Welcome to the world of Global Health!

It sounds exciting — an entire world to explore! 

But what do we even mean by Global Health? You may have heard of the field Public Health as well. Are Public and Global Health the same? Similar, but different? Where does the field of clinical medicine fit in? And why do we even need an entire field dedicated to Global Health?

The COVID-19 pandemic has launched the fields of Public and Global Health to the forefront of our lives — from news headlines to conversations with families and friends to rules, regulations, recommendations and legal battles that drastically altered the rhythms of life — most of the world whether they know it or not has been living Public and Global Health for months. Actually, we’ve always been living Public and Global Health!

But again, what do these terms actually mean?

In this first section, let’s break it all down. 

We will start with the definition of health.

Health

Global Life Expectancy

Advancements in the field of medicine have inarguably made substantial contributions to health gains globally in the last centuries. Think of the video you watched on smallpox. Without vaccine technology, the smallpox virus would almost certainly never have been eradicated. However, most of our major health milestones would have been impossible to achieve without Public Health solutions and actions as well. But what is Public Health? See different definitions for this wide-ranging field below.

Public health is the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society. 

(Acheson, 1988; WHO)

Public health researchers, practitioners and educators work with communities and populations. They identify the causes of disease and disability, and implement large scale solutions (also referred to as interventions).

(Johns Hopkins Bloomberg School of Public Health, n.d.)

Public health is committed to justice and equity, especially relating to the achievement of the highest standard of health and well-being.

Public Health is interdisciplinary, encompassing and relying on the knowledge, skills and approaches from a range of disciplines and professions. 

(WHO, 2012)

Epidemiologists use data – both quantitative (statistics) and qualitative (interviews and focus groups) data – to study and identify patterns and causes of diseases. These analyses are used in the formation of public health policy and programming at all levels of public health systems.

Essential Public Health Services

The Ten Essential Public Health Services were created to help define the role and purpose of public health when working within communities (see Figure 1).

There are three major components that these Ten Essential Public Health Services fall into: 

• Assessment
• Policy development
• Assurance 

Assessment provides the agencies and departments time to look at the health of their community. This gives them time to interpret and share data that was collected within their community. 

Policy development uses the known information that was collected during Assessment and implements policies to solve health problems of the community. 

Assurance involves public health agencies providing programs that the community needs. Programs may come directly from the agency itself or from external actors (refer to Public Health Systems Actors above). Overall, making sure that their community has the services they need in order to thrive in an healthy environment (Pomeroy, Asante and St. Louis, n.d.).

Public Health & Clinical Medicine: Same or Different?

Is Public Health different from the field of clinical medicine? Now that you know how Public Health is defined, read and reflect on the definition of clinical medicine below. 

What similarities do you see between the fields of Public Health and clinical medicine? How are the two fields different?

Clinical medicine is focused on the prevention, diagnoses, and treatment of diseases at the individual level

(Fineberg, 2011)

What key terms stood out to you in each definition? Table 1 helps us break down the differences between Public Health and medical approaches to addressing health challenges. As you review the differences between the two fields, note that both fields contribute in interrelated ways to addressing health challenges and improving health overall.

Would health outcomes improve if one field existed in isolation from the other? Probably not. It would be very hard to address major health challenges with just Public Health or clinical medicine alone. Think again of smallpox. Would we have eradicated smallpox without a vaccine from clinical medicine and research? Almost certainly not. But, if we had  not had Public Health systems to get the vaccine to populations around the world the vaccine would have been useless!

Table 1. What distinguishes Public Health from Medicine?

Dimension	Public Health	Clinical Medicine
Focus	Populations	Individual
Ethical orientation	Public service	Personal service
Approach to addressing health challenges	Disease prevention and health promotion for the entire community	Some prevention, but main focus on disease diagnosis and treatment for the individual patient
Intervention emphasis	Spectrum of interventions aimed at the environment, human behavior and lifestyle, and medical care	Places predominant emphasis on medical care
Foundational scientific perspectives	Life sciences central, with a prime focus on major threats to the health of populations Research moves between laboratory and field	Biological sciences central, stimulated by needs of patients Research moves between laboratory and bedside
Integration of social science perspectives*	Social sciences and public policy disciplines an integral part of public health education	Social sciences tend to be an elective part of medical education (though this is changing)

Table 2. offers examples of health interventions to address different health challenges from both Public Health and clinical medical perspectives. Again, note the interrelated nature of the two fields — for example, could we prevent the spread of COVID-19 globally with only Public Health or medical actions alone?

