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Demystifying Global Health
Definitions, Players, History and
Current Day Realities
Outline
 Defining ‘global health’
 The Big Players
 History and evolution of global health
 Current day reality
What is global health?
 Cross-disciplinary view
 Evolved from concern over infectious
disease control in industrialised ...
Social determinants of health
Social determinants of health
 Conditions in people grow, live, work
and age have powerful influence on
health
 Vast maj...
International Public Health
“the application of the principles of
public health to health problems and
challenges that tra...
What’s global about it?
 The determinants circumvent,
undermine or are oblivious to the
territorial boundaries of states ...
Three principal concerns:
(1) The global distribution of health and
disease and their determinants;
(2) The impact of glob...
So what?
 Self-interest: Migration and
infectious disease; human ‘security’
 Trade: Impact on economic growth
 Social j...
The ‘Big Players’
 Bretton Woods Institutions
 World Bank
aims to “reduce poverty and improve living standards by promot...
A short tour of global health
1945
United Nations
1948
World Health
Organisation;
UDHR
1978
Declaration
of Alma Ata
1970s+...
The United Nations
 Created 1945
 Purpose was to maintain international
peace and security
 International economic and ...
A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Gl...
World Health Organisation
“Health is a state of
complete physical,
mental, and social well-
being and not merely the
absen...
The World Health Organisation
 International efforts to
monitor/combat infectious diseases
 Development and distribution...
A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Gl...
Health for All by 2000
 Alma Ata – Kazakhstan – September
1978
 Declaration of Alma Ata:
 “Primary health care is essen...
Health for All by 2000
 Components of primary health care:
 Education
 Promotion of food and nutrition
 Water and sani...
Health for All by 2000
 Involves related sectors:
 Agriculture
 Animal husbandry
 Food
 Industry
 Education
 Housin...
Selective vs Comprehensive Care
 ‘Counter-revolution’
 World Bank challenges comprehensive
approach
 Costs of $5.4-9.3 ...
A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Gl...
Structural Adjustment Policies
 Oil crisis of 70s and 80s
 Global economic recession
 Period of crisis, increased pover...
Structural Adjustment Policies
 Cuts in public spending and
consumption
 Social services such as health and
education hi...
A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Gl...
A declaration with a difference?
 Millennium Development Goals
#1 Eradicate extreme poverty and hunger
#2 Achieve univers...
A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Gl...
Pressure on governments to relieve debt
$83 billion in debt cancellation
Spending on public services increased by 20%
http...
A short tour of global health
1945
United Nations
1948
World Health
Organisation
1978
Declaration
of Alma Ata
1970s+80s
Gl...
The Global Fund
 To fight AIDS, Tuberculosis and
Malaria
 Financing agency (>90% funds from
governments)
 Claims that b...
Current state of global health
 Aid vs Trade - $79 billion in 2004
 “some thirty official donors in addition to
several ...
Final remarks
 Inequality and injustice widespread
 Principles of primary care still
neglected
 Global health affects u...
Intro to Global Health
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Intro to Global Health

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Intro to Global Health

  1. 1. Demystifying Global Health Definitions, Players, History and Current Day Realities
  2. 2. Outline  Defining ‘global health’  The Big Players  History and evolution of global health  Current day reality
  3. 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. 4. Social determinants of health
  5. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  26. 26. 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
  27. 27. 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
  28. 28. 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
  29. 29. 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?
  30. 30. 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
  31. 31. 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

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