Global Health Issues: Causes and Challenges

• Global health seeks to improve health and achieve health equity worldwide
• Global health addresses multiple problems across disciplines

Leading Causes of Mortality

• High-income countries: Ischemic heart disease, cerebrovascular disease, trachea/bronchus/lung cancers
• Low-income countries: Lower respiratory infections, ischemic heart disease, diarrheal diseases

Examples of Global Health Issues

• COVID-19, Ebola, and Zika outbreaks are global health concerns

Biosocial Approach to Global Health

• Definition: An interdisciplinary method to analyze biological, social, political, and economic causes of "wicked" problems
• Health is shaped by social and structural conditions, not just individual behaviors
• Grounded in principles of social justice, human rights, and health equity
• Uses research, training, and advocacy to inform program planning directly
• Anthropology, history, and political economy help "resocialize" global health

Key Challenges in Global Health

• Rising chronic diseases, like heart disease, diabetes, and cancer are challenges in global health
• Emerging/re-emerging infectious diseases, such as HIV/AIDS, tuberculosis, and malaria all present key challenges
• Mental illness and substance abuse are problems that create a burden in health management
• Health disparities between rich and poor countries are a major point of concern
• Climate change, weak health systems, and social determinants (poverty, education, gender equality) can all have negative impacts

Wicked Problems

• Complex and dynamic issues that lack a definitive solution
• Multiple, interwoven causes and effects make them unpredictable

Concept Maps

• Tools that visually represent relationships between concepts using nodes and linking phrases

Problem Types

Simple Problems

• Have clear causes and solutions such as when following a recipe

Complex Problems

• Evolve and require adaptive solutions such as when working on space travel

Wicked Problems

• Messy, unpredictable issues lacking clear resolution that can lead to unintended consequences, such as climate change

Why "Resocialize" Global Health Projects?

• Projects can have unintended consequences when social theories are ignored
• Colonial-era interventions serve as an example of what happens when overlooking local social structures

Intended vs. Unintended Consequences

• Intended consequences are expected outcomes, like studying to get good grades
• Unintended consequences are unexpected or adverse outcomes

Models of Authority

• Traditional authority is based on customs or tradition (e.g., monarchies)
• Charismatic authority is based on a leader's personal qualities (e.g., revolutionary leaders)
• Rational-legal authority is based on formal rules and laws such as bureaucracies

Biopower

• Institutions define, control, and discipline populations using biological and medical data
• This is done through surveillance and normalization, without overt coercion

Social Suffering & Structural Violence

• Social suffering: Widespread pain caused by political, economic, and social forces (e.g., poverty, discrimination)
• Structural violence: Harm caused by social structures that disadvantage certain groups

Modern Challenges in Global Health Approaches

• Unreflective activism includes initiatives lacking evidence and grounding in theory
• Paralytic skepticism describes a state of inaction due to lack of motivation or passion

Sociology & Social Theories

• These theories explain why some global health initiatives succeed while others fail

Berger & Luckmann

• Studied how practices and norms become institutionalized as "knowledge"

Merton:

• Studied unintended consequences of actions despite clear goals

Max Weber:

• Weber differentiated between traditional, charismatic, and legal-rational authority

Colonial Medicine's Purpose

• Colonial medicine aimed to maintain the health of European military troops, administrators, and local laborers
• This often took place in a paternalistic, racist manner

Colonial vs. Tropical Medicine

• Colonial medicine focused on settler health and control of colonized populations
• Tropical medicine studied diseases in tropical regions, driven by economic or military interests Legacy

Legacies of Colonial and Tropical Medicine

• Capital and control were emphasized over altruism
• Vertical programs often disregarded local systems and knowledge

Measurement & Health Systems

DALY (Disability-Adjusted Life Year) =

• Measure of years lost due to ill health, disability, or early death

Indicators

• Indicators for health system development includes maternal mortality, infant mortality, and under-5 mortality

