A Primer on Global Health

Global health is as large a topic as it sounds, covering everything that affects human health on this planet. The big overarching global health themes include infectious diseases that cross borders, health conditions serious enough to have impact on global politics and economics, and issues like pollution and war which impact health and ignore national boundaries. It overlaps a lot of other disciplines, including public health, international development, and medicine. People tend to use global health to mean tragic-human-suffering-in-the-developing-world, but that's inaccurate in a lot of ways. Wealthy countries have health issues too, and those health issues can have a global impact. And global health does have successes – it's not just a long list of tragedies.

Major Global Health Theme #1 - Communicable Diseases

Communicable diseases are a major threat to global health. They include familiar killers like HIV/AIDS, polio, tuberculosis, and malaria (in 2007, an estimated 33 million people were living with HIV worldwide). They are deadly, devastating illnesses, but for many of them there are vaccinations or treatments - sometimes even cures - if we have the will to pay for them. For example, as a result of concentrated efforts to fight polio, in 2008 only four countries -- Afghanistan, India, Nigeria and Pakistan -- remained polio endemic. Malaria and tuberculosis are almost always treatable. That's good news, but many governments can't afford the cost of providing treatment or lack the health infrastructure to manage necessary care.

Emerging infectious diseases like avian influenza and extremely drug-resistant tuberculosis (XDRTB) present new challenges. We'll need research and fresh ideas if we're going to really do anything about them. They're both extremely scary. XDRTB is resistant to most current tuberculosis drugs, and can only be cured 50-80% of the time. Avian influenza (and other new forms of influenza) could decimate the world's healthcare systems – we simply don't have the infection-control in place to contain a major flu outbreak.

Avian influenza, known as H5N1, can be spread by migratory birds to a nation's domestic chicken population and then to people. We can't stop wild birds from flying, there is no available vaccine, and almost all the people who are infected die rapidly. It can mutate at any time to a new form of the virus which could spread from person to person instead of just via birds. We are going to need better prevention against contagion – better hospital guidelines, better treatment guidelines, and serious equipment like positive-pressure isolation rooms – just to slow an epidemic of influenza or XDRTB. We're going to need new drugs if we want to put up a serious fight against them.

These big-name illnesses are compounded by the effects of diarrhea and respiratory infections. In an adult, these sicknesses can complicate an existing illness and lead to death. In a child, they are deadly on their own. Diarrhea kills 2.2 million children every year worldwide; respiratory infections cause about 20% of all child deaths in the developing world.

Major Global Health Theme #2 – War, pollution, and poverty

Illness and disease are not the only factors that affect global health. Systemic problems like war, pollution, and poverty have a powerful impact on health, quite possibly a greater impact than infectious diseases.

The health effects of these systemic problems include direct impacts such as cancers caused by pollution, deaths from war, and poverty-related malnutrition. They also include indirect impacts. War causes displacement – people leave their homes. This displacement puts them at risk for dramatically worsened health. Pollution may completely eliminate water sources, kill off fisheries, damage farmland, and poison food sources. Poverty makes every aspect of life more difficult. As the WHO puts it, "poverty creates ill-health because it forces people to live in environments that make them sick, without decent shelter, clean water or adequate sanitation." Janet Torpy, in the Journal of the American Medical Association, points out that "poor people have a shorter life expectancy than wealthier people, and more mothers and children die in poor areas…"

Major Global Health Theme #3 – More developed does not equal healthy

It's easy to think that global health actually means "health in the developing world." People in the US or Sweden don't generally die from tuberculosis; children in France don't die from diarrhea. However, there are a number of health conditions in the developed world with the potential for world-wide impact. This is both because of the way they affect the economies of wealthy nations and because, most likely, they will soon be problems for the developing world.

Diabetes is epidemic in the United States and in other parts of the wealthy world. (It is also on the increase in poorer countries..) Alzheimer's and other dementias are seeing a frightening rise which may have a dramatic effect on health care systems in North America and Europe. It has been estimated that there will be 16 million Americans with Alzheimer's Disease by 2050; there are currently 700,000 Britons with the disease. Cardiovascular disease is a major threat in wealthier countries; it's the number-one cause of death in Europe and the United States.

Chronic diseases like diabetes, cardiovascular disease, and dementia are expensive to treat and require tremendous efforts from health care providers; they are already straining health care capacity. As these ailments multiply, they will push health care systems to their limits, forcing governments to make difficult economic choices.

What does the future hold?

It's going to get worse. Global warming is going to be very bad for human health, pollution is worsening, and urbanization is making life harder for whole lot of people. Global poverty will be intensified by the recession we're seeing. Globalization and increasing air travel let infections spread to more people than ever before. The systemic and biological challenges facing global health are getting more severe, and there is very little we can do to prevent that.

That being said, we've seen global health successes. We actually eradicated smallpox; it ravaged human health for 3,000 years and then we got rid of it in 1979. We've got vaccinations for measles, mumps, whooping cough, even chicken pox. We're slowly but surely pushing polio off the planet. These are victories, and they prove that our global public health system is capable of great things, if we find the funding and the will.

We can fight the new global health threats, too. We're extending the boundaries of health knowledge all the time. Good research can help us fight treatment, cures, and vaccines for new and evolving infectious diseases. Globalization actually contributes to good research, by letting people share knowledge and methods. We're also learning more about how to address systemic factors that damage health. International financial actors like the International Monetary Fund and the World Bank are starting to address the health impact of poverty and war. The World Health Organization, from the other side, is looking at the full web of factors that contribute to health and starting to advocate for anti-poverty measures and other pro-active attempts to protect health.

Here’'s what we have to do to face the new global health challenges: make our governments take them seriously, support innovative efforts to protect health, and improve health in our families and communities.

Push your elected officials to provide financial support to global health programs like the World Health Organization, the Global Fund, and your country's international health programs. Talk to your friends and neighbors about why funding for global health programs matter. Use your vote wisely.

Donate to projects and programs doing work you believe in. Identify what health issues have resonance and importance for you, learn about them, and give to organizations what work on them. This could be HIV/AIDS, child health, maternal health, cancer – whatever matters to you.

Lastly, we have to do our own personal work to support global health. Use protection when you have sex; don't become part of the HIV/AIDS epidemic. Eat a diet low in saturated fat to minimize your chances of cardiovascular disease. Get your vaccinations. Choose a walkable place to live, and support neighborhood organizations that promote health at the local level. Global health includes all of us, not just as donors but as active participants.