User:LGreg/sandbox/Approaches to Knowledge (LG seminar 2020/21)/Seminar 18/History/History of Global Health

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Defining global health[edit | edit source]

Global health lies at the convergence of many fields such as medicine, epidemiology, economics, demography, and international relations. As cited by Beaglehole et al., it is defined by Macfarlane et al. as the ‘worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders'.[1]

Origins[edit | edit source]

Formal international health cooperation, whilst not yet termed 'global health', first began in the mid-nineteenth century, in the form of the fourteen International Sanitary Conferences,[note 1]which took place between 1851 and 1938, with the objective of regulating the length of quarantine periods for diseases across different countries.[2]

However, whilst in practice what might now be regarded a constituent of global health was prevalent beforehand, conceptually, global health only emerged when the term first began to be used in scientific literature in the late 1940s, during the immediate aftermath of the Second World War (which had drastically affected the health of citizens around the world).[3] This was a period characterised by the onset of a changing socio-political landscape, whereby scientific developments flourished, and states adopted a more internationalist and multilateral outlook.[4]This, furthered by increasing globalisation and the easier proliferation of knowledge worldwide, led to nations being more invested in developing solutions to scientific issues collaboratively.[4]

Development as a discipline[edit | edit source]

The consolidation of global health as a discipline occurred following the inception of the World Health Organisation in 1948 - the first international governing body to institutionalise and specialise on the growing movement (whilst the OIHP and the health organisation of the League of Nations, formed in 1914, also dealt with improving the control of diseases, they were not formed in response to the emergence of global health as a discipline).[2] The year 1995 also denotes a pivotal moment in the history of global health, as it signifies the start of the dramatic increase in searches on PubMed using the term.[5]Subsequently, other organisational frameworks have also arisen to further formalise the area, and provide a network for contributors to engage with each other and advance the field, including academic journals such as The Lancet Global Health, founded in 2013, and now many universities, such as University College London, the University of Oxford, and Harvard University offer professional certifications on the field.

Whilst often still conflated with the two, global health distinguishes itself from both public and international health given its specialised object of research, which focuses on health related issues that can only be solved by the implementation of strategies on a global scale (as implied by its name).[6]Public health, on the other hand, solely works at a national level, whilst international health focuses on binational partnerships to aid low and middle-income countries.[6] Indeed, it has even been contested by Jose Miguel DeAngulo and Luz Stella Losada that global health is gradually replacing international health all together and thus signalling a paradigm shift in health governance and management.[7]Moreover, global health is further distinct in that one of its primary objectives is to achieve health equity for all citizens around the world.[6]

Global health research[edit | edit source]

A crucial component of global health's methodology is that, in order to be considered part of the discipline, studies must be either one of two types of global health research (GHR).[3] Type 1 GHR includes studies collating data from a broad range of locations and ethnic populations, whilst Type 2 GHR involves studies with a global framework and consideration, but with data limited to only one small region.[3]

Contributors to the field, notably Craig Stephen, have now also suggested the identification of four key competencies required by global health researchers.[8] These entail: collaborative skills, systems-based thinking (as opposed to a linear approach), the ability to lead and manage a project, and 'ethical and personal perspectives'.[8]Stephen further highlights six common themes prevalent in the GHR practices of the fourteen teams he studied - to include: excellence in research, an emphasis on long-term research goals, a priority on implementing strategies, the formation of partnerships between different agencies around the world, an 'ethical foundation', and the presence of skilled researchers - which he presents as being integral to the discipline as a whole.[8]

Future of the discipline[edit | edit source]

Despite its relative brevity as a discipline, conflicts have already arisen in global health regarding the extent to which it reflects neocolonialist attitudes. The current paradigm of global health, argued by Rafael Pérez-Escamilla, is inherently racist given its assumption that low-income countries are unable to implement solutions without the assistance of Western powers.[9] On a similar vein, Büyüm et al. contest that historical ideas, such as slavery and racism, perpetuate modern-day inequalities and silences within the discipline (evidenced by the 10/90 gap and the fact that most global health networks are based in the Northern Hemisphere)[1], and that without addressing these factors and other underlying social determinants of health, health equity cannot truly be achieved.[10] These sentiments have led to players in the discipline calling for a paradigmatic shift from the so-called 'charity model of global health' to one based upon principles of justice.[11]

