contribute to the health and well-being of individuals living in a community. It considers environmental factors that contribute to the health of whole populations. Public health is an incredibly broad conception of health that covers a wide range of potential topics: chronic disease as well as communicable illness; food, road, and workplace safety; nutrition; access to adequate health care; and clean air and drinking water.

Conceptualizing health in this way suggests that public health is not—and cannot be—a subject that is of concern only to medical practitioners or public officials responsible for health care policy. The practice of medicine and health care policy are pieces of the public health puzzle, but they do not complete it. To be sure, medical professionals play an essential role in the promotion of public health. However, public health does not fall solely under the purview of doctors and nurses. Similarly, health care policy is a necessary but insufficient tool for promoting public health. Because public health is fundamentally shaped by governmental policy, public officials can play an instrumental role in helping to determine the health of the communities that they govern. Bureaucrats play a critical role in monitoring food, water, and workplace safety.

Yet, public health goes further still, beyond medical practitioners and public officials, in requiring contributions from people from many walks of life. Engineers are an essential part of the process of creating safe roads, public buildings, and workplaces. Educators are key in helping to teach about nutrition and hygiene and to promote the levels of education that contribute to good health. Social workers can have an impact on public health through their contacts with populations who are vulnerable to poverty-related health problems. Agricultural practices can fundamentally shape the health of communities, and, in this way, people working in agriculture—from small-scale farmers to executives in agribusinesses—have an influence on the quality of health in their communities. In short, individuals working in a vast array of professions have the potential to shape public health, for better or worse, in the communities where they live and work, whether or not they explicitly consider themselves to be involved in public health work. Thus, efforts to promote and improve public health require knowledge among professionals in many fields and commitment among the citizenry at large.

To talk about global health is simply to apply this broad conception of health on an even larger scale. In fact, the Association of Schools of Public Health has taken the position that the concepts of public health and global health are essentially indistinguishable.⁹ If public health is the health of communities, then global health is public health on the grandest possible scale—it is the health of the human community. The global dimension of public health underscores the importance of the globalization of disease and wellness. If individual health is shaped by communal factors (national income, public health infrastructure, civil society, and the health of the natural environment), then at a global level, health is shaped by these socioeconomic determinants of health writ large. The health of particular individuals is significantly shaped by transnational economic, political, social, and ecological processes and structures. Health is a phenomenon that reflects the interdependence of countries and the interconnectedness of human beings across borders. The health of a wealthy individual can be affected by poverty and environmental degradation in developing countries, just as the health of a person in a relatively poor country can be shaped by the consumption patterns of average people in a developed country or the policies of governments in these countries. Transnational public health challenges have causes and consequences that transcend national borders, and countries cannot effectively promote public health in isolation.

In fact, perhaps the idea that global health is the health of the human community is too limiting in that the logic of public health suggests that human health is inextricably linked to the health of the environment in which humans live. In this way, human health is inevitably connected to the health of the plant and animal worlds as well. Economic and social changes alter the ecological environments in which people live and can lead to new microbial threats to human health. The destruction of natural plant and animal habitats can undermine public health when it reduces the quality of air, soil, and water. Thus, at the broadest global level, interconne...

Table of contents

• Cover Page
• Half Title page
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• List of Tables, Figures, and Boxes
• Preface
• Acknowledgments
• Part I Foundations of Global Health
• Part II Medical Aspects of Global Health
• Part III The International Relations of Global Health
• Part IV Promoting Global Health
• Notes
• Index
• About the Authors