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The reconceptualisation of global health

How should global health be understood in an era marked by the rising burden of non-communicable diseases (NCDs), climate change and other environmental crises, integrated chains of production and consumption, a power shift towards emerging economies, intensified migration and instant information transition? (Frenk et al, 2014, p.94)

This question, asked by Julio Frenk and colleagues in an article published in The Lancet, is our starting point for our journey into health systems strengthening. How we conceptualise health, and health systems, shapes how we act in health systems strengthening.

…global health should be reconceptualised as the health of the global population, with a focus on the dense relationships of interdependence across nations and sectors that have arisen with globalisation (p.94).

In discussing global health, the authors critique the understanding and practices associated with the older term ‘international health. They suggest that it was focused on control of epidemics and the problems of poor countries; an excessively technocratic (expert-driven) approach to solutions, and an understanding of aid that viewed problems as located in poor countries with solutions located in rich countries.

Importantly, for our concerns in this course, they state that ‘international health’ as a discipline overemphasised control of particular diseases (for example, malaria or pneumonia) through narrow interventions and programs, but did not pay much attention to broader health systems.

Two key points are used to support the ideas for the reconceptualisation of global health proposed:

  1. Global health should not be ‘foreign health’ but the health of the global population
  2. Global health should not be about dependence but about interdependence, and exploring interdependence through:
  • Cross-border movement of elements of the natural environment.
  • Consumption of globally marketed goods and services.
  • The global spread of information, knowledge, and culture (such as patterns of use of technologies that lead to antimicrobial resistance).
  • Transnational rules such as trade treaties and the International Health Regulations.

They depict managing inter-dependence as highly cross-sectoral, with many actions far outside the traditional boundaries of the health sector.

The globally inter-dependent nature of health risks produces a ‘triple burden’ of health concerns globally: the unfinished agenda of infectious disease control; the global epidemic of non-communicable disease, and the health risks caused by globalisation itself, such as those associated with the import of food, or the migration of health workers.

Recognising that this agenda can only be addressed at the global level, but that a global government is not a realistic option, Frenk and colleagues suggest that what is required is to slowly build a ‘global society’ in which global citizens

accept to share the risks, rights, and duties related to protection and promotion of the health of every member of this society (p.96)

How do you respond to this? Do you see the challenges of the health system in your setting to be predominantly local and independent, or global and interdependent in nature? Reflect on this as we look at the next three steps and explore the history of health systems strengthening.

Frenk, J., Gómez-Dantés, O. and Moon, S. 2014, From sovereignty to solidarity: a renewed concept of global health for an era of complex interdependence. The Lancet, 383(9911), pp.94-97.

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