Routledge Handbook of Global Public Health

Richard Parker, Marni Sommer, Richard Parker, Marni Sommer

• Publisher: Routledge
• Year: 2010
• ISBN:
  9781136838323
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

At the beginning of the twenty-first century, key public health issues and challenges have taken centre stage. They range from arsenic in drinking water to asthma among children and adults; from the re-emergence of cholera, to increasing cancer rates and other chronic diseases; from AIDS to malaria and hepatitis; from the crises faced by displaced or refugee populations to the new challenges that have emerged for reproductive health and rights.

Like most aspects of contemporary life, these problems have been impacted by globalization. The issues that confront us are being shaped by evolving processes such as the growth of inequalities between the rich and the poor in countries around the world, the globalization of trade and commerce, new patterns of travel and migration, as well as a reduction in resources for the development and sustainability of public health infrastructures.

The Routledge Handbook of Global Public Health explores this context and addresses both the emerging issues and conceptualizations of the notion of global health, along with expanding upon and highlighting the critical priorities in this rapidly evolving field. It is organized in ten main sections. The topics covered include:

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• The transition from international to global health

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• Structural inequalities and global public health

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• Ecological transformation and environmental health in the global system

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• Population and reproductive health

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• Conflict, violence and emergencies in global public health

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• Global public health policy and practice

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• Global public health and development

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• Global mental health

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• Global access to essential medicines

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• Health systems, health capacity, and the politics of global public health

This comprehensive handbook will provide an authoritative overview for students, practitioners, researchers, and policy makers working in or concerned with public health around the globe.

1

Introduction

Richard Parker and Marni Sommer

At the beginning of the twenty-first century, key public health issues and challenges have taken centre stage on the global scene. Ranging from arsenic in drinking water to asthma among children and adults; from the re-emergence of cholera and diphtheria, to increasing rates of various forms of cancer; from HIV and AIDS to MDR-TB, malaria, and hepatitis; from the crises faced by displaced or refugee populations to the new challenges that have emerged for reproductive health and rights; from the experience of public health emergencies as the result of disasters such as tsunamis, earthquakes, and catastrophic storms to the growing spectre of potential global pandemics such as those linked to H5N1. The expansion of serious public health problems, increasingly taking shape on a global scale, has been one of the defining features of recent history.

Like most aspects of contemporary life, the range of key public health problems faced by specific countries has increasingly been affected by a range of factors associated with globalisation. The issues that confront us presently have been, and are being, shaped by evolving processes such as the growth of inequalities between the rich and the poor in countries around the world, the globalisation of trade and commerce, new patterns of travel and migration, as well as a significant reduction in available resources for the development and sustainability of public health infrastructures. The social, cultural, economic, and political transformations associated with globalisation have, in turn, increasingly intersected with the growing range of environmental threats produced by industrialisation, epidemics of newly emerging infectious diseases, and the rapid increase of chronic diseases linked to changing lifestyles.

The new public health challenges of the twenty-first century have taken place within the context of a rapidly changing political and institutional landscape. In recent decades the field that was initially described as international health involving sovereign states has increasingly been re-conceptualised as the field of global health within the global system. This change represents more than a simple shift in language. It stems from a fundamental transformation in the nature of health threats and in the kinds of solutions that must be posed to them. It recognises that many of the most serious health threats facing the world community today reach beyond the sovereign borders of nation-states and require the attention not only of governments but also of a range of non-state institutions and actors.

Just as we have witnessed remarkable changes in recent decades in the nature of the public health problems that challenge us globally, we have also witnessed an unprecedented period of growth in the field that has come to be known as global health. As is reported in a number of the contributions to this volume, there has been a massive increase in development assistance for health over the course of the past two years. A field once largely dominated by the agencies of the UN system and bilateral donor agencies in high-income countries has seen significant reorganisation with the entrance and rising importance of a growing range of new non-state or hybrid public/private agencies such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the Global Alliance for Vaccines and Immunisation (GAVI), the Bill & Melinda Gates Foundation, and a wide range of international non-governmental organisations (NGOs). Multilateral institutions, bilateral agencies, private foundations, and universities and research institutes around the world have announced and begun to implement large-scale global health initiatives. These changes have been reflected, as well, on college and university campuses, where epidemiology, public health policy, and, in particular, global health have become among the fastest growing undergraduate and graduate courses of study for what has been described as the global generation.

