International health
service is a field of health care, usually
with a public health emphasis, dealing with health across regional or national
boundaries. One subset of international medicine, travel medicine, prepares
travelers with immunizations, prophylactic medications, and preventive
techniques such as bednets and residual pesticides, in-transit care, and
post-travel care for exotic illnesses. International
service is a field of health care, usually
with a public health emphasis, dealing with health across regional or national
boundaries. One subset of international medicine, travel medicine, prepares
travelers with immunizations, prophylactic medications, and preventive
techniques such as bednets and residual pesticides, in-transit care, and
post-travel care for exotic illnesses. International
health, however, more
often refers to health personnel or organizations from one area or nation
providing direct health care, or health sector development, in another area or
nation. It is this sense of the term that is explained here. More recently, public
health experts have become interested in global processes that impact on human
health. Globalization and health, for example, illustrates the complex and
changing sociological environment within which the determinants of health and disease
express themselves.
The major
international agency for health is the World Health Organization (WHO). Other
important agencies with impact on global health activities include UNICEF, World
Food Programme (WFP), and the World Bank. A major initiative for improved
international health services is the United Nations Millennium Declaration and
the globally endorsed Millennium Development Goals.
international agency for health is the World Health Organization (WHO). Other
important agencies with impact on global health activities include UNICEF, World
Food Programme (WFP), and the World Bank. A major initiative for improved
international health services is the United Nations Millennium Declaration and
the globally endorsed Millennium Development Goals.
International
health focuses on the determinants and distribution of health in international
contexts from several perspectives:
health focuses on the determinants and distribution of health in international
contexts from several perspectives:
1. Medicine: This describes the pathology of diseases
and promotes prevention, diagnosis, and treatment.
and promotes prevention, diagnosis, and treatment.
2. Public health: This emphasizes the health of
populations.
populations.
3. Epidemiology: This helps identify risk factors and
causes of health problems.
causes of health problems.
4. Demography: This provides data for policy
decisions.
decisions.
5. Economics: This emphasizes the cost-effectiveness
and cost-benefit approaches for the optimal allocation of health resources.
and cost-benefit approaches for the optimal allocation of health resources.
6. Other social sciences such as sociology,
development studies, anthropology, cultural studies and law can help understand
the determinants of health in societies.
development studies, anthropology, cultural studies and law can help understand
the determinants of health in societies.
History of International Health Services
In the 19th
century, major discoveries were made in medicine and public health that influenced
the field of international health. The Broad Street cholera outbreak of 1854
was central to the development of modern epidemiology. The microorganisms
responsible for malaria and tuberculosis were identified in 1880 and 1882,
respectively. The 20th century saw the development of preventive and curative
treatments for many diseases, including the BCG vaccine and penicillin in the
1920s. The eradication of smallpox, with the last naturally occurring case recorded in 1977, raised hope
that other diseases could be eradicated as well.
century, major discoveries were made in medicine and public health that influenced
the field of international health. The Broad Street cholera outbreak of 1854
was central to the development of modern epidemiology. The microorganisms
responsible for malaria and tuberculosis were identified in 1880 and 1882,
respectively. The 20th century saw the development of preventive and curative
treatments for many diseases, including the BCG vaccine and penicillin in the
1920s. The eradication of smallpox, with the last naturally occurring case recorded in 1977, raised hope
that other diseases could be eradicated as well.
Important
steps were taken towards global cooperation in health with the formation of the
United Nations (UN) and the World Bank Group in year 1945, after WWII. In 1948,
the member states of the newly formed United Nations gathered together to
create the World Health Organization (WHO). A cholera epidemic that took 20,000
lives in Egypt in 1947 and 1948 helped spur the international community to
action. In 1977, the concept of essential medicines was published by WHO and
also mentioned in the 1978 Alma Ata declaration which underlined the importance
of primary health care.
steps were taken towards global cooperation in health with the formation of the
United Nations (UN) and the World Bank Group in year 1945, after WWII. In 1948,
the member states of the newly formed United Nations gathered together to
create the World Health Organization (WHO). A cholera epidemic that took 20,000
lives in Egypt in 1947 and 1948 helped spur the international community to
action. In 1977, the concept of essential medicines was published by WHO and
also mentioned in the 1978 Alma Ata declaration which underlined the importance
of primary health care.
At a United
Nations Summit in 2000, member nations declared eight Millennium Development
Goals (MDGs) reflecting major challenges facing human development globally, to
be achieved by 2015. Three of the eight MDGs focus explicitly on health, while
others address broad social conditions. Across all goals, there are 18 targets,
supported by 48 health indicators. The declaration has been matched by
unprecedented global investment by donor and recipient countries. The UN report
released on July 2, 2012 reveals that several MDG targets have been met ahead
of the 2015 timeline, there is progress on others, and some e.g., goal 5, are seriously
lagging.
