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.