As in any field undergoing such rapid and transformative change, the pace of events and the implementation of new initiatives often threaten to move more quickly than the capacity of the field to reflect upon its most basic assumptions, and to reorganise itself in order to provide the conceptual and structural foundations for its continued development. In the case of global health, key questions have emerged about the ways in which global transformations have affected the changing patterns of communicable and non-communicable disease (both North and South), about the impact of global inequalities on the social determinants of health and disease, about unresolved conflicts and contradictions in global health governance structures, and about the probable outcome and possible response to major environmental shifts such as global climate change, as well as to major economic events such as the global financial crisis. In turn, these questions have been linked to important, but largely unresolved, debates about both the possibilities and the potential limitations of technological advances aimed at confronting global health challenges and about the need for far-reaching changes to strengthen health systems and reorganise models of development cooperation to more effectively address global health priorities in the future. The very definition of global health, and the unique role of public health within this rapidly changing field, have both been questions that have been the focus of much recent attention and debate. The challenge of developing a vision for this field that will truly reflect the true extent of global diversity – inclusive as much of the voices and views of experts and policymakers from the global South as it is of those from the global North – continues as one of the key unmet objectives for a field that is still very much in a process of formation and transformation.

Within such a context, there is an increasingly urgent need to respond to these important questions and controversies by opening up new opportunities for meaningful intellectual dialogue, debate, and exchange about the key questions and challenges that currently confront the field of global health, and for critical reflection and increased awareness concerning the kinds of contributions that public health and population sciences can offer in relation to these challenges. This Handbook has emerged and taken shape within this context, and seeks to address both the emerging issues and conceptualisations of the notion of global public health, along with expanding upon and highlighting the critical priorities in this rapidly evolving field. While it has been developed with the goal of raising issues that are of importance for the field of global health broadly defined, it also prioritises an understanding of the special contributions that public health and population sciences can make within this field – an emphasis that we have sought to make explicit in choosing the title of the Routledge Handbook of Global Public Health. It seeks to offer in one location a broad introduction to key experts, key material, and key debates. All of the chapters take the form of original contributions, although a small number have been adapted in abridged form from elsewhere. Our goal is to offer readers a rich understanding of the field of global public health, tracing the origins of big debates, describing the current state of play in particular fields, and hinting at where the future might be heading. The Handbook thus seeks to provide an authoritative overview for students, practitioners, researchers, and policymakers working in or concerned with public health around the globe. It is organised into ten main sections (Parts I to X), which by no means exhaust the possible topics in such a vast field, but which do seek to map out some of the important areas of analysis and debate that are currently the focus of much of the most important attention in the field. In this Introduction to the volume, we will try to briefly describe the contents of each of these major sections, and to offer a sense of why these discussions are so central to the evolving field of global public health.

Part I of the Handbook, ‘The Transition from International Health to Global Health’, includes chapters about a number of the pioneering institutions and individuals in international health, with a key focus on exploring the conceptual transition to global health. It emphasises early efforts to build the field of international health, as well as more recent critique on the limited nature of conceiving health as international, rather than as operating within the global system. Contributions in this section explore the ways in which institutional structures, policies, and programmes have been shaped by broader social, economic, and political forces, and highlight the changing institutional architecture of the field as a growing range of intergovernmental agencies have become increasingly involved in health-related issues, and as the evolving field of global health has also become populated by private organisations and new hybrid public-private initiatives. They focus on the extent to which the major health issues confronting low-income countries are embedded in the global economic policies and practices that are articulated and controlled by wealthier countries, and describe the ways in which global health challenges have been framed through such policies in relation to health and security, health and development, health and global public goods, health and trade, health and human rights, and health and ethical reasoning.

Part II of the Handbook, ‘Structural Inequalities and Global Public Health’, examines the social patterning of health, including social exclusion, health disparities, and inequalities.
Chapters in this section focus on the unequal distribution of power in society and its implications for the social determinants and the social distribution of health. They explore diverse strategies for eliminating inequities and disparities in health based on structural factors, including class, race and ethnicity, and gender, among other axes of inequality. They discuss the shift from public health approaches focused on behaviour change and individual agency, to the importance of utilising a structural approach in exploring public health challenges and devising realistic interventions for improving population health. Contributors emphasise the complex relationship that exists between diverse forms of power and the social distribution of health, highlighting the ways in which social exclusions translate into health disparities. They call our attention to the need for a fundamental re-conceptualisation in public health, in particular through a shift from a focus on what has been described as ‘the natural history of disease’ to a new emphasis on the ‘social dimensions of vulnerability’. They offer key insights into the ways in which social transformations and the empowerment of disenfranchised communities and populations might be able to transform existing health inequalities – while also highlighting the very different conceptual and programmatic approaches that currently exist within global public health for how best to achieve such transformations. In different ways, all the chapters in this section of the Handbook thus call attention to the extent to which the most important challenges in the field of global public health are not merely technical but fundamentally political in nature, and highlight how the transformation of health systems will ultimately be possible only through the transformation of broader social, political, and economic systems that shape and determine health in highly specific ways.