Nations Summit in 2000, member nations declared eight Millennium Development
Goals (MDGs) reflecting major challenges facing human development globally, to
be achieved by 2015. Three of the eight MDGs focus explicitly on health, while
others address broad social conditions. Across all goals, there are 18 targets,
supported by 48 health indicators. The declaration has been matched by
unprecedented global investment by donor and recipient countries. The UN report
released on July 2, 2012 reveals that several MDG targets have been met ahead
of the 2015 timeline, there is progress on others, and some e.g., goal 5, are seriously
lagging.
Measurement of International Health Services.
Measurement
of International health includes the collection of health indicators followed
by analysis of the same to draw a conclusion. Several measures exist: life
expectancy, disability-adjusted life year (DALY), quality-adjusted life years
(QALYs), infant and child mortality and morbidity measurements. The choice of
measures can be controversial and includes practical and ethical
considerations.
of International health includes the collection of health indicators followed
by analysis of the same to draw a conclusion. Several measures exist: life
expectancy, disability-adjusted life year (DALY), quality-adjusted life years
(QALYs), infant and child mortality and morbidity measurements. The choice of
measures can be controversial and includes practical and ethical
considerations.
Life Expectancy
Life expectancy
is a statistical measure of the average life span (average length of survival)
of a specified population. It most often refers to the expected age to be
reached before death for a given human population (by nation, by current age,
or by other demographic variables). Life expectancy may also refer to the
expected time remaining to live, and that too can be calculated for any age or
for any group.
is a statistical measure of the average life span (average length of survival)
of a specified population. It most often refers to the expected age to be
reached before death for a given human population (by nation, by current age,
or by other demographic variables). Life expectancy may also refer to the
expected time remaining to live, and that too can be calculated for any age or
for any group.
Disability-adjusted Life Years
The DALY is
a summary measure that combines the impact of illness, disability and mortality
on population health. The DALY combines in one measure the time lived with
disability and the time lost due to premature mortality. One DALY can be
thought of as one lost year of ‘healthy’ life and the burden of disease as a
measurement of the gap between the current health status and an ideal situation
where everyone lives into old age free of disease and disability. For example,
DALYs for a disease are the sum of the years of life lost due to premature
mortality (YLL) in the population and the years lost due to disability (YLD)
for incident cases of the health condition. One DALY represents the loss of one
year of full health equivalent.
a summary measure that combines the impact of illness, disability and mortality
on population health. The DALY combines in one measure the time lived with
disability and the time lost due to premature mortality. One DALY can be
thought of as one lost year of ‘healthy’ life and the burden of disease as a
measurement of the gap between the current health status and an ideal situation
where everyone lives into old age free of disease and disability. For example,
DALYs for a disease are the sum of the years of life lost due to premature
mortality (YLL) in the population and the years lost due to disability (YLD)
for incident cases of the health condition. One DALY represents the loss of one
year of full health equivalent.
Quality-adjusted life years
QALYs are a
way of measuring disease burden including both the quality and the quantity of
life lived, as a means of quantifying in benefit of a medical intervention. The
QALY model requires utility independent, risk neutral, and constant
proportional tradeoff behaviour. QALYs attempt to combine expected survival
with expected quality of life into a single number: if an additional year of
healthy life expectancy is worth a value of one (year), then a year of less
healthy life expectancy is worth less than one (year). QALY calculations are
based on measurements of the value that individuals place on expected years of
survival. Measurements can be made in several ways: by techniques that simulate
gambles about preferences for alternative states of health, with surveys or
analyses that infer willingness to pay for alternative states of health, or
through instruments that are based on trading off some or all likely survival
time that a medical intervention might provide in order to gain less survival
time of higher quality. QALYs are useful for utilitarian analysis, but does not
in itself incorporate equity considerations.
way of measuring disease burden including both the quality and the quantity of
life lived, as a means of quantifying in benefit of a medical intervention. The
QALY model requires utility independent, risk neutral, and constant
proportional tradeoff behaviour. QALYs attempt to combine expected survival
with expected quality of life into a single number: if an additional year of
healthy life expectancy is worth a value of one (year), then a year of less
healthy life expectancy is worth less than one (year). QALY calculations are
based on measurements of the value that individuals place on expected years of
survival. Measurements can be made in several ways: by techniques that simulate
gambles about preferences for alternative states of health, with surveys or
analyses that infer willingness to pay for alternative states of health, or
through instruments that are based on trading off some or all likely survival
time that a medical intervention might provide in order to gain less survival
time of higher quality. QALYs are useful for utilitarian analysis, but does not
in itself incorporate equity considerations.
