1. Demystifying Global Health
Definitions, Players, History and
Current Day Realities

2. Outline
 Defining ‘global health’
 The Big Players
 History and evolution of global health
 Current day reality

3. What is global health?
 Cross-disciplinary view
 Evolved from concern over infectious
disease control in industrialised world
and in colonies
 ‘Social determinants’ approach

4. Social determinants of health

5. Social determinants of health
 Conditions in people grow, live, work
and age have powerful influence on
health
 Vast majority of inequalities in health
are avoidable and, hence, inequitable

6. International Public Health
“the application of the principles of
public health to health problems and
challenges that transcend national
boundaries and to the complex array
of global and local forces that affect
them”
“Improving the health status of these
populations requires an understanding
of their social, cultural and
economic characteristics”
Merson, Black and Mill (2001)

7. What’s global about it?
 The determinants circumvent,
undermine or are oblivious to the
territorial boundaries of states and,
thus, beyond the capacity of
individual countries to address
through domestic institutions’
(Lee and Collins, 2005)

8. Three principal concerns:
(1) The global distribution of health and
disease and their determinants;
(2) The impact of globalisation on health
(3) The changing nature of global health
governance
(Kickbusch, 2002)

9. So what?
 Self-interest: Migration and
infectious disease; human ‘security’
 Trade: Impact on economic growth
 Social justice: Moral concern for
fellow human beings
“In a globalised world, we all swim in a single
microbial sea”
Gro Harlem Brundtland, 2001

10. The ‘Big Players’
 Bretton Woods Institutions
 World Bank
aims to “reduce poverty and improve living standards by promoting
sustainable growth an investment in people”
 International Monetary Fund (IMF)
Set up to ensure smooth running of the global economy
 World Health Organisation/UN
 Philanthropic organisations
 World Trade Organisation
 NGOs

11. A short tour of global health
1945
United Nations
1948
World Health
Organisation;
UDHR
1978
Declaration
of Alma Ata
1970s+80s
Global economic
recession & ‘Structural
adjustment
2000
Millennium Declaration
and MDGs
2000
‘Drop the
debt’
campaign
2001
Global Fund

12. The United Nations
 Created 1945
 Purpose was to maintain international
peace and security
 International economic and social
cooperation
 50 nations signed Charter of the
United Nations

13. A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Global economic
recession & ‘Structural
adjustment
2000
Millennium Declaration
and MDGs
2000
‘Drop the
debt’
campaign
2001
Global Fund

14. World Health Organisation
“Health is a state of
complete physical,
mental, and social well-
being and not merely the
absence of disease or
infirmity”
“The enjoyment of the
highest attainable standard
of health is one of the
fundamental rights of
every human being…”
health as “complete physical, psychological, and
social wellbeing” is achieved only at the point of
simultaneous orgasm, leaving most of us
unhealthy diseased) most of the time.

15. The World Health Organisation
 International efforts to
monitor/combat infectious diseases
 Development and distribution of
vaccines, medicines and diagnostics
 Successes
 Smallpox
 ?Polio
 Tobacco convention

16. A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Global economic
recession & ‘Structural
adjustment
2000
Millennium Declaration
and MDGs
2000
‘Drop the
debt’
campaign
2001
Global Fund

17. Health for All by 2000
 Alma Ata – Kazakhstan – September
1978
 Declaration of Alma Ata:
 “Primary health care is essential
health care…made universally
accessible…at a cost that the
community and country can afford…”

18. Health for All by 2000
 Components of primary health care:
 Education
 Promotion of food and nutrition
 Water and sanitation
 Maternal and child care
 Family planning
 Immunisations
 Prevention, control and treatment of local and
common diseases
 Provision of essential drugs

19. Health for All by 2000
 Involves related sectors:
 Agriculture
 Animal husbandry
 Food
 Industry
 Education
 Housing
 Public works
 Communications
“Coordinated efforts of these sectors”

20. Selective vs Comprehensive Care
 ‘Counter-revolution’
 World Bank challenges comprehensive
approach
 Costs of $5.4-9.3 billion by 2000
 Proposed to fight against limited number of
diseases:
 Vaccinations
 Breast feeding
 Anti-malaria activities
 Oral rehydration
‘Selective
Primary
Health
Care’

21. A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Global economic
recession & ‘Structural
adjustment
2000
Millennium Declaration
and MDGs
2000
‘Drop the
debt’
campaign
2001
Global Fund

22. Structural Adjustment Policies
 Oil crisis of 70s and 80s
 Global economic recession
 Period of crisis, increased poverty and
debt for developing countries
 World Bank, International Monetary
Fund and US imposed
restrictive policies

23. Structural Adjustment Policies
 Cuts in public spending and
consumption
 Social services such as health and
education hit
 Privatisation and decentralisation
 Fee payments for health services

24. A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Global economic
recession & ‘Structural
adjustment
2000
Millennium Declaration
and MDGs
2000
‘Drop the
debt’
campaign
2001
Global Fund

25. A declaration with a difference?
 Millennium Development Goals
#1 Eradicate extreme poverty and hunger
#2 Achieve universal primary education
#3 Promote gender equality and empower women
#4 Reduce child mortality
#5 Improve maternal health
#6 Combat HIV/AIDS, malaria and other diseases
#7 Ensure environmental sustainability
#8 Develop a global partnership for development

27. A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Global economic
recession & ‘Structural
adjustment
2000
Millennium Declaration
and MDGs
2000
‘Drop the
debt’
campaign
2001
Global Fund

28. Pressure on governments to relieve debt
$83 billion in debt cancellation
Spending on public services increased by 20%
http://youtube.com/watch?v=gFfIIW_xQq4

29. A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Global economic
recession & ‘Structural
adjustment
2000
Millennium Declaration
and MDGs
2000
‘Drop the
debt’
campaign
2001
Global Fund

30. The Global Fund
 To fight AIDS, Tuberculosis and
Malaria
 Financing agency (>90% funds from
governments)
 Claims that by Jan 2007 had saved
1,146,000 lives (3,000 a day)
 BUT has it neglected other health
areas?

31. Current state of global health
 Aid vs Trade - $79 billion in 2004
 “some thirty official donors in addition to
several dozen international NGOs…through
over a thousand distinct projects and several
hundred resident foreign experts”
 Ongoing focus on disease-specific
interventions (‘vertical approach)
 Immense power imbalance

32. Final remarks
 Inequality and injustice widespread
 Principles of primary care still
neglected
 Global health affects us all
 “The greatest single challenge facing
our globalized world is to combat and
eradicate its disparities”
Nelson Mandela