The New Global Health

Kevin M. De Cock

, Patricia M. Simone, Veronica Davison, and Laurence Slutsker

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Abstract

Global health reflects the realities of globalization, including worldwide dissemination of infectious and noninfectious public health risks. Global health architecture is complex and better coordination is needed between multiple organizations. Three overlapping themes determine global health action and prioritization: development, security, and public health. These themes play out against a background of demographic change, socioeconomic development, and urbanization. Infectious diseases remain critical factors, but are no longer the major cause of global illness and death. Traditional indicators of public health, such as maternal and infant mortality rates no longer describe the health status of whole societies; this change highlights the need for investment in vital registration and disease-specific reporting. Noncommunicable diseases, injuries, and mental health will require greater attention from the world in the future. The new global health requires broader engagement by health organizations and all countries for the objectives of health equity, access, and coverage as priorities beyond the Millennium Development Goals are set.

“People are beginning to understand there is nothing in the world so remote that it can’t impact you as a person.”—William H. Foege, Director, US Centers for Disease Control, 1977–1983
Health has become an area for diplomatic engagement and a priority subject on the world stage. Funding for global health has reached ≈$30 billion/year, and the United States provides at least one third of this total (1). However, too often there is lack of coordination across the inordinately complex architecture of global health. Agencies other than the World Health Organization (WHO), such as the World Bank and the Bill and Melinda Gates Foundation, have become prominent funders that influence policy; new multilateral organizations, such as the United Nations Joint Programme on HIV/AIDS, the Global Alliance for Vaccines and Immunisation, UNITAID, and the Global Fund to Fight AIDS, Tuberculosis and Malaria have sprung up; and civil society groups such as Médecins Sans Frontières implement programs and exert substantial political pressure.
These developments have challenged WHO, which although retaining unique credibility and convening authority, is hampered by funding shortages and donor-imposed earmarks, an inflexible bureaucratic and governance structure, and difficulty prioritizing in the face of unrealistic demands. Many decisions are now made outside the World Health Assembly, the world’s senior and most representative forum for global health discussion. Newer global health actors are often seen as swifter and more focused on performance and accountability.
With global emphasis on austerity, there is now more than ever a need for bilateral and multilateral assistance to be coordinated for maximal effect, to avoid duplication and gaps, and to focus on measureable results. The diversity of multilateral agencies working in health distracts from the limited essentials expected from the global sector: estimating fiscal requirements and tracking financing; normative guidance; detecting and coordinating responses to complex emergencies and international health threats; monitoring and communicating health trends; and advocacy. A first requirement, including for bilateral partners, is agreement on what constitutes global health and which agencies are best placed to play particular roles.
This report discusses the evolving nature of global health and its priorities. Progress requires revision of the dichotomous view of a static world of industrialized or developing countries, rich or poor. Today’s health disparities are as extreme within countries as between them. A more useful perspective is that global health requires synergistic engagement by all countries in an interdependent world, replacing the model of donors and recipients that characterized earlier international health assistance.

Global Health

The term global health has replaced tropical medicine and international health, disciplines linked to the history of colonialism, the post-independence era of the former European colonies, and the experience of development assistance (2,3). Global health is multidisciplinary, encompasses many elements besides development, and requires coordination of multiple parties, rather than direction by one organization or discipline. The increased technical and political complexity of global health, with many actors, including philanthropic and faith-based organizations, is reflected in its breadth, which covers diverse diseases but deals also with health systems issues and financing.
Global health reflects the realities of globalization, especially the increased movement of persons and goods, and the global dissemination of infectious and noninfectious public health risks. Global health is concerned with protecting the entire global community, not just its poorest segments, against threats to health and with delivering essential and cost-effective public health and clinical services to the world’s population. A fundamental tenet is that no country can ensure the health of its population in isolation from the rest of the world, as articulated in the Global Health Strategy of the United States Department of Health and Human Services (4). This vision reflects today’s health realities but was arrived at through milestones such as the 1993 World Development Report (Investing in Health) (5), the 2000 report of the Commission on Macroeconomics and Health (6), and the tremendous investment in HIV/AIDS begun earlier this century (7).