Furthermore, whilst historically to date global health has always incorporated aspects of foreign policy and international affairs, in terms of aid distribution and multinational agreements, a new (sub-)discipline of global health diplomacy is currently evolving, which has the potential to break free and distinguish itself as a separate entity in its own right.[12] Thus, the future of global health as a discipline remains open to significant change.[12]

Notes[edit | edit source]

  1. ↑ It was at the 1903 conference where government representatives conceived the idea of an international health regulatory body. This notion was actualised in 1907 with the establishment of the Office international d'hygiène publique (OIHP) in France, which commenced operations the following year

References[edit | edit source]

  1. ↑ a b Beaglehole R, Bonita R. What is global health?. Global Health Action [Internet]. 2010 [Accessed 16 October 2020];3(1):5142. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852240/.
  2. ↑ a b WHO | Origin and development of health cooperation [Internet]. Who.int. 2020 [Accessed 16 October 2020]. Available from: https://www.who.int/global_health_histories/background/en.
  3. ↑ a b c Chen X, Li H, Lucero-Prisno D, Abdullah A, Huang J, Laurence C et al. What is global health? Key concepts and clarification of misperceptions. Global Health Research and Policy [Internet]. 2020 [Accessed 16 October 2020];5(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136700/.
  4. ↑ a b Robinson S. Collaboration on Defence, Intelligence, and Internationalism During the 1950s. Ocean Science and the British Cold War State [Internet]. 2018 [Accessed 16 October 2020];:113-151. Available from: https://link.springer.com/chapter/10.1007/978-3-319-73096-7_4.
  5. ↑ Chen X. Understanding the development and perception of global health for more effective student education. Yale J Biol Med [Internet]. 2014 Sep [Accessed 16 October 2020]; 3;87(3):231-40. PMID: 25191139; PMCID: PMC4144278. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144278/.
  6. ↑ a b c Koplan J, Bond T, Merson M, Reddy K, Rodriguez M, Sewankambo N et al. Towards a common definition of global health. The Lancet [Internet]. 2009 [Accessed 16 October 2020];373(9679):1993-1995. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60332-9/fulltext.
  7. ↑ DeAngulo J, Losada L. Health paradigms shifts in the 20th Century. Christian Journal for Global Health [Internet]. 2015 [Accessed 17 October 2020];:49-58. Available from: https://journal.cjgh.org/index.php/cjgh/article/view/37/182.
  8. ↑ a b c Stephen C, Daibes I. Defining features of the practice of global health research: an examination of 14 global health research teams. Global Health Action [Internet]. 2010 [Accessed 17 October 2020];3(1):5188. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903310/.
  9. ↑ Pérez-Escamilla R, Desai M. Neocolonialism and Global Health Outcomes: A Troubled History [Internet]. Yale School of Public Health. 2020 [Accessed 17 October 2020]. Available from: https://publichealth.yale.edu/news-article/27971/.
  10. ↑ Büyüm A, Kenney C, Koris A, Mkumba L, Raveendran Y. Decolonising global health: if not now, when?. BMJ Global Health [Internet]. 2020 [Accessed 17 October 2020];5(8):e003394. Available from: https://gh.bmj.com/content/5/8/e003394.
  11. ↑ Adams L, Wagner C, Nutt C, Binagwaho A. The future of global health education: training for equity in global health. BMC Medical Education [Internet]. 2016 [Accessed 17 October 2020];16(1). Available from: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0820-0.
  12. ↑ a b Kickbusch I. Global health diplomacy: training across disciplines. Bulletin of the World Health Organization [Internet]. 2007 [Accessed 17 October 2020];85(12):971-973. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636315/.
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