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Global health addresses social issues and attributes that are contextual and knocks on the social determinants of health of an individual and the community and the society when looking for solutions.
Global health is a relatively new term, a few years or decades old, coming of age of late measured by the increasing number of academic institutions and organizations using this name to highlight their interests and expertise. Koplan and colleagues propose a definition of global health that they hope will receive wide acceptance and thus encourage global health efforts. They distinguish between global health, international health, and public health; tropical medicine has close connections with international health.
International health, in Koplan’s view, focuses on the health issues, especially infectious diseases, and maternal and child health in low-income countries. However, multiple discussions and opinions have also termed it as the “involvement of countries in the work of international organizations, usually through small departments of international health in the Ministries of Health, and as development aid and humanitarian assistance.” Then comes “public health”, a widely popular and equally misunderstood term, usually viewed as having a focus on the health of the population of a specific country or community. Public health is also used to address underlying social, economic, environmental, and political determinants of health.
Defining Global Health
This brings us to “global health”. Koplan et al. defines global health as ‘an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide’. This is a useful definition, with a broad focus on health improvement and health equity. At the same time, this definition has been criticized as “wordy” and “uninspiring” by certain scholars of the same intellectuality. Around the European world, global health has been described as “those health issues where the determinants circumvent, undermine, or are oblivious to the territorial boundaries of states, and are thus beyond the capacity of individual countries to address through domestic institutions”.
Global health is focused on people across the whole planet, rather than the concerns of particular nations. Global health recognizes that health is determined by problems, issues, and concerns that transcend national boundaries. A proposed definition describes global health as a “collaborative transnational research and action for promoting health for all”, along with another that proposes it to be a “worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders”. Health for all refers back to the Alma Ata Declaration and positions global health at the forefront of the resurgence of interest in multi-sectoral approaches to health improvement and the need to strengthen primary health care as the basis of all health systems.
After the text-book friendly definitions and descriptions comes reality. So, is global health a high-income community concern? Is it feasible to be talking about international issues when low and middle income countries are grappling with health and social challenges of their own? Is the approach to solving their problems more local than it is global?
Ebola: A Global Health Issue
An example of a global health scale response would be Ebola. The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo has continued this month (August 2019), with transmission intensity to recent weeks, with an average of 85 cases per week. More than 11,000 people died from Ebola virus disease (EVD) in Guinea, Liberia, and Sierra Leone during the 2014–15 West Africa epidemic: many times more than the total infected during all previous outbreaks of the disease combined. Ebola virus disease (formerly known as Ebola hemorrhagic fever) is a severe, often fatal illness, with a death rate of up to 90% caused by Ebola virus, a member of the filovirus family.
The Ebola virus can cause severe viral hemorrhagic fever (Ebola HF) outbreaks in humans with a case fatality rate of up to 90%. Ebola HF symptoms include a sudden onset of fever, intense weakness, muscle pain, headache, and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver functions, and in some cases, both internal and external bleeding. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. People can become exposed via direct contact with blood and/or secretions of an infected person. Friends and family members are at an elevated risk when caring for the infected person through close contact with such secretions. Health care workers have also been frequently infected in medical facilities. No specific treatment or vaccine is yet available for Ebola HF, but new promising drug therapies are being evaluated.
The severity of the outbreak opened the eyes of the world to our collective vulnerability to emerging and re-emerging infectious diseases, and the need for coordinated global action to ensure that we are better prepared for the next outbreak. International surveillance systems were up and running to screen travelers and migrants to prevent and detect cases. News on prevention protocols, transmission, and control were disseminated. International non-governmental organizations working with the national health systems had referral systems for treatment and prevention. In areas with compromised access and lacking specialized forces, unreachable areas, or insufficient resources of other kind, countries were helping each other and working towards preventing, detecting, and responding to Ebola. Organizations are involved in the response and continuous monitoring of changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last assessment has concluded that the national and regional risk levels remain very high, while global risk levels remain low.
A Comprehensive Approach
“Diseases do not understand boundaries. People are traveling more. Food and medical product supply chains stretch across the globe. Biological threats pose a growing danger to people everywhere, whether diseases are naturally occurring, intentionally produced, or the result of a laboratory accident. In today’s interconnected world, poorly treated cases of tuberculosis or pneumonia in Asia and Africa show up in U.S. hospitals within days.” (U.S. CDC).
Global health addresses issues on a rather comprehensive scale, encompassing transnational problems and boundaries. At the same time, global health addresses social issues and attributes that are more contextual and knocks on the social determinants of health of an individual and the community and the society when looking for solutions. It primarily addresses issues of equity and disparities among castes, creed, and other forms more common to low and middle income countries like ours. “Why treat people and send them back to the conditions that made them sick?” Michael Marmot asks his readers. Global health works towards improving those conditions in a sustainable manner, not just in treating the illness.
On some days, its income, other days its hygiene and mostly, we blame the society we grow up in. So, that way, rich and educated countries should be boasting of good health and prosperity always, which is not the case. Poverty, inequality and equity, social disadvantage and empowerment, we all know the causes of ill health, but we still have them. Conventional approaches have emphasized access to technological sources and change in the behavior of individuals, but these have only helped so much. Among others, what has worked is improving the conditions for people to live in, so they can lead healthy flourishing lives. Improving conditions decreases vulnerability and susceptibility.
Now, conditions comprise of a whole lot of things, starting from birth, lifestyle, sanitation, education, awareness, health security, migration, genetics, the life course, and many others .While it may mean this for us, it may mean something completely different for someone who belongs to the other side of the globe. Everything is hence contextual, to each their own; one person’s health needs are different from that of another. This highlights the key of global health—Equity or Equity in Health. The road is a collective one, that of economic, social, and environmental development. Countries have long been working hard to achieve this goal, and while it has not been an easy one, marked progress is being made, acknowledging this as a goal being one of the most important one.
Promising Results of Experimental Drugs for Ebola
A randomized, controlled trial of four investigational agents (REGN-EB3, mAb114, ZMapp, and remdesivir) for the treatment of patients with Ebola virus disease began on Nov 20, 2018 as part of the emergency response to an ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC). As of Aug 9, 2019, the trial had enrolled 681 patients toward an enrollment total of 725.
The preliminary results in 499 participants indicated that those receiving REGN-EB3 and mAb114 had a greater chance of survival compared to participants in the other two arms. Based on this result, an independent data and safety monitoring board (DSMB) recommended that all future patients be randomized to receive either REGN-EB3 or mAb114 as an extension phase of the study. Co-sponsored and funded by the National Institute of Allergy and Infectious Diseases of the U.S. National Institutes of Health and Institut National de Recherche Biomédicale, the study is carried out by an international research consortium coordinated by the World Health Organization and supported by four pharmaceutical companies, namely, Regeneron, Ridgeback Biotherapeutics, MappBio, and Gilead.
