ABS 100 note - Professor Maufin PDF

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ABS 100: Global Health (세계보건) CH 1 What is Global Health? • Global Health topic terms: Disease, Sickness, Health, Equality, Worldwide, Enviromint, People, Culture, Wellbeing, Improving, Medicine, etc. • Definitions of Global Health ◦ Do we need a common definition of Global Health? ▪ To come up with shared ideas ◦ Transnational focus of health issues and interventions ▪ “health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions” (Ins. Of Medicine 1997) ▪ Those health issues that transcend national boundaries and governments and call for actions on the global forces that determine the health of people (Kickbush 2006) ▪ Health issues where their determinants circumvent, undermine or and oblivious (의식하 의식하 지 못하는 못하는) to the territorial boundaries of states, and are thus beyond the capacity of individual countries to address through domestic institutions (HK Gov. 2008) ▪ Transnational impacts of globalization upon health determinants and health problems which are beyond the control of individual nations. (Smith et al. 2006) ◦ Equity and Action ▪ Places a priority on improving health and achieving health equity for all people worldwide. (Global health emphasizes transnational health issues, determinants and solutions; involves many disciplines within and beyond the health sciences and promotes inter-disciplinary collaboration; and is a synthesis of population-based prevention with individual-level clinical care.’ (Koplanet al. 2009, emphasis added)) ▪ Promoting health for all (collaborative trans-national research and action for (Beagleholeand Bonita 2010)) ▪ improvement of health, reduction of disparities, and protection against global threats ◦ Collaboration of non-governmental and institutional actors ▪ The term “global” is also associated with the growing importance of actors beyond governmental or intergovernmental organizations and agencies (ex. The media, internationally influential foundations, non-governmental organizations, and transnational corporations. - Brown et al. 2006) ▪ Global health is not only about ideas or concerns, but about actors whom we must clearly identify and whose interests we should analyze. • Global, Public, and international Health ◦ How does global health differ from Public Health or international health? ◦ Public Health ▪ The science of protesting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases. ▪ Public health is concerned with protecting the health of entire population. (the population can be as small as a local neighborhood, or as big countries or regions of the world) ▪ P.H. professionals try to prevent problems from happening or recurring through implementing educational programs, recommending policies, administering services and conducting research • Public Health as Global Health? ◦ Health as a human right

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Scientific inquiry and translating knowledge into practice Health promotion and disease prevention Interdisciplinary Multilevel systems-based interventions Comprehensive frameworks for financing and structuring health policies and services Two large-scale goals of Public Health: o Reduction of social and health inequalities o Strive for health-sustaining environments o Globalization Processes o Economic globalization o Technological globalization o Cultural globalization o Globalization impacts on health o environment and climate International Health (spoken by celebrities) o Public health is the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases. o Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country or region of the world. o Public health professionals try to prevent problems from happening or recurring through implementing educational programs, recommending policies, administering services and conducting research—in contrast to clinical professionals like doctors and nurses, who focus primarily on treating individuals after they become sick or injured. Public health also works to limit health disparities. A large part of public health is promoting healthcare equity, quality and accessibility.

International Health as Global Health? o Multidisciplinary, health equity focus o Transnational cooperation (not just bilateral) ◦ International Health as Global Health ◦ Is “Global health” a distinct field even among educators I the same institutions, or a general terms that incorporates wide range of disciplines?  Umbrella Term: a qualitative study among Global Health teachers in German medical education 

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Global Health in ASU o No single definition among the diverse Global Health faculty o Transdisciplinary (초학문적)

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Grtounded in Anthropology Emphasis on cultural context of beliefs and behavior Emphasis on social origins of disease or suffering Emphasis on deep time depth Student engagement

*Global actors – Michelle Obama, Government, Red Cross, Bill Gates / world health organization, world bank, Gates Foundation, USAID, Global Fund, GAVI, PERFAR CH2 01/15/19  Definition of Global Health o Collaboration of non-governmental and institutional actors  In general, global health implies consideration of the health needs of the people of the whole planet above the concerns of particular nations. Also, associated with the growing importance of actors beyond governmental or intergovernmental organizations and agencies (Ex. The media, internationally influential foundations, nongovernmental organizations, and transnational corporations)  Global health is not only about ideas and concerns, but about actors whom we must clearly identify and whose interests we should analyze.  Health Systems o Comprises all organizations, people and actions whose primary intent is to promote, restore, or maintain health (WHO: 2009) o WHY health-systems Frameworks  Service delivery  Health workforce  Information  Medical products  Vaccines and technology  financing  leadership and governance  Global Health System o Promote primary purpose to restore or maintain health, the persistent and connected sets of rules, prescribe behavioral roles, constrain activity, and shape o Such actors may operate at the community, national, or global levels, and may include governmental, intergovernmental, private for profit, not for profit entities

