Global Public Health Overview

Global Public Health

• Global public health picks up on thinking about health as a global issue.
• Many environmental health issues tie into the larger issues of globalization.
• Many forms of global health disparities are caused by, and further cause, environmental and occupational health issues.
• Environmental, occupational and global health are linked by systems of trade, capital accumulation, systematic oppression and wealth inequality.
• Global health explores patterns of disease and ill-health across populations.
• Tackling global public health issues means tackling the inequalities that lead to clustering of ill health, disease and shortened lifespans in particular areas.
• The work of global public health seeks to improve health via social determinants by promoting social justice and equity, human rights and sustainable development.
• Work is done on the national and international scale by fostering availability of and access to healthcare professionals.

Global Health Inequalities and Disparities

• Health patterns across the globe: not evenly distributed.
• Differences in health patterns are known as global health inequalities or global health disparities.
• Global health inequities are the differential distribution of health issues across the globe.
• Global health inequities are the differences in population-level health status between countries.
• These differences are based on differential access to resources.
• Factors influencing global health disparities include wealth, environmental conditions, historical conditions and political conditions.
• Many global health disparities are socially created and avoidable rather than being due to different gene pools or biological factors.
• Health status reflects global social and economic inequalities.
• High-income countries have played a role in creating health disparities that leave many people in other parts of the world suffering.
• Diseases do not stay put, and the ill health of people in “far away countries” can impact those of us who are far away and live in places that are, currently, “healthy," so it benefits more people to ensure they also have access to decent living standards and care.

Vaccine Distribution and Global Health

• The WHO called for global solidarity regarding vaccine distribution through a program called COVAX.
• COVAX was designed so wealthier nations would contribute to the global vaccine pool, giving poorer nations access to vaccine supplies.
• As of mid-March 2021, wealthy countries containing 16% of the global population had administered half the vaccines delivered to date.
• The poorest countries had administered just 0.1% of the vaccines.
• COVID-19 is terrible and it is morally the right thing to ensure that folks across the world are protected, particularly elderly people and frontline health care providers through equitable vaccine distribution.
• Viruses mutate regularly, particularly when they have ample chance to replicate and spread, potentially leading to variants not matched by current vaccines.

Globalization and Health Inequities

• Globalization: there is large-scale global movement increasing inequality.
• Late stage global capitalism privileges accumulation of capital, and can fail to account for the needs of the world's most vulnerable people.
• Globalization is the worldwide spread of people, goods, ideas and money.
• The social phenomenon of globalization is the rapid spread of ideas, information and cultural practices.
• Economic globalization is the interconnectedness and movement of money and business across the globe.
• Economic globalization relies on the exploitation of cheap pools of labour and material resources to produce goods at the lowest possible cost.
• In the past two decades, the movement of people means the movement of illness across the globe at alarming speed.
• Economic globalization has the effect of increasing inequality.
• Some labour markets (like those across North America) are left jobless when companies move, while underpaid labour markets (like those across parts of Asia) remain entrenched in poverty and bear the brunt of exploitative labour practices.
• Exploitation of vulnerable/poor populations exacerbates inequality and global poverty while the movement of labour out of places where there is more regulation or where labour costs more creates new pockets of poverty.
• Exploitation and movement of goods creates environmental issues.
• The fast movement of people means a higher risk for emergent infectious diseases.

Measuring the Burden of Disease and Global Health Disparity

• Measurements are done in terms of quantity and quality.
• Calculations look at how long people in a particular region live, or population life in aggregate
• There are two main different quantitative measurements: Life expectancy, and potential years of life lost (PYLL and YPLL)
• These are the life expectancies of the populations in aggregate and, as such, tells you a great deal about the burden of disease, injury and ill health on the population in general.
• PYLLs (Potential Years of Life Lost) are based on the idea that, under ideal circumstances, there is an average human life span.
• PYLLs compare how many of these average years of the ideal life span have been lost due to premature death.
• Measurements relating to quality of life indicators include Disability-Adjusted life years (DALYs) and Quality-Adjusted Life Years (QALYs).
• DALYs measure how many of these "years of perfect health" have been lost to disease or disability, and is a term that is problematic for many members of the disability community.
• QALYs calculate the number of years of perfect health gained through a population-level intervention.

What's Being Done: Millennium Development Goals

• The United Nations (UN) and the WHO have worked to further some of the key public health goals in order to combat global health disparities.
• The WHO has engaged broad scale, population-level efforts to tackle the social determinants of health (SDOH) as a means of improving inequality and preventing disease.
• The UN's Sustainable Development Goals are a set of global policy goals that seek to improve overall forms of social, economic and environmental inequalities.
• The goals seek to improve overall forms of social, economic and environmental inequalities and issues as a means of supporting global health and combating global health inequities.
• Goals directly relate to health, but also include items such as "gender equality” and “sustainable cities and communities” which relate to health more tangentially.
• Collective, international goals provide a road map for the global community to work individually and collectively on issues that impact global health.

Case Study: Sleeping Sickness and Neglected Tropical Diseases

• Sleeping sickness is considered a neglected tropical disease (an NTD).
• NTDs are diseases that disproportionately affect poorer countries (often located in warmer climates like the tropics).
• NTDs are given scant attention by either the research industry, or the pharmaceutical industry.
• Examples of NTDs include Chagas disease, leprosy, rabies etc.
• These diseases are neglected in terms of research and development because they are not profitable.
• NTDs are a burden in countries where the citizens and governments are poor, and where infrastructure is lacking.
• Testing and treatment options must be extremely cheap and easy to deliver if they are to be cost effective and profitable.
• The ongoing impact of sleeping sickness that is that affected residents will struggle - the world has lost access to not only the individuals who died, but the communities that are also compromised by their deaths.

Conclusion

• Global health, like environmental and occupational public health issues, are complicated and tied to human indifference, ineptitude, and exploitation.
• Understanding the issues of global disease distribution is a first step toward changing social patterns that enrich some and deprive others.
• Goals of global public health are deeply tied to social justice and equity.