GLOBAL HEALTH: ISSUES, CHALLENGES AND MANAGEMENT

Being a lead paper presented at the International Conference on 'Global health: issues, challenges and management, organised by Centre for Women, Gender,  and Development Studies; [CWGDS] and Institute of Environmental Health Technology, IEHT, Federal Univeersity of Technology, Owerri

Introduction

Global health has emerged as a growing field, particularly over the past two decades. Greater recognition of the global AIDS crisis, combined with the appearance and rapid international spread of epidemics such as SARS, anthrax, the Ebola virus, swine flu (H1N1), etc., have reinforced that health threats transcend national borders. While much of the media attention has focused on epidemic of infectious diseases, poverty, environmental pollution and degradation, social inequalities, global health looksat a wider scope of health problems, determinants, and solutions, such as chronic illnesses, accidents  and injuries. Other global health challenges include but not limited to poverty, environmental and health emergencies, gender violence and abuse, substance use and abuse, sex and sexuality, infant and maternal mortalities, terrorism etc.

Health was first defined in Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948; as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. While there have been criticisms of this definition, the WHO has not changed its 1946 definition of health. More contentious, however, has been the definition of “global health.”

On the other hand, Public Health can be defined as the combination of sciences, skills, and beliefs that are directed to the maintenance and improvement of health of all people. The classic definition of public health describes it as  “the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health”

Globally, the overall mission of public health is to "fulfil society's interest in assuring conditions in which people can be healthy." The three core public health functions are:

•  assessing and monitoring  the health of communities and populations at risk to identify health problems and priorities;
•  formulating public policies designed to solve identified local and national health problems and priorities;
•  Assuring that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluation of the effectiveness of that care.

Concept of Global Health

According to the Institute of Medicine, "Global health is the goal of improving health for all people in all nations by promoting wellness and eliminating avoidable diseases, disabilities, and deaths. Global health can be attained by combining clinical care at the level of the individual person with population-based measures to promote health and prevent disease. To achieve global health, an understanding of health determinants, practices, and solutions, as well as basic and applied research concerning risk factors, disease, and disability, is very important. Unlike Public Health, Global Health is more encompassing allowing the contributions of many other professionals in health issues and solutions.

Issues

Since 1950, global health has known quite a lot of improvements. However, this progress has not been equally distributed worldwide. A considerable number of countries primarily in Sub-Saharan Africa, especially Nigeria, lag behind the rest of the world on many health indices. For instance, health care systems are still neither available nor accessible (when and if available) to a great many people in Nigeria; infrastructural decay is common in the available health care systems; non-communicable diseases (such as cardiovascular diseases, cancer, diabetes and chronic lung diseases) are still major threats to Nigerians between the ages of 30 and above; hundreds of children under the age of 5 die from malnutrition, diarrhoea, measles, respiratory diseases and mostly preventable diseases, each year. It is on records that millions of people die of infectious diseases, such as HIV/AIDS, pneumonia, diarrhoea, tuberculosis and malaria annually. Other global issues include man-made and natural disasters (such as landslide; tsunamis; earthquakes; and flooding. The flooding of 2012 in Nigeria affected farming and sustenance of food availability in the nation, and displaced at least 10,000 people; etc.Furthermore terrorism, conflict, gender inequality, poor healthcare financing, emerging and re-emerging diseases, etc are other global health issues confronting Nigeria.

These health indicators continue to have a devastating impact on Nigeria and the world’s poorest countries. They make those countries vulnerable to social instability, economic breakdown, and decrease in population strength, spread of infectious diseases and increase in risk factors for chronic diseases.The vast range of global health issues are not without challenges.

Major Challenges

The biggest challenge in global health is the lack of financial resources to combat the multiple scourges ravaging the world's poor and sick. Today, more funds are needed for pressing heath issues than ever before. Furthermore, funds are needed to support research, build health facilities, train more health personnel, build capacity and competence among health care providers.

Tackling the world's diseases burden has become a key feature of many nations' foreign policies over the last five years, given that microbes know no borders. The focus of those nations is on keeping life expectancy high. That is another major challenge.For example,overall, 35% of Africa's children are now at higher risk of death than they were 10 years ago. Every hour, more than 500 African mothers lose a child. In 2002, more than four million African children died. Those who do make it past childhood are confronted with adult death rates that exceed those of 30 years ago. Life expectancy, that is always shorter here than almost anywhere else, is reducing still. In some African countries, it has been cut by 20 years and life expectancy for men is now less than 46 years.