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Global health Actors o National health systems o Multilateral actors  UN institutions  Multilateral development banks o Bilateral actors o Non-state actors o Global health initiatives Multilateral actors o United Nations Agencies and Institutions (1945)  World health organization  United nations children’s fund  United nations population fund  Joint united nations program on HIV/AIDS World Health Organization (WHO) o Founded 1948 o Organization  194 Member states in Health Assembly  Executive board with 34 elected representatives  Director-General  6 world regions  Africa  Americas  South East Asia  Europe  Eastern Mediterranean  Western pacific o “We are the directing and coordinating authority on international health within the United Nations’ system.” o We do this by:  Providing leadership  Research agenda  Norms and standards  Ethical and evidence-based  Technical support

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 Monitoring o WHO Priorities:  Health systems  Non-communicable disease  Promoting health through the life-course  Communicable disease  Preparedness, surveillance and response  Corporate service o History  Decline in Global Health influence (1980’s- present)  Selective health care  Debt crises and structural adjustment programs  Rise of World Bank as Global Health actor  Diversification of Global Health landscape o What are the strengths of the WHO in the Global Health system?  Health as a global system o What are the limitations of the WHO in the Global Health System?  Idea of GHS may not effect on globalization Multilateral Actors o Multilateral development banks (MDBs)  African Development Bank  Asian Development Bank  Inter-American Bank  World Bank World Bank o Founded 1944 o 189 member countries o Governing Board generally formed by ministers of finance or development of member countries o 25 Executive Directors o 1 Executive Director  Appointed by 5 largest shareholders o 5 institutions working for sustainable solutions that reduce poverty and build shared prosperity in developing countries o The World Bank Group has set 2 goals for the world to achieve by 2030:  End extreme poverty by decreasing the percentage of people living on less the $1.90 a day to no more than 3%  Promote shared prosperity by fostering the income growth of the bottom 40% for every country o The W.B is a vital source of financial and technical assistance to developing countries around the world. o 5 interrelated banking organizations:  The international Bank for Reconstruction and Development  The int. Bank for Reconstruction and Development lends to governments of middle income and creditworthy low-income countries  The International Development Association (1960)  Provides interest free loans- called credits- and grants to governments of the poorest countries

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 The International Finance Corporation  The Multilateral Investment Guarantee Agency  The International Centre for Settlement of Investment Disputes o Funding Priorities  1940’s – 1970’s  Modernization theory of development  Largely focus on reconstruction and development o Mostly power and transportation o Little emphasis on sanitation, education, and health  1960’s – 1990’s  Growing interest in population and nutrition as aspects of development o Found population, health, and nutrition department 1979 o Stand along load for nutrition by 1976 o Collaborate in Onchocerciasis control program 1974 with WHO, UNPD. FAO o Collaborate in sage motherhood with WHO UNPF in 1987  Structural Adjustment programs and neoliberal frameworks o Privatization, trade liberalization, public sector contraction o Investing in Health 1993 o Three-Pronged approach to poverty reduction  Fostering an environment that enables households to improve health:  Pursue growth policies that benefit the poor;  Expand investment in education, particularly for females and promote the tights and status of women  Improving government spending on health:  Reduce gov’t expenditures on tertiary care  Finance and implement a package of essential clinical services; and improve management of public health services  Promoting diversity and competition:  Encourage social or private insurance for clinical services outside the essential package  Encourage public and private suppliers to complete to provide inputs and service  Provide information on provider performance and accreditation and cost effectiveness Bilateral Actors o Collaborations between government agencies or sub government institutions that provide aid or support to other governments, institutions, or nongovernmental organizations generally in low and middle income countries o United States of America  Dept. of Health and Human Services (HHS)  Office of Global Affairs (Includes CDC, FDA, NIH) o Department of State  United States Agency for International Development (USAID)- 1961

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 President’s Emergency Plan for AIDS Relief (PEPFAR) – 2013  Peace Corps – 1961 Non-State Actors o “non-State actors are nongovernmental organizations, private sector entities, philanthropic foundations and academic institutions”  WHO (2016) o Philanthropic  Gates Foundation  Ford Foundation  Rockefeller Foundation o Global Civil Society and non-governmental organizations  OXFAM  CARE  SHARE  World Vision  Doctors Without Borders o Academic  ASU  Duke University  Emory University  Johns Hopkins University o Private Sector  Pharmaceutical companies Bill & Melinda Gates Foundation (2000) o Have access to the opportunities they need to succeed in school and life o Grand Challenges initiative o Over $45.5 billion in grants dispersed by 2018 What are the strengths of non-state actors in driving the global health system? o Focus on issue other people aren’t interesting What are the limitations of non-state actors in driving the GHS? Global Health Initiative (GHIs) o “A set of innovative and influential hybrid organizations, which are governed by representative s from both within and outside national governments” o Global Alliance for Vaccines and Immunization (GAVI) (2000)  Collaboration between WHO, UNICEF, Gates Foundation, and the World Bank along with national governments, pharmaceutical industries, research institutes, an civil society  “Improve access to new and underused vaccines for children living in the world’s poorest countries.” o The Global Fund to Fight AIDs, Tuberculosis, and Malaria (Global Fund) (2002)  The Global Fund is 21st century partnership organization designed to accelerate the end of AIDs, tuberculosis and malaria as epidemics  “Founded in 2002, the Global Fund is a partnership between governments, civil society, the private sector and people affected by the diseases. The Global Fund raises and invests nearly US $4 billion a year to support programs run by local experts in countries and communities most in need” Mapping Global Health System