Table 2. Addressing health challenges from Public Health and Medical perspectives

Health challenge	Public Health actions	Clinical Medical actions
Reducing child deaths from diarrhea	Improving water and sanitation systems to prevent children from contracting diarrheal diseases Educating communities about the importance of handwashing in preventing diarrhea	Health providers are trained to identify & diagnose severe diarrhea Health providers give patients treatment appropriate for symptom severity (oral rehydration, IV rehydration, antibiotics)
Preventing the spread of COVID-19 via vaccination	Coordinate production and distribution of vaccine (once it is created and tested for safety) Set policies for priority populations to receive vaccine Inform the community about the vaccine’s benefits and risks	Invent a vaccine Thoroughly research and test vaccine for efficacy and safety Physically deliver vaccine to patients
Preventing motorcycle deaths	Work with lawmakers to enact helmet laws Work with local government officials to make roads safe for motorcyclists Educate the community on the risks of riding without a helmet	Strengthen referral systems between health facilities so that serious injuries are transferred to advanced facilities and treated quickly Ensure medical facilities and health providers are equipped to treat serious road injuries

Public Health & Clinical Interventions

Taking it global

We’ve covered a lot of information so far —

✔ How do we define health?

✔ What is Public Health? 

✔ What are examples of different Public Health actions?

✔ How do Public Health and clinical medicine differ?

But we still have not answered our original question — what is Global Health? Let’s do that now!

As you saw with Public Health, the field of Global Health is broad and touches on a number of different subject areas and topics of interest. The field of Global Health is also much younger than the field of Public Health and has changed significantly over time. We will explore the roots, history and evolution of the field of Global Health in more detail in future sections of this course.

See different definitions of this relatively new and ever-evolving field below. 

You may also find it interesting to note how Global Health resources created before the COVID-19 pandemic discuss future health challenges — and how much has changed in the world of Global Health since the start of the COVID-19 pandemic in early 2020.

Global Health can be most succinctly defined as “collaborative trans-national [transcending national boundaries] research and action for promoting health for all”.

(Beaglehole and Bonita, 2010)

In more detail, we can say that 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. 
• Emphasizes transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences; and is a synthesis of population-based prevention with individual-level clinical care. 
• Places priority on prevention, [but] it also embraces curative, rehabilitative, and other aspects of clinical medicine and the study of basic sciences (Koplan 2009).

What is Global Health?

In more abstract, but very applicable terms Global Health can be understood as… 

      …an attitude. It is a way of looking at the world. It is about the universal nature of our human predicament. It is a statement about our commitment to health as a fundamental quality of liberty and equity.

(R. Horton to P. Farmer, personal communication, January 29, 2012)

What are some of the most pressing Global Health issues today?

As in Public Health, epidemiologists also work in Global Health to identify and study patterns and causes of diseases related to pressing Global Health issues. These analyses inform health policy and programming on national and global levels.

As you were learning about the fields of Public and Global Health, did you notice some similarities between the two? If you did, well done — there are many similarities between the fields of public and global health. Some might say that global health is just public health on a global scale. Others might say that the distinction between the two fields no longer exists — especially as we continue to respond to and live with a global pandemic. 

The blurring of lines between what is distinctly ‘local’ (public health) and ‘global’ (global health) can be described as Glo-cal health.

While public and global health in theory and practice overlap in many ways and our world is becoming ever-more Glo-cal, there are still some important distinctions to draw between the two fields. Table 3 helps us break these similarities and differences down. 

Table 3. Comparison of Global Health and Public Health

	Global Health	Public Health
Geographical reach	Focuses on issues that directly or indirectly affect health but that can transcend national boundaries	Focuses on issues that affect the health of the population of a particular community or country
Level of cooperation	Often requires global cooperation	Does not usually require global cooperation
Individuals or populations	Both prevention in population and clinical care of individuals	Main focus on prevention programmes for populations
Health equity and access to health	Focus on health equity among nations, for all people	Focus on health equity within a single nation or community

One Health: integrating the health of people, animals & the environment

One particular approach to global health is the field of One Health.  Some Global Health actors believe all global health interventions addressing health challenges should adopt a One Health approach. 

What do you think?