Infant and child mortality
Life expectancy,
DALYs and QALYs represent the average disease burden well. However, infant
mortality and under-five child mortality are more specific in representing the
health in the poorest sections of a population. Therefore, changes in these
classic measures are especially useful when focusing on health equity. These
measures are also important for advocates of children’s rights. Approximately
56 million people died in 2011. Of these, 10.6 million were children under 5
years of age, 99% of these children were living in low-and middle-income
countries. That translates to roughly 30,000 children dying every day.
DALYs and QALYs represent the average disease burden well. However, infant
mortality and under-five child mortality are more specific in representing the
health in the poorest sections of a population. Therefore, changes in these
classic measures are especially useful when focusing on health equity. These
measures are also important for advocates of children’s rights. Approximately
56 million people died in 2011. Of these, 10.6 million were children under 5
years of age, 99% of these children were living in low-and middle-income
countries. That translates to roughly 30,000 children dying every day.
Morbidity
Morbidity
measures include incidence rate, prevalence and cumulative incidence. Incidence rate is the risk of developing some new
condition within a specified period of time. Although sometimes loosely
expressed simply as the number of new cases during some time period, it is
better expressed as a proportion or a rate with a denominator.
measures include incidence rate, prevalence and cumulative incidence. Incidence rate is the risk of developing some new
condition within a specified period of time. Although sometimes loosely
expressed simply as the number of new cases during some time period, it is
better expressed as a proportion or a rate with a denominator.
International Health Conditions of Great Concern
The main
diseases and health conditions prioritized by global health initiatives are
sometimes grouped under the terms “diseases of poverty” versus
“diseases of affluence”, although the impacts of globalization are
increasingly blurring any such distinction.
diseases and health conditions prioritized by global health initiatives are
sometimes grouped under the terms “diseases of poverty” versus
“diseases of affluence”, although the impacts of globalization are
increasingly blurring any such distinction.
Respiratory infections
Infections
of the respiratory tract and middle ear are the major causes of morbidity and
mortality worldwide. Some respiratory infections of global significance include
tuberculosis, measles, influenza and pneumonias caused by pneumococci and
Haemophilus influenzae. The spread of respiratory infections is often increased
in crowded conditions, and poverty is associated with more than 20-fold
increase in the relative burden of lung infections.
of the respiratory tract and middle ear are the major causes of morbidity and
mortality worldwide. Some respiratory infections of global significance include
tuberculosis, measles, influenza and pneumonias caused by pneumococci and
Haemophilus influenzae. The spread of respiratory infections is often increased
in crowded conditions, and poverty is associated with more than 20-fold
increase in the relative burden of lung infections.
Diarrhoeal diseases
Diarrhoea is
the second most common cause of child mortality worldwide, responsible for 17%
of under-5 deaths worldwide. Poor sanitation can increase transmission of
bacteria and viruses through water, food, utensils, hands and flies.
Dehydration due to diarrhoea can be effectively treated through oral
rehydration therapy (ORT) with dramatic reductions in mortality. Important
nutritional measures include the promotion of breastfeeding and zinc
supplementation. Rotavirus is a major cause of severe diarrhoea and death in
children. While hygienic measures alone may be insufficient for the prevention
of rotavirus diarrhoea, it can be prevented by a safe and potentially
cost-effective vaccine.
the second most common cause of child mortality worldwide, responsible for 17%
of under-5 deaths worldwide. Poor sanitation can increase transmission of
bacteria and viruses through water, food, utensils, hands and flies.
Dehydration due to diarrhoea can be effectively treated through oral
rehydration therapy (ORT) with dramatic reductions in mortality. Important
nutritional measures include the promotion of breastfeeding and zinc
supplementation. Rotavirus is a major cause of severe diarrhoea and death in
children. While hygienic measures alone may be insufficient for the prevention
of rotavirus diarrhoea, it can be prevented by a safe and potentially
cost-effective vaccine.
Maternal health
Complications
of pregnancy and childbirth are the leading causes of death among women of
reproductive age in many developing countries. A woman dies from complications
from childbirth approximately every minute. According to the World Health
Organization’s World Health Report
2005, poor maternal conditions are the fourth leading cause of death for
women worldwide, after HIV/AIDS, malaria, and tuberculosis. Most maternal
deaths and injuries can be prevented and have been largely eradicated in the
developed world.
of pregnancy and childbirth are the leading causes of death among women of
reproductive age in many developing countries. A woman dies from complications
from childbirth approximately every minute. According to the World Health
Organization’s World Health Report
2005, poor maternal conditions are the fourth leading cause of death for
women worldwide, after HIV/AIDS, malaria, and tuberculosis. Most maternal
deaths and injuries can be prevented and have been largely eradicated in the
developed world.
