Health: Its a Global Issue

HHS 350 Spring 2014 January 31, 2014 Dr. Paula Stigler-Granados

Three Themes for Todays Talk

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Globalization: shared interests, shared responsibility in health Multinational responses to health challenges Health Diplomacy and the US Global Health Initiative

Global vs. International Health

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Global Health: problems, issues, and concerns that transcend national boundaries and may best be addressed by cooperative actions.

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International health: bilateral foreign aid activities, specific disease control projects in developing countries, and direct medical assistance.

WHO Definition of Health

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Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

So What is Global Health?

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condition of global health) and competencies)

A notion (the current state of global health) An objective (a world of healthy people, a

A mix of scholarship, research, and practice (with many questions, issues, skills, Any health issue that concerns many countries or is affected by transnational determinants, such as climate change or urbanization, or solutions, such as polio eradication; Refers to scope of problem, not location.

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Global Public Health Problems: No National Borders

Emerging diseases

Tobacco

Climate Change

Hazardous and Nuclear Waste

Obesity

Bioweapons

Setting Goals to Reduce the Burden of Disease

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The Millennium Development Goals:

! Resolution adopted by the UN General Assembly in 2000 ! Eight goals to eliminate poverty by 2015 ! Four of these deal with health

! Are these useful efforts? ! Can they be met? Short Videos: ! Infographic ! UN Video

Measuring Disease
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Mortality: the ultimate disease outcome

! Death registries (Cause-specific-ICD) ! Death certification ! Verbal autopsies ! Age-specific mortality (infant, <5) ! Proportional mortality ! Mortality rate (per 100,000 in given yr)

Measuring Disease: Disability-adjusted Life Years (DALY)

Small Group Activity Break out into groups of 4 or 5

1.! Go to the Institute for Health Metrics and Evaluation website: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbdinsight 2.! Pick a country (write on the board your country before you start NO DUPLICATE COUNTRIES) 3.! Pick a person to report back information such as: ! Leading causes of disease ! Biggest changes in disease ! Major challenges ! Other important information

Globalization
A Driving Force for the Global Health Enterprise

Globalization and Health

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Increase in technological and economic interdependence allows spread of disease and risk factors Free movement of capital and labor affects sovereign nations ability to protect health of their citizens; National health interests depend on support or acquiescence (agreement without protest) of other nations

Multinational Responses to Global Health Challenges

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The World Health Organization (WHO), The World Bank (IBRD), Private sector and partnerships

World Health Organization

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193 Member States Normative declarations Surveillance and response to epidemics Multinational governance
! Treaties ! Consensus

World Bank
Largest single financier of health systems
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SWAPs: sector wide approaches for specific targets Technical assistance Financial management requirements for loans Health, Nutrition, Population (HNP) portfolio about $17 billion Funds additional private sector health development

The Changing Landscape of Global Health

Cuban Health Diplomacy

100,000 Cuban health professionals in 101 countries
Region Africa Americas Europe Asia/Mideast TOTAL Countries 38 37 8 18 101

July, 2006: 28,664 Cuban health professionals in 69 countries

Source: International Cooperation Unit, Ministry of Public Health, Havana

The Rise of China as Global Health Donor

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Long history of health assistance, esp. in Africa Political influence Increasing need for respect as economic power (after the shock of SARS)

Star Power in Global Health

Bono, Brad Pitt, Other Celebrities . To Raise Awareness of HIV/AIDS, Poverty

The Changing Face of Health and US Foreign Policy

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In the past: 40 uncoordinated Agencies! Now: The US Global Health Initiative (GHI)

Changing Geopolitical Context in 21st Century

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Power shift away from great powers to new multi-polarity Rise of civilian power Growth of US Military as conduit for development assistance (ODA) Economic crisis in high-income countries Domestic responses to multi-national challenges

U.S. Global Health Initiative May 2009

! $63 billion/six years to help partner countries improve health outcomes and strengthen health systems; ! Focus on the health of women, newborns, and children ! A new way of working to achieve dual objectives of: ! attaining significant health improvements and ! creating effective, efficient, sustainable, and countryled delivery of essential health care and public health programs.

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Foreign Policy and Health

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Soft power: obtain what you want through co-option and attraction Hard power: military or economic coercion Smart power: full range of tools: diplomatic, economic, military, political, legal, medical, and cultural

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Global Health Diplomacy: A Shared Foreign Policy Interest

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Political commitment to global health as a bridge to global peace and economic development Health and science linkages to overcome political conflict and power asymmetry Investment in human resources in health Better support for UN agencies and multinationalism

Health Diplomacy: Convergence of Interests

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Department of Defense
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Now 20% of nonmilitary foreign assistance $579 Million in 2012 from many different streams Shifting focus from Afghanistan/Iraq Pivot to Asia AFRICOM

USNS Mercy and Comfort

Linked to strategic priorities (hot spots, disaster assistance, terrorism, humanitarian assistance)

Conclusion
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Global health is a shared responsibility

! No borders ! Multi-disciplinary ! Increasingly complex governance

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The resources will be increasingly limited

! Need to shift focus to health systems strengthening ! National responsibilities and financing

Next week.
! Population, Poverty and Demography lecture ! Break out session for individual countries at the end of class MANDATORY attendance.

Group Break-out
MDGs
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Breakout into groups of 10 (max) Guidelines:

! Select a low-income country (developing country) and write the name on the board no duplicate countries ! Discuss and select 2 MDGs for your selected country and research the progress on those countries

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Select 1 final presenter from each group to write brief responses on board and report back info Resources:
! http://www.un.org/millenniumgoals/pdf/2012_Progress_E.pdf ! http://www.cgdev.org/page/mdg-progress-index-gauging-country-levelachievements ! http://www.undp.org/content/undp/en/home/librarypage/mdg/mdgreports/