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o Social network mapping of relationship between global health actors through relationships identified on websites o Criteria for defining actor:  Represents individual or organization  Operates in 3 or more countries  Identifies improving health as one of its primary intents o N=203 Governance in Global Health o Frenk and Moon (2013) o Governance challenges in Global Health  Sovereignty Challenge  Sectoral Challenge  Accountability Challenge o Lack of coordination in midwifery training program  Duplication  Gov’t health system  Gov’t contracted NGOs  Independent NGO o Stove piping of funds  Donor interest versus program focus  Vertical versus comprehensive program o Garrett (2007) challenges in Global Health  Little coordination  Inefficiency of funding  “Stove-piping” funding  Brain Drain  “Dutch Disease” Does GHS help or hurt national health systems? o WHO maximizing positive synergies study (2008)  Focus on impact of four GHIs in over 20 countries around the world  Global Fund  GAVI  PEPFAR  MAP  Qualitative and Quantitative Method and Analysis o Service Delivery  Gains in coverage levels and uptake for disease-specific interventions, engagement of civil society  Through integration into wider delivery system or impact on other health issues varies  Financing  Aggregate increase in overall health financing, model of providing free care at point of delivery, innovative financing models o Through disease-specific funding may not be aligned to country priorities and procedures, incomclusive changes in public sector spending, application and disbursement processes not optimal  Governance

Exposed weaknesses of good governance, innovative approaches, some attempt to harmonize approaches with country level actors, performance-based model incentive for accountability, new opportunities for civil society o Though may contribute to poor weakening governance, imbalance between what countries need to do and what is done, performance measures may distort goals if focused on quantitative disease-specific indicators  Health Workforce  Often focuses on training for disease- specific programs, task shifting increasing numbers of less qualified workers o Scale up not matched by expansion of health workforce, urban/rural imbalance countries or worsen  Information systems o Contributed to innovation in health information and technology, increase access to health info for certain diseases  Sometimes result in creation of duplicate and uncoordinated health information systems with fluctuating date sets  Supply management systems o Improvements in supply chain at country level, improvements in quality and access to commodities  Sustainability of supply chain uncertain, less focus on distribution and logistics than procurement and supply Global Health Policy o Global Health Policy: statement of goals, objectives, and means that cereate the framework for global health activities. Also, incorporates both policy content, the substance of policy comprising rules and guidelines, and policy processes, the purposeful, deliberate actions, methods, and strategies that influence the shape and impacts o Global Health policy “Triangle”  Context  Actors  Process  Content 

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o Global and national health in history  Trade and travel  Ex. The “Black Death”  Colonialism  Depopulation of the Americas  Health, Policy, and power  Post- World War 2  Reconstruction and development o Modernization theory o Dependency theory o Neoliberalism Milestones in GHP o Eradication campaigns o Primary health care o Selective adjustment programs o Structural adjustment programs o Millennium development goals o Sustainable development goals Eradication Campaigns o Smallpox eradication programme (1966-1980) o Global Polio Eradication Initiative (1988- ) Primary Health Care o Antecedents  Critiques of modernization theory of development  Critiques of vertical programs  Critiques of medical elitism o Declaration of Alma Ata (1978) (WHO/UNICEF)  “Health, which is state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity  fundamental human right  attainment of the highest possible level of health is a most important world-wide social goal  actions of many other social economic sectors in addition to the health sector

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o Essential health care based on practical, scientifically sound and socially acceptable method and technology which made universally accessible to individuals and families in the community  Right of people to participate individually and collectively in planning and implementing programs  Gov’t have responsibility for health of people  Health programs must be linked to wider social and economic development programs Comprehensive Primary Health Care o Education concerning prevailing health problems and the methods of preventing and controlling them o Promotion of food supply of safer water basic sanitation o Maternal and child health care, including family planning o Immunization against the major infectious disease o Prevention and control of locally endemic diseases o Appropriate treatment of common disease and injuries o Provision of essential drugs o Health for all by 2000  Governmental reforms as part of comprehensive national health reform to ensure PHC for all people  Programs reflect local economic, socio-cultural, and political contexts  Address main health problems in community  Integrate development programs  Rely on local health workers  Integrated, functional referral system Selective PHC o Critiques of comprehensive PHC  Idealistic timeline  Lack of measurement in process or results  Cost  Primary as primitive  Lack of gov’t or medical professional commitment  Politicizing WHO and health organizations o 1979 “Health and population in development” Conference  Rockfeller foundation, Ford Foundation, UNICEF, USAID, World bank o Emphasize attainable goals and cost-effective planning  GOBI  Growing monitoring  Oral rehydration therapy  Breastfeeding  Immunization  -FFF  family planning  female education  food supplementation o Critiques  Techno-centric approach that diverts attention from basic health and socioeconomic development

De-politicize health Targeted ...