HIV/AIDS
Human
immunodeficiency virus (HIV) is transmitted through unprotected sex, unclean
needles and blood transfusions or from mother to child during birth or
lactation. Globally, HIV is primarily spread through heterosexual intercourse.
The infection damages the immune system, leading to acquired immunodeficiency
syndrome (AIDS) and eventually, death. Antiretroviral drugs prolong life and
delay the onset of AIDS by minimizing the amount of HIV in the body.
immunodeficiency virus (HIV) is transmitted through unprotected sex, unclean
needles and blood transfusions or from mother to child during birth or
lactation. Globally, HIV is primarily spread through heterosexual intercourse.
The infection damages the immune system, leading to acquired immunodeficiency
syndrome (AIDS) and eventually, death. Antiretroviral drugs prolong life and
delay the onset of AIDS by minimizing the amount of HIV in the body.
Malaria
Malaria is a
mosquito-borne infectious disease caused by the parasites of the genus Plasmodium. Symptoms may include
fever, headaches, chills and nausea. Approximately 500 million cases of malaria
occur worldwide yearly, most commonly among the children and pregnant women in
underdeveloped countries. Malaria can hinder economic development of a country
due to decreased work productivity, treatment cost, and time spent for getting
treatment. Malaria deaths can be cost-effectively reduced by the use of
insecticide-treated bednets and prompt artemisin-based combination therapy,
supported by intermittent preventive therapy in pregnancy.
mosquito-borne infectious disease caused by the parasites of the genus Plasmodium. Symptoms may include
fever, headaches, chills and nausea. Approximately 500 million cases of malaria
occur worldwide yearly, most commonly among the children and pregnant women in
underdeveloped countries. Malaria can hinder economic development of a country
due to decreased work productivity, treatment cost, and time spent for getting
treatment. Malaria deaths can be cost-effectively reduced by the use of
insecticide-treated bednets and prompt artemisin-based combination therapy,
supported by intermittent preventive therapy in pregnancy.
Nutrition
Malnutrition
can take the form of hunger and inadequate nutrition, or overweight and
obesity. About 104 million children worldwide (2010) are underweight, and
undernutrition contributes to about one third of all child deaths.
Undernutrition impairs the immune system, increasing the frequency, severity,
and duration of infections (including measles, pneumonia and diarrhoea).
Infection is also an important cause and contributor to malnutrition. Micronutrient
deficiencies including lack of vitamin A, iron, iodine and zinc are common
worldwide and can compromise intellectual potential, growth, development and
adult productivity. Interventions to prevent malnutrition include micronutrient
supplementation, fortification of basic grocery foods, dietary diversification,
hygienic measures to reduce spread of infections, and promotion of
breastfeeding.
can take the form of hunger and inadequate nutrition, or overweight and
obesity. About 104 million children worldwide (2010) are underweight, and
undernutrition contributes to about one third of all child deaths.
Undernutrition impairs the immune system, increasing the frequency, severity,
and duration of infections (including measles, pneumonia and diarrhoea).
Infection is also an important cause and contributor to malnutrition. Micronutrient
deficiencies including lack of vitamin A, iron, iodine and zinc are common
worldwide and can compromise intellectual potential, growth, development and
adult productivity. Interventions to prevent malnutrition include micronutrient
supplementation, fortification of basic grocery foods, dietary diversification,
hygienic measures to reduce spread of infections, and promotion of
breastfeeding.
Violence against women
Violence
against women is a major threat to social and economic development. That has
been defined as “physical, sexual and psychological violence occurring in the
family and in the general community, including battering, sexual abuse of
children, dowry-related violence, rape, female genital mutilation and other
traditional practices harmful to women, non-spousal violence and violence
related to exploitation, sexual harassment and intimidation at work, in
educational institutions and elsewhere, trafficking in women, forced
prostitution and violence perpetrated or condoned by the state.”In
addition to causing injury, violence may increase “women’s long-term risk of a
number of other health problems, including chronic pain, physical disability,
drug and alcohol abuse, and depression”.
against women is a major threat to social and economic development. That has
been defined as “physical, sexual and psychological violence occurring in the
family and in the general community, including battering, sexual abuse of
children, dowry-related violence, rape, female genital mutilation and other
traditional practices harmful to women, non-spousal violence and violence
related to exploitation, sexual harassment and intimidation at work, in
educational institutions and elsewhere, trafficking in women, forced
prostitution and violence perpetrated or condoned by the state.”In
addition to causing injury, violence may increase “women’s long-term risk of a
number of other health problems, including chronic pain, physical disability,
drug and alcohol abuse, and depression”.
