1. What is global health and
how can it be applied ?
Division of international and humanitarian medicine –
Department of community medicine, primary care & emergency
how can it be applied ?
Dr Slim Slama, MD, MPH
Division of International & Humanitarian Medicine
Geneva University Hospitals
September 11, 2013
slim.slama@hcuge.ch

2. Outline
• Let’s first have your insights – group work
• Global health: a new paradigm or just a
fashion ?fashion ?
• From «international» to «global»
• Health in a context of global changes
• Global Health in practice

3. Group work
• 10 minutes
• One rapporteur
Questions:Questions:
1. What does the term «global health» evoke to
you ?

5. Where do we start?
“Health is a state of complete
physical, mental, and socialphysical, mental, and social
well-being and not merely the
absence of disease or infirmity.”
World Health Organization

6. Public Health
"the science and art of preventing disease,
prolonging life and promoting health through
the organized efforts and informed choices ofthe organized efforts and informed choices of
society, organizations, public and private,
communities and individuals."
C.E.A. Winslow, 1920

7. Global health: a new paradigm or just
a fashion ?
• Recent change in terminology : from
«international» to «global health»
A field growing in popularity and visibility• A field growing in popularity and visibility
over the past several years
• Is this shift in terminology trendy, trivial, or
trenchant?

8. Global health: a new paradigm or just
a fashion ?
• Bunyavanitch and Walkup
interview with 29
international health leaders
in 1999: 50% thought thein 1999: 50% thought the
new vocabulary was
meaningless jargon; 50%
thought a major shift was
underway but seemed
unable to clearly articulate
what it was
Bunyavanich, S. and R. B. Walkup (2001). "US public health leaders shift toward a new paradigm of global health."
American journal of public health 91(10): 1556.

9. From international health
to global health
A long history…
The Roots of International Health: Colonialism and
Tropical Medicine
The Interwar period and the Origins of InternationalThe Interwar period and the Origins of International
Health Institutions
The Postwar Period and the era of Decolonization:
from Disease Eradication to Primary Health Care
Health Care in the 1980s and 1990s: From Primary
Health Care to Disease Eradication
The Global Health Era

10. Any changes or old wines
of international health in
the new bottles of neo-
liberal discourses ?

11. Some common trends
1. Health strategies tend to be developed outside of
countries where health problems exist.
2. Approaches to health tend to be selective rather2. Approaches to health tend to be selective rather
than comprehensive.
3. Health programs are linked to economic
development but serving ideological/political
purposes
4. Neglect of underlying determinants of health

12. From international health
to global health
“ the term ‘global health’
emerged as part of larger
political and historical
processes, in which WHO found
Brown, T. M., M. Cueto, et al. (2006). "The World Health Organization
and the transition from “international” to “global” public health."
Journal Information 96(1). http://1.usa.gov/SoodPs
processes, in which WHO found
its dominant role challenged
and began to reposition
itself within a shifting set of
power
alliances.

13. International health
• Focuses on health issues in other countries in
comparison with our own, stressing
differences rather than the commonalities
between nationsbetween nations
• Historically linked to missionary work and
disease control in low-income countries
• Involved the efforts from wealthier northern
countries to improve the health of peoples
living in poorer southern areas of the globe

14. Characteristics that makes global
health ”global”
• Central concern with the interconnectedness among
populations
• The consequences of globalization on evolving patterns of
health, disease, and social determinants
• The consequences of globalization on evolving patterns of
health, disease, and social determinants
• The transfer of health risks across national borders
(Harvard Global Health Institute 2012)

15. From international health
to global health
“The shift from international to global
health can be said to be occurring where the
determinants of health or health outcomes
circumvent, undermine or are oblivious to thecircumvent, undermine or are oblivious to the
territorial boundaries of states and, thus,
beyond the capacity of individual countries
alone to address through domestic institutions.”
Lee and Collin (2005)

16. Global health
3 main features
1. Trans-national: health issues and determinants
that transcend national boundaries
2. Health equity for all with a focus on the global2. Health equity for all with a focus on the global
socioeconomic, environmental and cultural
factors that determine health
3. Collaborative (or collective) action: critical
importance of collaboration across countries, sectors
and disciplines

17. Global health:
Towards a common definition
“Global health is an area for study, research, and
practice that places a priority on improving health and
achieving equity in health for all people worldwide.
Global health emphasises transnational health issues,Global health emphasises transnational health issues,
determinants, and solutions; involves many disciplines
within and beyond the health sciences and promotes
interdisciplinary collaboration; and is a synthesis of
population-based prevention with individual-level
clinical care.”
Source: Koplan, J.P., T.C. Bond, and M.H. Merson et al. (2009). “Towards a common definition of global health”. The Lancet, Volume
373, Issue 9679, 6 June 2009-12 June 2009, Pages 1993-1995

