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What is global health?

In this video, Tanja Hammel discusses the definition, scope and emergence of global health.
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The concept of global health seems
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to be simple: health that is considered in a global context. However, there are many definitions of global health.
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Let us consider three examples: Global health is “Public health somewhere else” “The emerging discipline of healthcare delivery in improvised settings” “Health and disease patterns in terms of the interaction of global, national and local forces, processes, and conditions in political, economic, social and epidemiological domains” You will find further definitions attached to this step. Reading these definitions, you will notice that they bring together various elements. Global health is understood as a condition, an aim, a field of work and a field of research. This is very universal. One way or another, we are all part of global health. As you follow this course, you are part of global health as a field of research. The definitions include a spatial element.
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Public health focuses on the national and international health on the binational. Global health concentrates on issues that concern the planet as a whole. The concept of global health doesn’t just have a spatial dimension; it also has a temporal one. Viewed from a historical perspective, international health emerged from the field of colonial and tropical medicine. International health is the study of health in countries other than one’s own, especially if the countries are representatives of the developing world. In the 20th century, international health was concerned with the control of epidemics and infectious diseases. Global health focuses on people’s health needs beyond national borders worldwide in a global perspective.
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A situation becomes the focus of global health when it affects people worldwide – as we witnessed with the spread of Covid-19. Global health involves the crossing of borders, as this map of the spread of the virus impressively shows.
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In the constitution of the World Health Organization, health is defined as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Thus, “global health” is understood as “holistic”. Globalisation has allowed people to engage with one another in “one world”, in a social space. This “one world” replaces smaller geographical units such as nations, countries or regions. The rise of globality brought the spread of supraterritorial processes and connections with it whose impacts cannot be located to territorial units. Consider climate change or pandemics. They occur at the same time worldwide, at one place at one time. Causes and consequences cannot be located to individual territories. That is why global health is supraterritorial.
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We can neither work nor do research on global health without considering historical developments. We need to know the burdens and legacies that global health is confronted with. One example is the gender and high-income bias in global health. The Global Health 50/50 report 2020, for instance, shows that more than 70% of the leaders in the sample of 200 global health organisations are men. 80% of these leaders are nationals of High-Income Countries, and more than 90% were educated in High-Income Countries. The report concludes that the current system is “neither fair nor fit-for-purpose”. It recommends that “the health and well-being of people around the world will benefit from – and require – diverse leadership.”
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Another problem was raised by a report called “Delivered by Women, led by Men”, which the World Health Organization released in 2019. The analysis of the gender and equity Global Health and Social Workforce showed that 7 out of 10 social healthcare workers are women. This imbalance shows that Global Health also has an important historical component, carrying with it the legacies of the past. In summary, the word “global” in “global health”
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means: worldwide, border-crossing, holistic, supraterritorial, and, last but not least, historical.
Global health is a field of many different vested interests. Sometimes the parties involved combine their efforts to achieve a common objective. Sometimes these parties put their own objectives above the common good and come into conflict with one another. But what exactly is global health?

During the Covid-19 pandemic, the benefits and challenges of a global health approach became very visible. On the one hand, we all witnessed medical and technological progress: The vaccines were developed incredibly fast. And in order to ensure that the vaccines are equally distributed, the World Health Organization initiated the COVAX scheme. On the other hand, the pandemic showed the limits of global health. We witnessed unsuccessful surveillance and communication; we saw how important supply chains broke down. The way in which high-income countries bought vaccines risked ruining the global COVAX vaccine distribution plan.

Are the limits of global health just the effect of a world overwhelmed by a global crisis? Apparently not. According to the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, the problems in global health predated the Covid-19 pandemic. In a speech before the general assembly in January 2021, he remembered the HIV pandemic in the 1980s and the H1N1 pandemic in 2009. He pointed out that in both pandemics, the world’s poor did not get access to life-saving medicines and vaccines for an incredibly long time. He emphasised that we should avoid the mistakes made during both pandemics. In order to do so, we need to understand that the problem persists.

Watch how Tanja Hammel discusses the definitions, scope, and emergence of global health in this video. Then listen to the audio of the speech of the Director-General of the World Health Organization. Do you think it is possible to ensure that we do not repeat the mistakes of past pandemics? How do we do that?

References

Abdalla SM, Solomon H, Trinquart L, et al. What is considered as global health scholarship? A meta-knowledge analysis of global health journals and definitions. BMJ Global Health [Internet]. 2020 [cited 7 December 2021]; 5 (10). Available from: https://gh.bmj.com/content/bmjgh/5/10/e002884.full.pdf

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