Although
statistics can be difficult to obtain as many cases go unreported, it is
estimated that one in every five women faces some form of violence during her
lifetime, in some cases leading to serious injury or even death. Risk factors
for being a perpetrator include low education, past exposure to child
maltreatment or witnessing violence between parents, harmful use of alcohol,
attitudes accepting of violence and gender inequality. Equality of women has
been addressed in the Millennium development goals.
statistics can be difficult to obtain as many cases go unreported, it is
estimated that one in every five women faces some form of violence during her
lifetime, in some cases leading to serious injury or even death. Risk factors
for being a perpetrator include low education, past exposure to child
maltreatment or witnessing violence between parents, harmful use of alcohol,
attitudes accepting of violence and gender inequality. Equality of women has
been addressed in the Millennium development goals.
Surgical disease burden
While
infectious diseases such as HIV exact a great health toll in low-income
countries, surgical conditions including trauma from road traffic crashes or
other injuries, malignancies, soft tissue infections, congenital anomalies, and
complications of childbirth also contribute significantly to the burden of
disease and impede economic development. It is estimated that surgical diseases
comprise 11% of the global burden of disease, and of this 38% are injuries, 19%
malignancies, 9% congenital anomalies, 6% complications of pregnancy, 5%
cataracts, and 4% perinatal conditions. The majority of surgical DALYs are
estimated to be in South-East Asia (48 million), though Africa has the highest
per capita surgical DALY rate in the world.
infectious diseases such as HIV exact a great health toll in low-income
countries, surgical conditions including trauma from road traffic crashes or
other injuries, malignancies, soft tissue infections, congenital anomalies, and
complications of childbirth also contribute significantly to the burden of
disease and impede economic development. It is estimated that surgical diseases
comprise 11% of the global burden of disease, and of this 38% are injuries, 19%
malignancies, 9% congenital anomalies, 6% complications of pregnancy, 5%
cataracts, and 4% perinatal conditions. The majority of surgical DALYs are
estimated to be in South-East Asia (48 million), though Africa has the highest
per capita surgical DALY rate in the world.
As discussed
above, injuries are the largest contributor to the global surgical disease
burden with road traffic accidents (RTAs) contributing the largest share.
According the WHO, more 3500 RTA related deaths occur daily with millions
injured or disabled for life. Road traffic accidents are projected to rise from
the ninth leading cause of death and DALYs lost globally in 2004, to the top
five in 2030. This would place injuries ahead of infectious diseases by 2030.
above, injuries are the largest contributor to the global surgical disease
burden with road traffic accidents (RTAs) contributing the largest share.
According the WHO, more 3500 RTA related deaths occur daily with millions
injured or disabled for life. Road traffic accidents are projected to rise from
the ninth leading cause of death and DALYs lost globally in 2004, to the top
five in 2030. This would place injuries ahead of infectious diseases by 2030.
Chronic disease
The relative
importance of chronic non-communicable disease is increasing. For example, the
rates of type 2 diabetes, associated with obesity, have been on the rise in
countries traditionally noted for hunger levels. In low-income countries, the
number of individuals with diabetes is expected to increase from 84 million to
228 million by year 2030. Obesity is preventable and is associated with
numerous chronic diseases including cardiovascular conditions, diabetes, stroke,
cancers and respiratory diseases. About 16% of the global burden of disease,
measured as DALYs, has been accounted for by obesity.
importance of chronic non-communicable disease is increasing. For example, the
rates of type 2 diabetes, associated with obesity, have been on the rise in
countries traditionally noted for hunger levels. In low-income countries, the
number of individuals with diabetes is expected to increase from 84 million to
228 million by year 2030. Obesity is preventable and is associated with
numerous chronic diseases including cardiovascular conditions, diabetes, stroke,
cancers and respiratory diseases. About 16% of the global burden of disease,
measured as DALYs, has been accounted for by obesity.
In September
2011, the United Nations is hosting its first General Assembly Special Summit
on the issue of non-communicable diseases. Noting that non-communicable diseases are the
cause of some 35 million deaths each year, the international community is being
increasingly called to take important measures for the prevention and control
of chronic diseases, and mitigate their impacts on the world population
especially on women, who are usually the primary caregivers. Current
non-communicable disease efforts include global oncology.
2011, the United Nations is hosting its first General Assembly Special Summit
on the issue of non-communicable diseases. Noting that non-communicable diseases are the
cause of some 35 million deaths each year, the international community is being
increasingly called to take important measures for the prevention and control
of chronic diseases, and mitigate their impacts on the world population
especially on women, who are usually the primary caregivers. Current
non-communicable disease efforts include global oncology.