Indigenous Health is Global Health

How do Indigenous communities, peoples and nations self-identify?

Indigenous communities, peoples and nations are those which, having a historical continuity with pre-invasion and pre-colonial societies that developed on their territories, consider themselves distinct from other sectors of the societies now prevailing on those territories, or parts of them. 

They form at present non-dominant sectors of society and are determined to preserve, develop and transmit to future generations their ancestral territories, and their ethnic identity, as the basis of their continued existence as peoples, in accordance with their own cultural patterns, social institutions and legal system…

On an individual basis, an indigenous person is one who belongs to these indigenous populations through self-identification as indigenous (group consciousness) and is recognized and accepted by these populations as one of its members (acceptance by the group). This preserves for these communities the sovereign right and power to decide who belongs to them without external interference.

Excerpt from the Introduction of the United Nations report State of the World’s Indigenous People: Indigenous People’s Access to Health Services UN (2015)

The United Nations estimates that more than 370 million Indigenous people live across 90 different countries worldwide (UN, 2015). Indigenous peoples around the world share rich histories and practices of health and well-being: from the resurgence of traditional midwifery and child-rearing practices, for example, to the hunting and consumption of local foods; the observance of ceremonies, rites of passage, and end-of-life customs; and the everyday enactment of respectful relations with the natural world, Indigenous peoples across the globe cultivate the health and well-being of individuals, communities and nations.  And yet, despite the continuance and resurgence of such practices, Indigenous peoples experience disproportionate health and social problems in comparison to the non-Indigenous peoples living within the same borders (Gracey and King 2009; King, Smith, and Gracey 2009; Smith 1999; United Nations 2009, 2015).  Source: Henry, LaVallee, Van Styvendale and Innes (2018) Introduction to Global Indigenous Health.

It is important to distinguish how Indigenous communities generally understand and frame the concept of health differently from western clinical medicine as well as the definitions of health, Public Health and Global Health we explored above.

When reading the description of Indigenous conceptualizations of health below, note which words and phrases strike you the most.

Does this understanding of health differ greatly from your own or not? What similarities and differences do you see between Indigenous perceptions of health and the western-based descriptions of health, Public Health, Global Health and One Health we explored above?

Also essential to note — by using the term ‘Indigenous’ we in no way mean to erase the incredible diversity within and between Indigenous nations and communities around the world. While Indigenous identity can be defined using the concepts listed above, each Indigenous population has unique historical, socio-cultural and political contexts and practices.

While we cannot within the context of this survey course give space to each of the 370+ million Indigenous peoples around the world, we will offer students narrative case studies of a select number of communities residing on different continents. The grave injustices forced upon Indigenous communities by settler colonialists over the past centuries and which continue today demand exposure — but we will also acknowledge and celebrate Indigenous resistance to these injustices in an attempt to redefine mainstream western narratives and representations of Indigenous people globally.

Indigenous Health 

Indigenous peoples’ concept of health and survival is both a collective and an individual inter-generational continuum encompassing a holistic perspective incorporating four distinct shared dimensions of life. These dimensions are the spiritual, the intellectual, physical, and emotional. Linking these four fundamental dimensions, health and survival manifests itself on multiple levels where the past, present, and future co-exist simultaneously

(Committee on Indigenous Health, 1999)

Indigenous Health theories, models, and practices often have a deeply relational character: the well-being of individuals is intimately bound with the well-being of others, both human and other- or more-than-human.

( Henry, LaVallee, Van Styvendale and Innes (2018) Introduction to Global Indigenous Health)

Importance and roles of non-western medical knowledge & practice

As highlighted in our brief introduction to Indigenous health above, western clinical medicine and perceptions of health that inform the fields of public and global health are only one way of understanding health, well-being and health care. 

People in all regions of the world — including in high income countries — integrate medical knowledge and practices from systems and philosophies other than western clinical medicine into their self-care and medical routines every day. While we do not have the specific expertise or capacity to explore all health knowledge and systems in detail in this course, we will discuss the roles, use and necessary considerations of traditional medicinein the fields of Public and Global Health.

We offer basic definitions of traditional medicine and traditional Arabic and Islamic medicine below as well as links to further readings under Supplementary Resources in this section.

Traditional Medicine “is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness”

(WHO, n.d.).