18. Differences between Global, International, and
Public Health
Source: Koplan, J.P., T.C. Bond, and M.H. Merson et al. (2009). “Towards a common definition of global health”. The Lancet, Volume
373, Issue 9679, 6 June 2009-12 June 2009, Pages 1993-1995

19. Globalization
“A set of processes intensifying human
interaction across economic, political,
sociocultural, environmental andsociocultural, environmental and
technological realms. These changes are
evident across spatial, temporal and
cognitive boundaries.”
Kelley Lee, LSHTM

20. Global connectivity

21. Global Connectivity
mobile phone subscriptions (billions)
In 2013, there are almost as many
mobile-cellular subscriptions (6.8
Source: ITU World Telecommunication/ICT 2013 Facts and Figures. Available at: http://bit.ly/1aA8eqB
mobile-cellular subscriptions (6.8
billion) as people in the world, with
more than half in the Asia-Pacific
region

22. Global Connectivity
Internet users by development level, 2003-2013
Source: ITU World Telecommunication/ICT 2013 Facts and Figures. Available at: http://bit.ly/1aA8eqB

23. Global Connectivity
In 2013, over 2.7 billion people are using the
Internet, which corresponds to 39% of the
world’s population.
Source: ITU World Telecommunication/ICT 2013 Facts and Figures. Available at: http://bit.ly/1aA8eqB
world’s population.
In the developing world, 31% of the population
is online, compared with 77% in the developed
world.

24. Malaria supply chain data
collection using mobile
phone
and an open source cloud-
based mobile data
collection platformcollection platform
(Magpi) in Zambia

25. Globalization and mass media
until 1980s media systems
(print and broadcast) national
in scope
• trade in books, films, music,television for
decades, but broadcasting and publishingdecades, but broadcasting and publishing
industries largely domestically
owned and regulated
• deregulation and privatisation
of media and communication
systems since 1980s
• advent of new satellite and
digital technologies

26. Global Mobility

27. World Air Transport in 2012
and World Passenger Traffic Forecastskilometresperformedpassenger-kilometresperformed

28. World Air Transport in 2012
and World Passenger Traffic Forecasts
World Passenger Traffic increased by 4.5% in
2012, corresponding to 3 billion passengers and2012, corresponding to 3 billion passengers and
43.5 million aircraft departures
Source: International Civil Aviation Organization (ICAO)
http://bit.ly/1aAaYV9

29. Cognitive dimension of global change
• Changes to how we
think about
ourselves and the
world around us
• Mass media
culture
• Culture
• Wants/needs
culture
• Advertising firms
• Consultancy firms
• Research
institutions
• religious groups
political parties
Wants/needs
• Aspirations
• Knowledge
• Values
• Ideologies

30. Health in the context of globalization
“the world is rapidly being
moulded into a shared social space by
economic and technological forces and that
developments in one region of the world candevelopments in one region of the world can
have profound consequences for the life
changes of individuals and communities on
the other side of the globe”
Held et al. (1999)

31. Health in the context of globalization
• World become single entity
• Increased movements of information, services
and people
• Across borders of countries• Across borders of countries
• Facilitated by
– IT : improved communication
– Policies on various sectors

32. Globalization and Economy
From economic perspective, globalisation is
characterised by:
• Increase in international trade
• Foreign Direct Investment• Foreign Direct Investment
• Capital Market Flows
• “Openness”of individual countries economy to
the rest of the world

33. Globalization:
Opportunities or threat to health?
“All the indications are that the current forms
of globalisation are making the world a safe place
for unfettered market liberalism and the consequent
growth of inequities. This economic globalisationisgrowth of inequities. This economic globalisationis
posing severe threats to both people’s health and
the health of the planet.”
Professor Fran Baum
Flinders University, Australia
(2001)

35. Impacts of globalization on health
• Spread of Communicable Diseases and Non Communicable Diseases
SARS Outbreak, Avian Influenza (H5N1)
Obesity, DM and increase in lifestyle related NCDs
Global Trade including liberalisation in health services• Global Trade including liberalisation in health services
Brain drain, medical tourism, telemedicine
Access to Medicine and Drugs (IPs)
Tobacco trade
• “Forced adoption” of adverse health policies
Privatisation
User fees
Private Health Insurance

36. Global health threats: Bioterrorism

37. Between November 2002 and July 2003,
an outbreak of SARS spread from Hong
Kong to infect individuals in 37 countries
becaming a pandemic, with 8,422 cases
and 916 deaths worldwide
Global health threats- Emerging
infectious diseases

38. An example of
health risk at the
human-animal-
ecosystem
interface
H5N1 viruses are thought
to be circulating
endemically in poultry in
China, Egypt, Indonesia,
Viet Nam, Bangladesh
and India

39. Cumulative number of confirmed human cases for
avian influenza A(H5N1) reported to WHO, 2003-2012
(as August 2012)
608 cases, 359 deaths, 15 countries