International Health Interventions
Many
low-cost, evidence-based health care interventions for improved health and
survival are known. Priority global targets for improving maternal health
include increasing coverage of deliveries with a skilled birth attendant.
Interventions for improved child health and survival include: promotion of
breastfeeding, zinc supplementation, vitamin A fortification and
supplementation, salt iodization, handwashing and hygiene interventions,
vaccination, treatment of severe acute malnutrition. In malaria endemic
regions, use of insecticide treated bednets and intermittent pharmacological
treatment reduce mortality. Based on such studies, the Global Health Council
suggests a list of 32 treatment and intervention measures that could
potentially save several million lives each year.
low-cost, evidence-based health care interventions for improved health and
survival are known. Priority global targets for improving maternal health
include increasing coverage of deliveries with a skilled birth attendant.
Interventions for improved child health and survival include: promotion of
breastfeeding, zinc supplementation, vitamin A fortification and
supplementation, salt iodization, handwashing and hygiene interventions,
vaccination, treatment of severe acute malnutrition. In malaria endemic
regions, use of insecticide treated bednets and intermittent pharmacological
treatment reduce mortality. Based on such studies, the Global Health Council
suggests a list of 32 treatment and intervention measures that could
potentially save several million lives each year.
Progress in
coverage of health interventions, especially relating to child and maternal
health (Millennium Development Goals 4 and 5), is tracked in 68 low-income
countries by a WHO- and UNICEF-led collaboration called Countdown to 2015. These countries are estimated to account for
97% of maternal and child deaths worldwide.
coverage of health interventions, especially relating to child and maternal
health (Millennium Development Goals 4 and 5), is tracked in 68 low-income
countries by a WHO- and UNICEF-led collaboration called Countdown to 2015. These countries are estimated to account for
97% of maternal and child deaths worldwide.
To be most
effective, interventions need to be appropriate in the local context, be timely
and equitable and achieve maximum coverage of the target population. Interventions
with only partial coverage may not be cost-effective. For example, immunization
programs with partial coverage often fail to reach the ones at greatest risk of
disease. Furthermore, coverage estimates may be misleading if not distribution
is taken into account. Thus, mean national coverage may appear fairly adequate,
but may nevertheless be insufficient when analyzed in detail. This has been
termed ‘the fallacy of coverage’.
effective, interventions need to be appropriate in the local context, be timely
and equitable and achieve maximum coverage of the target population. Interventions
with only partial coverage may not be cost-effective. For example, immunization
programs with partial coverage often fail to reach the ones at greatest risk of
disease. Furthermore, coverage estimates may be misleading if not distribution
is taken into account. Thus, mean national coverage may appear fairly adequate,
but may nevertheless be insufficient when analyzed in detail. This has been
termed ‘the fallacy of coverage’.
Although
health intervention programs are in place, there are paradoxes affecting their
capability to make a difference. As Farmer states in his article, many
populations are facing the ‘outcome gap’ meaning that some populations have
access to medical treatment while others do not. The reason for this is that
the countries supporting these populations do not have sustainable
infrastructure. The unfortunate problem with this is that a more effective
treatment will leave many untreated solely for the reasons that their country
does not have sustainable infrastructure to support it. Human rights are
central with this problem because sustaining health in a population should be
universal and accessible to all. It is also noted in the article that lack of
infrastructure is commonly referenced to for a lack of healthcare in a country,
demonstrating its prevalence in global health. In making progress with health
interventions, taking into account the ‘outcome gap’ is vital to a program’s
success and whether or not treatments will be able to reach those who need it.
It is important to note that although we do have these interventions in place,
many external factors influence how effective (if at all) a program can be.
health intervention programs are in place, there are paradoxes affecting their
capability to make a difference. As Farmer states in his article, many
populations are facing the ‘outcome gap’ meaning that some populations have
access to medical treatment while others do not. The reason for this is that
the countries supporting these populations do not have sustainable
infrastructure. The unfortunate problem with this is that a more effective
treatment will leave many untreated solely for the reasons that their country
does not have sustainable infrastructure to support it. Human rights are
central with this problem because sustaining health in a population should be
universal and accessible to all. It is also noted in the article that lack of
infrastructure is commonly referenced to for a lack of healthcare in a country,
demonstrating its prevalence in global health. In making progress with health
interventions, taking into account the ‘outcome gap’ is vital to a program’s
success and whether or not treatments will be able to reach those who need it.
It is important to note that although we do have these interventions in place,
many external factors influence how effective (if at all) a program can be.