A third major challenge is how to keep new health threats from emerging. While positive in many respects, urbanization, globalization, and demographic changes have intensified timeless health issues, changed the dynamics of health and resulted in the emergence of new health threats. Although HIV/AIDS, tuberculosis, and malaria are treatable and preventable diseases, meanwhile, many rich and poor countries alike have undergone an epidemiological transition in which non-communicable diseases – including depression, diabetes, cardiovascular disease, and cancers – have replaced infectious diseases as the leading causes of morbidity and mortality. Out of every 10 deaths worldwide, six are due to non-communicable conditions, three to communicable diseases, reproductive issues, or nutritional conditions, and one to injuries.

With increasing urbanization comes increasing violence and crime. In addition, the effects of depression and social exclusion can be more profound. About 14 per cent of the global burden of disease has been attributed to neuropsychiatric disorders, mostly owing to depression and other common mental disorders, alcohol- and substance-use disorders, and psychoses. The burden of major depression is expected to rise to be the second leading cause of loss of disability-adjusted life years in 2030 and will pose a major urban health challenge.

A fourth major challenge global health is confronted with is the manner in which to improve living conditions. Declining living conditions and reduced access to basic services have led to decreased health status. In Africa today, almost half of the population lacks access to safe water and adequate sanitation services. As immune systems have become weakened, the susceptibility of Africa’s people to infectious diseases has greatly increased. Global health initiatives aimed at improving the health and well-being of impoverished, vulnerable, and underserved people worldwide include poverty reduction strategies, disease prevention measures, efforts to improve nutrition and food security, policy to raise environmental standards and living conditions, and the promotion of gender equality.Health disparity between high-income and low-income countries, as well as between individuals within a country, often make this impossible, leaving many people living in unhealthy settings without sufficient access to care.

Management

For the world to begin to address health issues, three principles of action should be considered:

1.    Conditions of daily life have to be improved --- the conditions in which people are born, grow up, live, work and age;

2.    The inequitable distribution of power, money, and otherresources has to be tackled; the structural drivers of those conditions of daily life globally, nationally, and  locally;

3.    Problems have to be measured, actions evaluated, knowledge base expanded; a workforce that is trained in the social determinants of health has to be developed, and a public awareness has to be raised about the social determinants of health.

One framework for addressing global health challenges is the Millennium Development Goals (MDGs). The MDGs were adopted by the Member States of the United Nations in 2000 to achieve demonstrable reductions in poverty and improve specific health and social outcomes by 2015. The outlined goals reach beyond health issues, but four of the eight goals pertain directly to health:

• Goal 1: Poverty Reduction
• Goal 4: Reduce child mortality
• Goal 5: Improve maternal health
• Goal 6: Combat HIV/AIDS, malaria, and other diseases

The MDGs reflect widespread acknowledgement that improving global health is an integral part of development. However, the midpoint between 2000 and 2015 has passed, and the MDGs remain a distant goal for many countries especially Nigeria. For example, an estimated half-million women continue to die as a result of childbirth each year.  While substantial progress has been made in child health, the global community needs to intensify and sustain efforts in other areas in order to meet the MDG targets.

It is important to note that most health problems are caused not by health issues as such, but by social, political and economic conditions that drive people’s lives.

Conclusion

Poverty exacerbates health issues. Under conditions of poverty, entities such as pharmaceutical companies can wield even more power and influence over poor countries. Some major reasons for unnecessary deaths around the world are, therefore, due to human decisions and politics, not just natural outcomes. Well-intentioned companies, organizations and global action show that humanity and compassion still exists, but tackling systematic problems is paramount for effective universal healthcare that all are entitled to.

Addressing health problems goes beyond just medical treatments and policies; it goes to the heart of social, economic and political policies that provide not only for healthier lives, but also for a more productive and meaningful one that can benefit other areas of society.

The Federal Ministry of Health under President Goodluck Jonathan (GCFR) has in the last two years improved the infrastructure of our Health System for improved service delivery across the nation.

The Ministry is also currently involved in disease control and prevention through sustained routine immunization, health promotional activities, Environmental sanitation, safe motherhood.

In this respect the maternal and infant mortality rates are gradually going down, and hope that it will continue to improve.

This transformational agenda of President DrGoodluck Jonathan (GCFR) has also put in place various empowerment programmes to reduce poverty in Nigeria and this will continue until all global health indices are improved.