A Brief Intro to Global Health

There is no definitive definition of Global Health. In fact, if you ask 5 different people within the field (or even a class on campus) you will get a different response each time. Unlike many other scientific discourses, it bridges the gap between science and the traditionally labelled, ‘humanities’ to build a multivariate picture of an environment or circumstance; it is in its simplest form, an interdisciplinary approach to health and medicine. 

Naturally, the interest in this subject has grown worldwide in the past 8 months; personally I am now less likely to receive a ‘what’s that’ accompanied with a questioning glance when I say I study Global Health, but the nuance of the subject tends to be lost within the folds of COVID reports. Epidemiology and epidemics are an important side to it, don’t get me wrong, but there is so much more to it than that. It understands that we are products of our socio-economic, political and cultural environments, each of which is unique and can be affected by any number of factors- local or national health policies, discrimination, globalisation and war or technology (to name a few). Each can be a determining factor for someone’s health or access to medicine, and consequently requires the ability to switch between different lenses of scale and to gather information across disciplines. Simply, it is the branch of healthcare that looks at a person as a sum of their parts. In order to explain some of the sectors global health works across, I have split things up into five segments, which are not exhaustive or definitive:

Governance

Does our governing system have an effect on your health? Apart from potentially raising your blood  pressure, in short, yes it can. As a universal example, capitalism requires a hierarchy of living, meaning those that are at the top are more socially and economically secure. As proven in the Whitehall Studies, this means that whilst those at the top have better access to healthcare, they also have high-stress jobs and, often, worse eating habits. However, as the study goes on to reveal, those with less financial freedom and choice within their work experience higher levels of stress which not only causes health problems by itself but sparks off coping behaviours such as smoking, drinking, less exercise and a higher consumption of saturated fatty foods to off balance the long hours and limited mobility and choice within their career. 

On a simpler note, laws and policies that are in place to protect people, will unfortunately often harm them too - take the abortion laws in different states in America for example, or even the fact that it is still technically a criminalised act in the UK. Drug laws are the same too, whether that’s through licensing and patents (see the TRIPS agreement or attempts at BiDil production in the last 20 years) or the regulation of illegal drugs and how and why that may be flawed. This follows on to the next section, as the treatment of those charged with drug related offences whilst in custody, is, too, rarely equitable, along with their treatment whilst they are arrested. 

Equity

We live in a racially institutionalised society, and the medical system is no different. A PNAS study in 2016 inspired further research worldwide when they published a report proving that Black patients are taken less seriously during pain assessment and are consequently given less/weaker levels of medication compared to their white counterparts. A woman recently died of COVID-19 after she rang 999 but was told they could not help until her lips started turning blue. Thing is, this woman was Black, and Black patients’ do not experience cyanosis in this way. However, was it the fault of the medic that gave that advice? Yes and no, accountability is necessary- especially in the medical world, but because medical education is based on white bodies and white bodies alone it was that system that failed all those involved that day.

This is just one area you could look at in health equity, but these issues expand into the LGBTQ+ community, or can look at health systems and insurance, or access to sanitation, habitable living space or how there hasn't been clean water access in Flint, Michigan for 6 years and counting (and why). Many of these topics can be linked to the social determinants of health, a theory popularised by Marmot that brings together all parts of the socio-cultural and economic environment to properly view health access and seeking behaviours. However, this particular theory and the use of the ‘rainbow’ exemplar is debated within the global health community, and its criticism is brilliantly explained in the recently published paper by Emily Yates-Doerr and well worth a read. 

Actors and Aid

Hoffman and Cole published a paper in 2018 that gathered and mapped the global health system as we know it, determining over 203 global health actors that had been created since 1864. They define a ‘global health actor’ as ‘an individual or organization that operates transnationally with a primary intent to improve health’- the main examples of which include the UN founded WHO, The Bill and Melinda Gates Foundation and the World Bank's GAVI Alliance. Due to the sheer size of wealth Gates has, it can be argued that he in fact holds the monopoly over much of the world’s health. For instance, he has poured millions into eradicating Polio, but with the containment of the disease to just 3 countries and only a handful of cases, is this the wisest way to continue spending that amount of money each year when even half of it could get many other diseases to the same stage of eradication? Not only that, but he and the American government (for now) are significant voluntary donors to the WHO, meaning the organisation is heavily reliant on their financial influence and the significant impact any potential retraction would have.

Globalisation

Interconnectedness and communication have only been strengthened with globalisation, enabling health facilities to become more widely accessed and accessible everyday. However, it does have its downsides too - the harrowing speed of the spread of COVID-19 being a perfect example. 

With the rise in urbanisation and the spread of consumerism the gap continues to widen between the rich and the poor. This all has an environmental impact, meaning global warming has its place here too; from the dramatic changes in seasons that are experienced by many living in Southern Asian countries, to the quality of the air we breathe everyday. Along with this there are the incredible levels of spatial, temporal and cognitive changes that cut across local networks and potentially take with them traditional knowledge and culture, and leave a trail of illicit trade and trafficking in their place. It has seen a reduction in biodiversity, an increase in war and migration, and sees someone with enough money being able to literally go shopping for a kidney rather than wait for a transplant. 

Communicable and Non Communicable Diseases

With an increasingly aging population and many physical, environmental and lifestyle changes there has been a severe increase in non-communicable disease prevalence, now accounting for over 70% of deaths worldwide. These diseases include: diabetes, cardiovascular, respiratory or neurodegenerative diseases, cancers and mental health disorders. Additionally, the Global South is experiencing what can be described as a delay or time shift from the Global North with communicable diseases. These countries don’t have the scale of westernised medicine that we do and are consequently suffering epidemics of diseases that are now easily controllable, treatable or preventable; these could be polio, some neglected tropical diseases, TB, or malaria, to name a few. 

Global Health is the critical engagement of the medical field, and has many corners, nuances and specialisations. It is about collaboration to hopefully build a better and more equitable future for people globally, and I hope this article can bring even the smallest bit of inspiration for you in how you bring it into your profession and studies.