There has
been several international debate that the field of global health is not
plagued by a lack of funds. There are many funds available to the global health
field at the present time through many different agencies. But more funds do
not always translate into any positive outcomes. The problem lies in the way
these funds are allocated to different issues; they are very narrow in their
approach where the focus is on one single disease. This stove-piping approach
disregards other dire health issues in global health, particular disease can
more funds due to interest of the donors and not to what is actually needed. Efforts
need to be coordinated rather than focusing on single disease. Most money that
is given comes with strings attached clauses where the money is spent at the
wishes of the donor. More money is needed where there are no conditions
attached. Donors must figure out how to build not only effective local health
infrastructures but also local industries, franchises, and other profit centres
that can sustain and thrive from increased health-related spending.
been several international debate that the field of global health is not
plagued by a lack of funds. There are many funds available to the global health
field at the present time through many different agencies. But more funds do
not always translate into any positive outcomes. The problem lies in the way
these funds are allocated to different issues; they are very narrow in their
approach where the focus is on one single disease. This stove-piping approach
disregards other dire health issues in global health, particular disease can
more funds due to interest of the donors and not to what is actually needed. Efforts
need to be coordinated rather than focusing on single disease. Most money that
is given comes with strings attached clauses where the money is spent at the
wishes of the donor. More money is needed where there are no conditions
attached. Donors must figure out how to build not only effective local health
infrastructures but also local industries, franchises, and other profit centres
that can sustain and thrive from increased health-related spending.
While
investments by countries, development agencies and private foundations has
increased substantially in recent years with aim for improving health
intervention coverage and equitable distribution including for measuring
progress towards the achievement of the Millennium Development Goals, attention
is also being increasingly directed to addressing and monitoring the health
systems and health workforce barriers to greater progress. For example, in its World Health Report 2006, the WHO
estimated a shortage of almost 4.3 million doctors, midwives, nurses and
support workers worldwide, especially in sub-Saharan Africa, in order to meet
target coverage levels to achieve the Millennium Development Goals 4 and 5.
investments by countries, development agencies and private foundations has
increased substantially in recent years with aim for improving health
intervention coverage and equitable distribution including for measuring
progress towards the achievement of the Millennium Development Goals, attention
is also being increasingly directed to addressing and monitoring the health
systems and health workforce barriers to greater progress. For example, in its World Health Report 2006, the WHO
estimated a shortage of almost 4.3 million doctors, midwives, nurses and
support workers worldwide, especially in sub-Saharan Africa, in order to meet
target coverage levels to achieve the Millennium Development Goals 4 and 5.
International Health Services Challenges
Health care workforce
The World
Health Organization (WHO) estimates that the world faces a shortage of 4.3
million health professionals required for delivering essential health care
services to populations in need. According to the WHO’s 2006 World Health
Report, 57 countries face severe shortages in their health care workforce,
mostly in sub-Saharan Africa. The WHO Global Code of Practice on the
International Recruitment of Health Personnel was developed in a context of
raising awareness of international health worker migration and addressing
global imbalances in health workforce distribution. The World Health Assembly
adopted the Code in 2010 to facilitate the strengthening of health workforces
with skills relevant to population needs.
Health Organization (WHO) estimates that the world faces a shortage of 4.3
million health professionals required for delivering essential health care
services to populations in need. According to the WHO’s 2006 World Health
Report, 57 countries face severe shortages in their health care workforce,
mostly in sub-Saharan Africa. The WHO Global Code of Practice on the
International Recruitment of Health Personnel was developed in a context of
raising awareness of international health worker migration and addressing
global imbalances in health workforce distribution. The World Health Assembly
adopted the Code in 2010 to facilitate the strengthening of health workforces
with skills relevant to population needs.
In addition
it takes appropriate conditions, health-care systems, and basic working
infrastructure to improve the general health of the public in developing
countries. However, long term neglect of basic infrastructure has made
hospitals, local health clinics, and medical schools with educated individuals
in the health field scarce. Thus, the cash flow and funds from public and
private sectors end up being spent less effectively.
it takes appropriate conditions, health-care systems, and basic working
infrastructure to improve the general health of the public in developing
countries. However, long term neglect of basic infrastructure has made
hospitals, local health clinics, and medical schools with educated individuals
in the health field scarce. Thus, the cash flow and funds from public and
private sectors end up being spent less effectively.
Aid effectiveness
In year
2005, over 100 donors and developing countries agreed to the Paris
Declaration on Aid Effectiveness. Among the distinguishing features was a
commitment to hold each other to account for implementing its principles at the
country level and to achieve joint progress by 2010 and beyond, through
attention to the following elements:
2005, over 100 donors and developing countries agreed to the Paris
Declaration on Aid Effectiveness. Among the distinguishing features was a
commitment to hold each other to account for implementing its principles at the
country level and to achieve joint progress by 2010 and beyond, through
attention to the following elements:
Ownership – Developing
countries set their own strategies for poverty reduction, improve their
institutions and tackle corruption.
countries set their own strategies for poverty reduction, improve their
institutions and tackle corruption.