Health Systems Concepts

Vertical programs

• Focus on one disease/condition

Horizontal programs

• Aim to strengthen the entire health system Overall, this strategy should improve health, responsiveness, financial risk protection, and efficiency, and reduce care gaps

Downsides of Parallel systems

• Inefficiencies, duplication, inequality, care gaps, and lack of accountability

Mental Health Measurement

• Measurements are challenging due to subjective symptoms, complex symptomatology, cultural interpretations, and stigma

Global Health Governance & Bureaucracies

• Key players include the WHO, World Bank, UNICEF, Rockefeller Foundation, and the Bill & Melinda Gates Foundation

WHO Innovations

• All countries are granted universal membership with a decentralized approach
• The Malaria Eradication (1955) act failed due to its over-reliance on vector control, incurred high costs, and had poor cooperation with the community
• The Smallpox Eradication (1967) act was successful with locally integrated, cost-effective teams and an effective, identifiable vaccine

Primary Health Care & Global Strategies

Alma Ata Declaration (Primary Care)

• Emphasizes access to technology, community-based care, and prevention or early intervention

Challenge

• Faltered partly because it did not specify how to finance Primary Health Care or PHC

Neoliberalism & Commodification

• Market-based solutions, privatization, and user fees may worsen health inequalities

Infections

• Preventing, testing, and treating for improved health for three-pillar HIV/AIDS management

Partnerships

• Partnerships such as the one between the US and NGOs plus Doha Declaration enable production, purchase of low-cost generics

UNAIDS 90-90-90:

Targets 90% diagnosis, 90% treatment, and 90% viral suppression

Tuberculosis

• The DOTS strategy involves the use of a cost-effective strategy but can lead to the unintended development of MDR-TB
• The DOTS+ strategy involves adding second-line drugs and addresses primary health/social needs
• Case Study – Haiti: Zanmi Lasante, used local healthcare providers and provided external support
• Centralization through groups like the Green Light Committee to helps reduce drug costs and maintain treatment standards

Effective Global Health Delivery Models

Partners in Health Model (8 Characteristics)

• Strengthening PHC access, providing care/education for the poor, fostering community partnerships, addressing basic needs, working with the public sector, focusing on women/children, harnessing technology/communication, and disseminating lessons learned.

Four Effective Delivery Principles:

• Adapting to local context requires the tailoring of inventions to sociocultural factors and local diseases
• Constructing a Care, Delivery Value chain
• Leveraging Shared Delivery requires Leveraging Shared Delivery Infrastructure as was done Bangledesh
• Improving Economic Development: was done by the Sumitomo Chemical Company in Tanzania.

Foreign Aid & Global Priorities

• Foreign aid consists Money, materials, manpower, technology, and expertise
• Resources are provided to NGO.s governments nad International Organizations such as Private foundations, NGOs, and local groups
• Challenges to foreign aid are the ‘poverty trap’ and debates about aid
• Alternatives to tradition aid approach include easterly’s Proposal and the Accompaniment Approach as outlined by Paris Declaration

International Aid Ethics

• International Aid requires a strong evidence base from diverse settings, political will (long-term, scalable investments), and social strategies (addressing structural violence and fostering local partnerships).

Sustainable Development Goals (SDGs)

• There are 17 sustainable goals that where agreed upon by the UN to address issues and well-being globally

The include

• Maternal/child health, infectious diseases, non-communicable diseases, substance abuse, road traffic injuries, reproductive health services, universal health coverage, and environmental health.

Drug Development Global Health and Equity (J. Richmond's Framework):

• A strong knowledge base (evidence-based interventions) is required, as well as sustained political will and strategies to addressing social violence.

Global Health Equity

• Is the process that identifies needs and follows through phases of development, trials, adoption, and application for medicine.
• The Double Burden disease has been highlighted where developing countries will face both infectious diseases and the issues of new non- communicable disease
• The challenges and gaps includes neglect for drugs due to low profitability, poor countries and the settings of weak health systems.