Part III of the Handbook, ‘Ecological Transformation and Environmental Health in the Global System’, focuses on the transformative nature of the interactions occurring around the globe between populations and the environment, with significant ramifications for population health. The chapters in this section discuss the social dimensions of environmental health, including the long-term impact of climate change, the challenges of water and air pollution, and the synergy between environmental devastation and other health issues. The discussions here focus on the human-driven aspects of climate change and its profound implications for population health. Highlighting the ways in which rapid economic growth, if continuing to be driven by the burning of fossil fuels, will contribute to increasingly adverse health consequences, this analysis points to the need for more accelerated policy making linked to the actual rate of climate change occurrences. Climate-related health impacts discussed include those linked to temperature-related illness, extreme weather and sea level rise, air pollution, food security, and social upheaval. A full awareness of these issues highlights the need for public health alongside of responses from national governments, as well as an overdue linkage to be made in climate change advocacy – one that links the important relationship between climate change and health impacts. The chapters in this section also highlight the fragile nature of the world’s existing water sources, and the potential responses to be utilised in protecting and managing the limited supply. Noting that as much as one-tenth of the global disease burden could be prevented by improving water supply, sanitation, hygiene, and management of water resources, they call attention to the importance of both quantity and quality of water supply, and the ways in which even water-scarce countries might be able to increase the availability of improved drinking water. They also focus on the interlinked nature of environmental factors and population health, such as the synergy that exists between vulnerable children’s exposure to lead and their increased risk of morbidity and mortality from infectious disease, and the dangers of increasing air pollution for human health. Highlighting the challenges that exist in quantifying the health impacts of diverse forms of pollution, the analyses in this section also emphasise the need for increased public health attention to research and advocacy, in both high- and low-income countries.

Part IV of the Handbook, ‘Population and Reproductive Health’, examines the priority global health challenges in population studies, sexual and reproductive health and rights, and the health of young people, as well as the global challenges of ageing. The chapters in this section provide an overview of the important changes that have taken place in the field of population studies in recent decades, particularly through the process that led up to the International Conference on Population and Development (ICPD) held in Cairo in 1994 – and, in particular, the fundamental conceptual shift that took place as a field primarily focused on population control was gradually reinvented and reoriented to focus on reproductive health and reproductive rights. They highlight the impact of this transformation for the delivery of reproductive health services and for the diverse populations of women and men that must have access to these services. Within this broader context, the chapters highlight the importance of key areas that continue to be highly contested politically, such as the urgent priority of reducing death and disability from unsafe abortion, and the struggle to understand and confront challenges and barriers to recognising men and masculinity as important issues within reproductive health and public health more generally, highlighting the health risks that young men suffer in performing masculinities shaped by societal and cultural forces that make them vulnerable by virtue of their gender. Finally, this section emphasises the special vulnerability not only of children and young people, particularly in low-income countries and communities, but also the rapidly increasing populations of older adults even in resource-poor settings where ageing has not been considered a serious concern in the past. The concluding chapter in particular explores the implications of these major demographic changes for both country-specific and global public health approaches and solutions in the future.