Alignment –
Donor countries align behind these objectives and use local systems.
Donor countries align behind these objectives and use local systems.
Harmonization
– Donor countries coordinate, simplify procedures and share information to
avoid duplication.
– Donor countries coordinate, simplify procedures and share information to
avoid duplication.
Results –
Developing countries and donors shift focus to development results and results
get measured.
Developing countries and donors shift focus to development results and results
get measured.
Mutual
Accountability – Donors and partners are accountable for development results.
Accountability – Donors and partners are accountable for development results.
Furthermore,
the type of aid given to improve global health is often associated with short
term goals. For example, increasing the amount of people receiving specific
treatment, decreasing pregnant women with HIV (aids), or increasing the number
of bed nets. Few donors realize that it will take up to at least one full
generation or more to substantially improve the public health, and that the
focus should be less on particular diseases and more on populations general
well-being.
the type of aid given to improve global health is often associated with short
term goals. For example, increasing the amount of people receiving specific
treatment, decreasing pregnant women with HIV (aids), or increasing the number
of bed nets. Few donors realize that it will take up to at least one full
generation or more to substantially improve the public health, and that the
focus should be less on particular diseases and more on populations general
well-being.
Sustainable development goals
Just as some
of the MDGs have been met and several others are beginning to show success, the
focus for new global health policy initiatives is converging with one of the
main outcomes of the Rio+20 Conference (June 20–22, 2012), namely agreement by
the member States to launch a process to develop a set of Sustainable
Development Goals (SDGs), which will build upon the Millennium Development
Goals and converge with the post 2015 development agenda. Implicit within this
remain key challenges for health, as a central component of human development.
of the MDGs have been met and several others are beginning to show success, the
focus for new global health policy initiatives is converging with one of the
main outcomes of the Rio+20 Conference (June 20–22, 2012), namely agreement by
the member States to launch a process to develop a set of Sustainable
Development Goals (SDGs), which will build upon the Millennium Development
Goals and converge with the post 2015 development agenda. Implicit within this
remain key challenges for health, as a central component of human development.
Sustainable
development is most frequently defined as the “development that meets the
needs of the present without compromising the ability of the future generations
to meet their own needs.” Human health is thus embodied within an ecological
context of sustainable development: all aspects of human ecology fundamentally
dependent on the quality of the natural environment, such as clean water, clean
air, wholesome nutrition and recreation. This duly recognized, the challenges
encountered in sustainable development for health not only include
environmental and social determinants, but are also substantively influenced as
well by organizational and technological systems.
development is most frequently defined as the “development that meets the
needs of the present without compromising the ability of the future generations
to meet their own needs.” Human health is thus embodied within an ecological
context of sustainable development: all aspects of human ecology fundamentally
dependent on the quality of the natural environment, such as clean water, clean
air, wholesome nutrition and recreation. This duly recognized, the challenges
encountered in sustainable development for health not only include
environmental and social determinants, but are also substantively influenced as
well by organizational and technological systems.
For example
major reductions in the burden of malaria have been achieved by improved
prevention and treatment. Yet, such success cannot be taken for granted:
tuberculosis control is now threatened by the emergence of multiple
antibiotic-resistant strains. While this disease has social and environmental
determinants, it is a health systems and technological challenge as well.
Similarly, while health promotion and primary prevention are critical in
combating the NCD pandemic, they are much less than 100% effective: hundreds of
millions of people are developing NCDs, most of them poor; affordable
technologies must be made accessible to assist in their management. The world
must respond to this challenge as well, as is now being addressed by the World
Health Organization, in a new Global Action Plan for the Prevention and Control
of Non-Communicable Diseases 2013-2020.
major reductions in the burden of malaria have been achieved by improved
prevention and treatment. Yet, such success cannot be taken for granted:
tuberculosis control is now threatened by the emergence of multiple
antibiotic-resistant strains. While this disease has social and environmental
determinants, it is a health systems and technological challenge as well.
Similarly, while health promotion and primary prevention are critical in
combating the NCD pandemic, they are much less than 100% effective: hundreds of
millions of people are developing NCDs, most of them poor; affordable
technologies must be made accessible to assist in their management. The world
must respond to this challenge as well, as is now being addressed by the World
Health Organization, in a new Global Action Plan for the Prevention and Control
of Non-Communicable Diseases 2013-2020.
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