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Towards A Common Definition of Global Health
Towards A Common Definition of Global Health
Global health is fashionable. It provokes a great deal of communicable infections, the education of the individual Lancet 2009; 373: 1993–95
media, student, and faculty interest, has driven the in personal hygiene, the organization of medical and Published Online
establishment or restructuring of several academic nursing services for the early diagnosis and preventive June 2, 2008
treatment of disease, and the development of social DOI:10.1016/S0140-
programmes, is supported by governments as a crucial
machinery which will ensure every individual in the 6736(09)60332-9
component of foreign policy,1 and has become a major community a standard of living adequate for the See Editorial page 1919
philanthropic target. Global health is derived from public maintenance of health; so organizing these benefits in
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health and international health, which, in turn, evolved such a fashion as to enable every citizen to realize his
Emory Global Health Institute
from hygiene and tropical medicine. However, although birthright and longevity.”
(Prof J P Koplan MD), and
frequently referenced, global health is rarely defined. Department of Epidemiology,
When it is, the definition varies greatly and is often little The US Institute of Medicine (IOM), in its 1988 Future Rollins School of Public Health
more than a rephrasing of a common definition of public of public health report,4 described public health in terms (T C Bond PhD), Emory
University, Atlanta, GA, USA;
health or a politically correct updating of international of its mission, substance, and organisational framework, Duke Global Health Institute,
health. Therefore, how should global health be defined? which, in turn, address prevention, a community Duke University, Durham, NC,
Global health can be thought of as a notion (the current approach, health as a public good, and the contributions USA (Prof M H Merson MD);
state of global health), an objective (a world of healthy of various partners. The IOM report defined the mission Public Health Foundation of
India, Delhi, India
people, a condition of global health), or a mix of of public health as “fulfilling society’s interest in assuring (Prof K S Reddy MD); Instituto
scholarship, research, and practice (with many questions, conditions in which people can be healthy”.4 In the Nacional de Salud Publica,
issues, skills, and competencies). The need for a Dictionary of epidemiology (2001), Last5 defined public Cuernavaca, Mexico
commonly used and accepted definition extends beyond health as “one of the efforts to protect, promote and (Prof M H Rodriguez MD);
School of Medicine, Makerere
semantics. Without an established definition, a shorthand restore the people’s health. It is the combination of University College of Health
term such as global health might obscure important sciences, skills and beliefs that is directed to the Sciences, Kampala, Uganda
differences in philosophy, strategies, and priorities for maintenance and improvement of the health of all the (Prof N K Sewankambo FRCP);
action between physicians, researchers, funders, the and Department of Global
people through collective or social actions”.
Health, University of
media, and the general public. Perhaps most importantly, International health has a more straightforward history. Washington, Seattle, WA, USA
if we do not clearly define what we mean by global health, For decades, it was the term used for health work abroad, (Prof J N Wasserheit MD)
we cannot possibly reach agreement about what we are with a geographic focus on developing countries and Correspondence to:
trying to achieve, the approaches we must take, the skills often with a content of infectious and tropical diseases, Prof Jeffrey P Koplan,
that are needed, and the ways that we should use water and sanitation, malnutrition, and maternal and Robert W Woodruff Health
Sciences Center, Emory
resources. In this Viewpoint, we present the reasoning child health.6 Many academic departments and University, 1440 Clifton Road
behind the definition of global health, as agreed by a organisations still use this term, but include a broader Suite 410, Atlanta, GA 30322,
panel of multidisciplinary and international colleagues. range of subjects such as chronic diseases, injuries, and USA
Public health in the modern sense emerged in the mid- health systems. The Global Health Education Consortium jkoplan@emory.edu
19th century in several countries (England, continental defines international health as a subspecialty that “relates
Europe, and the USA) as part of both social reform more to health practices, policies and systems...and
movements and the growth of biological and medical stresses more the differences between countries than
knowledge (especially causation and management of their commonalities”.7 Other research groups define
infectious disease).2 Farr, Chadwick, Virchow, Koch, international health as limited exclusively to the diseases
Pasteur, and Shattuck helped to establish the discipline of the developing world.8 But many find international
on the basis of four factors: (1) decision making based on health a perfectly usable term and have adapted it to
data and evidence (vital statistics, surveillance and coincide with the philosophy and content of today’s
outbreak investigations, laboratory science); (2) a focus globalised health practice.7,8 International health is
on populations rather than individuals; (3) a goal of social defined by Merson, Black, and Mills9 as “the application
justice and equity; and (4) an emphasis on prevention of the principles of public health to problems and
rather than curative care. All these elements are challenges that affect low and middle-income countries
embedded in most definitions of public health. and to the complex array of global and local forces that
The definition of public health that has perhaps best influence them”.
stood the test of time is that suggested by Winslow almost Global health has areas of overlap with the more
90 years ago:3 established disciplines of public health and international
“Public health is the science and art of preventing
health (table). All three entities share the following
disease, prolonging life and promoting physical health characteristics: priority on a population-based and
and efficacy through organized community efforts for preventive focus; concentration on poorer, vulnerable,
the sanitation of the environment, the control of and underserved populations; multidisciplinary and