Part V of the Handbook, ‘Conflict, Violence, and Emergencies in Global Public Health’, explores the current realities of conflict and health, including war, torture, civil disturbances, gender-based violence, and the public health challenges of displaced populations. Chapters in this section focus on the global dimensions of population-level violence, and the disproportionate impact that violence has on the poor and disenfranchised within populations affected by conflict and disasters. They include an analysis of the ways in which armed conflict has changed in recent decades, and its implications for population health. Describing the emergence of humanitarian organisations over time, they emphasise that a disciplined public health response to post-conflict settings is a relatively recent development, and focus on the importance of developing public health responses within the often unstable political and social context of many countries. Also discussed is the global pervasiveness of violence against women; this challenge is examined within a human rights framework and an argument is made that such an approach is critical because of interrelated contextual factors (such as poverty and discrimination), which impact on women’s lives and compound their vulnerability to violence. Related is an exploration of the need for protection of children as a population facing unique risks in conflict and post-conflict settings, with the presentation of eight fundamental elements of a framework for creating protected environments for vulnerable children, ranging from protective legislation and enforcement, to addressing relevant attitudes, traditions, customs, behaviours, and practices. This section also presents a succinct guide to using nutritional indicators and reference levels in emergency-affected populations, and seeks to clarify a widely held myth that wars over water are imminent around the world, arguing that sub-national disputes over water are more the norm. It highlights challenges of access in relation to both nutrition and water deprivation in situations of conflict or emergency, emphasising the critical importance of addressing these issues, particularly in low-income countries where rapid population growth and urbanisation aggravate shortages caused by emergencies.

Part VI of the Handbook, ‘Global Public Health Policy and Practice’, focuses on the changing priorities in health policy within and between countries around the globe, with chapters addressing the crucial importance of global health diplomacy, and the roles of international agencies, governments, and civil society in fostering improved population health. It begins with an examination of what has come to be described as ‘global health diplomacy’, and emphasises that precisely because the trans-border health challenges that characterise the recent era of globalisation can only be resolved through joint action on the part of many countries working together, health more than many other fields has moved beyond the technical realm and is becoming a key element in foreign policy, trade relations, and security agreements between countries. The area of global health diplomacy recognises these tendencies and seeks to capture the multi-actor and multi-level negotiation processes that shape the global health policy environment and manage it through global governance systems. There is also an overview of the politics of global aid for development and health that examines the historical evolution of international aid efforts, particularly in relation to health and development. Chapters explore important trends and distinctions in relation to current patterns of international giving that are directly relevant for global public health policy and practice, as well as many of the key critiques that have been directed at dominant approaches to humanitarian assistance and development aid (and their impact, or lack of it, in relation to key global public health challenges). They also provide detailed case studies of two important areas of global public health policy: tobacco control and nutrition. They describe the process through which the WHO’s Framework Convention on Tobacco Control (FCTC), a global public health treaty that seeks to incorporate best practices in terms of tobacco control, was developed and put into place, highlighting the extent to which the ongoing battle to control tobacco and the health impacts of smoking might provide a key case study offering insights that are relevant to global health diplomacy and global public health policy more broadly. The discussion of global nutrition includes a focus on the linkages between both undernutrition and overnutrition to poverty and economic exclusion, and signals the potential limitations of narrow technical solutions to the complex social, economic, and environmental challenges of global nutritional deprivation. This section also includes discussion of global health practice as well as policy, calling attention to the importance of health communication as a key to behaviour change aimed at reducing risk and vulnerability at both individual and population levels.

Part VII of the Handbook, ‘Global Public Health and Development’, examines the health effects of major economic development trends and the impact of key interventions aimed at responding to both long-term and emerging global health problems. It begins with a broad overview of the dramatic increase that has taken place in development assistance for health from 1990 to 2007. Following this overview, chapters provide detailed case studies of a number of key areas of intervention in global public health. The first focuses on addressing preventable blindness and visual impairment, and the strides that have been taken globally in combating cataract, trachoma, vitamin A deficiency, onchocerciasis, and other chronic causes of blindness, highlighting the ways in which visual impairment and economic development (or the lack of it) are intertwined globally. The next examines the importance of maternal and child survival for global health, highlighting the role of socio-economic inequalities in shaping both death rates and the success of interventions, providing an overview of the types of interventions that have been introduced to improve maternal and newborn survival, and giving attention to the importance of community-based interventions. The third case study outlines the emerging global crisis of chronic disease, highlighting the urgent need for action on what was once perceived to be a relatively lo...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures and tables
• Notes on contributors
• Acknowledgements
• Chapter Introduction
• PART I The Transition from International Health to Global Health
• PART II Structural Inequalities and Global Public Health
• PART III Ecological Transformation and Environmental Health in the Global System
• PART IV Population and Reproductive Health
• PART V Conflict, Violence, and Emergencies in Global Public Health
• PART VI Global Public Health Policy and Practice
• PART VII Global Public Health and Development
• PART VIII Global Mental Health
• PART IX Global Access to Essential Medicines 419
• PART X Health Systems, Health Capacity, and the Politics of Global Public Health
• Index