Traditional Arabic & Islamic Medicine is “a system of healing practiced since antiquity in the Arab world within the context of religious influences of Islam. It is comprised of medicinal herbs, dietary practices, mind-body practices, spiritual healing and applied therapy whereby many of these elements reflect an enduring interconnectivity between Islamic medical and prophetic influences as well as regional healing practices emerging from specific geographical and cultural origins”

(Al-Rawi & Fetters, 2012)

So there you have it — but that is just scratching the surface of the huge question ‘what is Global Health?’ Through each section of this course we will explore a different dimension of this vast, exciting and often complicated field. We look forward to this adventure together!

Supplementary Resources

• Northern and Indigenous Health and Healthcare (OER Textbook):
  • https://www.oercommons.org/courses/northern-and-indigenous-health-and-healthcare
• Public Health Achievements
  • Between 1920 and 2020, the average human life span doubled. How did we do it? Science
• Defining Global Health
  • Towards a common definition of global health
  • The importance of a common global health definition: How Canada’s definition influences its strategic direction in global health
• Traditional Medicine 
  • Traditional, Complementary and Integrative Medicine
• Islamic Medicine
  • Islamic Medicine and Evolutionary Medicine: A Comparative Analysis

References

Alrawi, S. N., & Fetters, M. D. (2012). Traditional arabic & islamic medicine: a conceptual model for clinicians and researchers. Global Journal of Health Science. https://doi.org/10.5539/gjhs.v4n3p164

American Veterinary Medical Association. (n.d.). One Health- What is it?. https://www.avma.org/one-health-what-one-health

Beaglehole and Bonita (2010). What is Global Health? Global Health Action. DOI: https://doi.org/10.3402/gha.v3i0.5142

CDC Foundation. (n.d.). What is Public Health?.   https://www.cdcfoundation.org/what-public-health

CDC (2020). Original Essential Public Health Services Framework. https://www.cdc.gov/publichealthgateway/publichealthservices/originalessentialhealthservices.html. Accessed May 18 2021.

Committee on Indigenous Health. (1999). Report of the International Consultation on the Health of Indigenous Peoples.

Economic and Social Research Council (2021). https://esrc.ukri.org/about-us/what-is-social-science/ Accessed on 5.17.21.

Esteban Ortiz-Ospina and Max Roser (2016) – “Global Health”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/health-meta‘ [Online Resource]

Fineberg, H. V. (2011). Public health and medicine: Where the twain shall meet. In American Journal of Preventive Medicine. https://doi.org/10.1016/j.amepre.2011.07.013

Henry, LaVallee, Van Styvendale and Innes (2018) Global Indigenous Health. Arizona University Press.

Ingram, R. C., Miron, E., & Scutchfield, D. F. (2012). From service provision to function based performance – perspectives on public health systems from the USA and Israel. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560218/

Institute of Medicine. (1998). America’s vital interest in global health: Protecting our people, enhancing our economy, and advancing our international interests. National Academies Press (US).

John Hopkins Bloomberg School of Public Health (n.d).  What is Public Health?  https://www.jhsph.edu/about/what-is-public-health/ Accessed on 5.17.21.

Kickbusch, I. (1999). Global + local = glocal public health. In Journal of Epidemiology and Community Health. https://doi.org/10.1136/jech.53.8.451

Koplan, J. (2009). Towards a common definition of Global Health. The Lancet. DOI: https://doi.org/10.1016/S0140- 6736(09)60332-9

Pomeroy, K., Asante, I., St.Louis, J. (n.d.) Models and Mechanisms of Public Health. https://courses.lumenlearning.com/suny-buffalo-environmentalhealth/. License: CC BY-NC-SA: Attribution-NonCommercial-ShareAlike

Skolnik, R. (2019). Global Health 101 Fourth Edition.

United Nations (2015) State of the World’s Indigenous People: Indigenous people’s access to health services. https://www.un.org/esa/socdev/unpfii/documents/2016/Docs-updates/SOWIP_Health.pdf. Accessed May 18 2021.

World Health Organization. (1948). Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June – 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948. The definition has not been amended since 1948.  

World Health Organization. (n.d.). Traditional, complementary and integrative medicine. https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine.   

World Health Organization (2012). European Action Plan for Strengthening Public Health Capacities and Services. WHO Europe Regional Office, Denmark. https://www.euro.who.int/__data/assets/pdf_file/0005/171770/RC62wd12rev1-Eng.pdf