What is Global Health?

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Welcome to Taming the SRU’s Global Health section, where our goals are to increase awareness of global health issues, discuss clinical and ethical cases, and develop opportunities for residents to participate in global health electives.  We believe global health education is critical to well-rounded medical education.  Global health electives (GHEs) often have a profound effect on participants at any level.  One study found that 70% of students participating in GHEs subsequently entered primary care residencies or intended to work in resource-limited settings. (1)  These experiences lead to enhanced clinical and communication skills, humanism, cultural competency, and understanding of alternative concepts of health and disease.  GHEs help trainees foster a deeper understanding of the global collective and how one’s own health is uniquely connected to the rest of the world. (2)

This leads us to some important questions:  What exactly is ‘global health’?  And how does this differ from ‘international health’ and ‘public health’?

Public health focuses on a community approach to health and disease prevention of a given population. (3)  International health, for decades, was the term used for any health work performed abroad.  It generally had a geographic focus on developing countries and a clinical focus on infectious and tropical diseases, water and sanitation, malnutrition, and maternal/child health. (4)  As such, international health is largely characterized by describing health practices, policies, and systems in comparison with our own, stressing differences rather than commonalities.  In my opinion, this tends to reinforce the unequal distribution of power that often permeates relationships between the global ‘North’ and ‘South.’

Global health is a term that subsumes both international and public health, and reflects a maturation of the field.  Global health places a priority on improving health and achieving health equity for all people worldwide and transcends national borders, class, race, ethnicity, and cultural divisions. (5)  There is an emphasis on the concept of a ‘global commons,’ which is based on the belief that the health of all people is connected and interdependent.  Another important term to understand is that of ‘health equity.’  The WHO defines health equity as the absence of systematic disparities in health (or social determinants of health) between different groups of people, whether those groups are defined socially, economically, demographically, or geographically. (6)  Inequities in health place socially disadvantaged people (poor or marginalized individuals, racial/ethnic/religious minorities, and women) at further disadvantage and reinforce unequal power structures.  Equity is an ethical principle and is closely related to human rights principles.  Achieving health equity is an important principle of global health and operationally the goal is to achieve the highest attainable standard of health for all individuals.

With these concepts in mind, we have embarked on developing a Global Health program at University of Cincinnati’s Department of Emergency Medicine.  This has been an active year and it began with the creation of a Global Health Discussion Group with expert led topics such as tuberculosis, collective violence, critical care medicine in resource-limited settings, and EMS development abroad.  Multiple residents and faculty have undertaken projects abroad (Tanzania, Ghana, Uganda, Haiti, Guatemala) this year.  Over the next few years we will be actively working to establish partnerships and collaborations that can serve as active rotation sites for residents and faculty wishing to participate in global health electives.  Finally, we have also achieved representation on the Global Health Advisory Council for UC’s College of Medicine.  The next year promises to be just as exciting as we integrate global health lectures into Grand Rounds, provide longitudinal learning via TamingtheSRU, expand our Discussion group, and develop clinical sites for GHEs.

References

  1. Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ.  Educational Effects of International Health Electives on U.S. and Canadian Medical Students and Residents: A Literature Review.  Academic Medicine.  2003; 78(3):342-7.

  2. Drain PK, Primack A, Hunt DD, et al.  Global Health in Medical Education: A Call for More Training and Opportunities.  Academic Medicine.  2007; 82(3):226-230.
  3. Institute of Medicine. The US commitment to global health: recommendations for the new administration. Washington, DC: Institute of Medicine, Dec 15, 2008. http://www.iom.edu/CMS/3783/51303/60714.aspx (accessed Feb 19, 2009).
  4.  Brown TM, Cueto M, Fee E. The World Health Organization and the transition from international” to “global” public health. Am J Public Health 2006; 96: 62–72.
  5. Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, et al. Towards a common definition of global health. Lancet 2009; 373: 19935.
  6.  World Health Organization.  Health Systems—Equity.  2014.  Accessed on Aug 12, 2014.  http://www.who.int/healthsystems/topics/equity/en/