41. Global Trade of Harmful Products

42. Global Trade of Harmful Products
In 2011, tobacco use killed almost 6 million
people, with nearly 80% of these deaths
occurring in low- and middle-income
countries.countries.
When considering 2010 deaths with tobacco
industry revenue, the tobacco industry
realizes almost $6,000 in profit for each
death caused by tobacco

43. Global health threats- Lifestyles
related health challenges

44. Trade in health services & health
workers’ brain drain
Doctors from abroad in numbers
and percentage
Adapted from the WHO 2006 World Health Report, Chap 5, p.98, Table 5.1

45. Climate changes and health threats
United States Areas Vulnerable to Dengue
Fever
Source: Natural Resources Defense Council: http://www.nrdc.org/health/climate/

46. Health and its determinants
• Determinants of health are the direct or
indirect causes of a disease
• either direct (proximal) or indirect (distal)
• The health effects of distal determinants are• The health effects of distal determinants are
often mediated through proximal and
intermediary determinants
• Distal determinants cannot be acted upon
through direct health sector interventions
Lerer LB et al. Health for All: vision to strategy – the role of health status
and determinants. World Health Statistics Quarterly, 1998, 51: 7–20.

47. Health and its determinants

48. Health and its determinants
Example:
• Smoking is a proximal determinant of health
status, while the economic, demographic andstatus, while the economic, demographic and
social factors that promote tobacco use are
distal determinants.

49. Health in the context of globalization
Conceptual framework for globalisation and population health.
Huynen et al. Globalization and Health 2005 1:14 doi:10.1186/1744-8603-1-14

50. Obesity: Web of causation

51. How does all this link to this course?
• Human & eco-systems health are linked
• Both are shaped by material, biological, social
and cultural circumstances

52. Human & eco-systems health
Courtesy: G.Rayner & T. Lang

53. An interesting podcast
on the concept of
ecological public health
from the British Medical
Journal:
http://bit.ly/1hBo3v2

54. What are these conceptual models
trying to do?
• Address complexity
• Capture dynamics and interactions
• See health as shaped by different levels,
dimensions or determinantsdimensions or determinants
• Identify key transitions shaping human health
• Spot key actors and institutions both making and
breaking health
• Place human health within biological, material,
social and psychological processes

55. Applying a systemic approach to
global health challenges
• Newly Emerging and Re-emerging Diseases of Public
Health Importance
SARS, Avian Influenza, HIV/AIDS, Tuberculosis,
Malaria
• Increase Global Burden of Non-Communicable Disease• Increase Global Burden of Non-Communicable Disease
and Unhealthy Lifestyle
Diabetes Mellitus, Hypertension, Stroke,
Obesity, Smoking
• Health Care Delivery System
Health Financing Issues, Efficiency, Equity,
Access, Quality of Care

56. The International
Council for Science
(ICSU) Programme
on Health and
Wellbeing in theWellbeing in the
Changing Urban
Environment
http://bit.ly/13IvRrU

59. http://bit.ly/13IxC8t

60. http://bit.ly/1hBpaec

61. Capacity of slum dwellers/informal settlements
to improve total health and wellbeing

62. Global Health as “Unifying Paradigm”
• Acknowledge complexity and adopt a
systemic approach
• Enable the integration of public health,
medecine and disciplines beyond health
sciences

63. Global Health Education
• Call for reforms
• From evidence based problem based
learning system thinking,
• Build competencies and skills to adapt to a• Build competencies and skills to adapt to a
multicultural world
• Interdisciplinarity

64. Global Health Research
Examples:
• Impact of globalization on health and
intersectoral policies
• Healthcare delivery in resource limited• Healthcare delivery in resource limited
settings
• Global health governance and diplomacy

65. Global Health advocacy
• Adopting a Human-Rights approach and taking a
position in favour of equity and social justice
at local and international level.
• Raising public awareness about global health
disparities and ways to reduce themdisparities and ways to reduce them
• Keeping a critical eye on policies and activities
that influence health and health determinants
• Understanding who are the key actors and how
do they frame/influence global health issues
• Giving a voice and listening to frontliners

66. Global health not just an academic
field
“Global Health is not merely academic: in fact,
promoting an ethic of social responsibility both for the
institutions and professionals involved, it embraces theinstitutions and professionals involved, it embraces the
fields of research, education and practice, and aims to
generate real changes in both the communities across
society, bridging the gap between scientific evidence
and operational decisions.”
Chiara Bodini, CSI, Bologna, Italy

67. “Education either functions as an instrument which is
used to facilitate integration of the younger generation
into the logic of the present system and bring about
conformity or it becomes the practice of freedom, the
means by which men and women deal critically andmeans by which men and women deal critically and
creatively with reality and discover how to participate in
the transformation of their world.”
Paulo Freire, Pedagogy of the Oppressed

68. The University of
Geneva undertook in
2012 an all faculties
mapping exercice
assessing the
University’s expertiseUniversity’s expertise
in the field of global
health. More than 400
people accross the
University are involved
in global health related
activities.

69. www.genevahealthforum.org

70. Thank you for your attention
Questions?Questions?