Managing Global Health Challenges PDF

Better Managers for a Better World Managing Global Health Challenges Global health policies, healthcare disparities and humanitarian healthcare, infectious and chronic diseases Your speaker today Alfredo Galletti Corporate Vice President and General Manager Novo Nordisk Italia 20 years in company...

Better Managers for a Better World Managing Global Health Challenges Global health policies, healthcare disparities and humanitarian healthcare, infectious and chronic diseases Your speaker today Alfredo Galletti Corporate Vice President and General Manager Novo Nordisk Italia 20 years in company across different functions Responsible for pricing and Access for International Operations Index 1. What is “global Health” and the concept of health 2. Key concepts in global health 3. History of global health 4. Global Health challenges and challenging factors 5. Current & Future global health priorities 6. Sustanable Development Goals 7. Governance and main actors in global health 8. Global Health and ethics 9. Conclusions and final remarks  Better Managers for a Better World Global Health and the concept of Health We live longer… Better Managers for a Better World Life expectancy by continent …but not better Better Managers for a Better World Life expectancy by continent Infectious Mental diseases and Health pandemics Health inequalities Non communicable diseases Anti- Environmental microbial factors resistance The concept of health is also changing Better Managers for a Better World WHO: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” In other words, it is not being “disease free” but “live well”  Global health is indeed global Better Managers for a Better World Institute Of Medicine, 1997: “Health problems, issues, and concerns that transcend national boundaries, which may be influenced by circumstances or experiences in other countries, and which are best addressed by cooperative actions and solutions” Focuses on factors beyond health: economic and political instability; income and social inequality; lack of education and employment; insufficient food; climate change and natural disasters; limited access to quality health care  Key concepts on Global Health Better Managers for a Better World Key Concepts related to Global Health Better Managers for a Better World The determinants of health The measurement of health status The importance of culture to health The global burden of disease The organization and function of local health systems  Determinants of Health Better Managers for a Better World Personal/Social factors Systemic factors Genetic make up Political stability Age Civil rights Gender Environmental degradation Lifestyle choices Population growth/pressure Community influences Income status Urbanisation Geographical location Country development Culture Environmental factors Work conditions Education Access to health services Source: Dahlgren G. and Whitehead M. 1991 Multi-cause-effect relationships Better Managers for a Better World Malnutrition ➔ more susceptible to disease and less likely to recover Cooking with wood and coal ➔ lung diseases Poor sanitation ➔ more intestinal infections Poor life circumstances ➔ STIs, HIV/AIDS Advertising tobacco and alcohol ➔ addiction and related diseases Rapid growth in vehicular traffic often with untrained drivers on unsafe roads ➔ road traffic accidents The Measurement of Health Status Better Managers for a Better World Cause of death Infant mortality rate Obtained from death certification but limited The number of deaths in infants under 1 year per because of incomplete coverage 1,000 live births for a given year Life expectancy at birth Neonatal mortality rate The average number of years a new-borns baby The number of deaths among infants under 28 could expect to live if current trends in mortality days in a given year per 1,000 live births in that were to continue for the rest of the new-born's life year Maternal mortality rate Child mortality rate The number of women who die as a result of The probability that a new-born will die before childbirth and pregnancy related complications per reaching the age of five years, expressed as a 100,000 live births in a given year number per 1,000 live births Rich tapestry of data available Better Managers for a Better World  Culture and Health Better Managers for a Better World Culture: The predominating attitudes and behaviour that characterise the functioning of a group or organisation Traditional health systems – e.g. herbal medicines Beliefs about health –e.g. epilepsy – a disorder of neuronal depolarisation vs a form of possession/bad omen sent by the ancestors –Psychoses – ancestral problems requiring the assistance of traditional healer/spiritualist Influence of culture of health –Diversity, marginalisation and vulnerability due to race, gender and ethnicity  The global burden of disease Better Managers for a Better World GBD is a comprehensive regional and global research program of disease burden that assesses mortality and disability from major diseases, injuries, and risk factors. GBD is a collaboration of over 12,000 researchers from more than 160 countries The global burden of disease Better Managers for a Better World The Organisation and Function of Health Systems Better Managers for a Better World  History of global health Better Managers for a Better World  Global Health timeline Better Managers for a Better World Age of exploration and Age of Pandemics and Birth of Birth of NGOs and Age of HIV and “tropical medicine” birth of first bureaus WHO structural aids health at forefront Infectious diseases were Between 1816 and 1899 six global In 1946, the recently formed International economic HIV/AIDS became a force that devastating to both the native cholera pandemics killed thousands United Nations (UN) met and organizations, such as the World galvanized international populations and to the European 1851: 12 European governments approved a Constitution for Bank and the International cooperation between government colonists. (Taino tribe of Hispaniola) created International Sanitary what would become the World Monetary Fund (IMF) created new and non-government organizations. Mortality rates for the European Convention Health Organization (WHO). policies to try and address the New agencies are born (President’s settlers were also high. For British 1907, the Office Initially signed by 61 countries, the struggling economies of the Emergency Fund for AIDS Relief colonists on Africa’s Gold Coast International d’Hygiene Publique WHO took over the function of the world’s poorest nation. (PEPFAR, 2002) (now Ghana) mortality rates were formed in Paris international health bureaucracies The World Bank and IMF created In 2000, the G8 included HIV/AIDS as high as 1913: Rockfeller Foundation of the early 20th century structural adjustment programs as a national security issue 300-700 per 1,000 during the first International Board of Health and became the central force in (SAPs) that were designed to 2000: WHO released Millenium year of the colony. 1924: Pan American sanitary global health. incentivize debt repayment. development goals bureau against yellow fever 16th-17th century 19th – 20th century 1946 1980s 1990s  Smallpox – a (once deadly) disease Better Managers for a Better World Smallpox is the first and only infectious disease that has been eradicated in humans Prior to eradication, smallpox was a serious disease caused by the variola virus (permanent scarring, blindness, and in many cases death) Spreads from person to person through direct and prolonged contact. Before smallpox was eradicated, the disease took a significant toll on humanity: –About 3 out of every 10 people infected died –300 million deaths in the 20th century –65-80% of survivors suffered from deep scars  Smallpox – a (once deadly) disease Better Managers for a Better World 1796, English physician Edward Jenner observed that milkmaids who previously had cowpox (which is caused by a virus that is closely related to variola) were resistant to smallpox. By transferring material from a cowpox sore on a milkmaid named Sarah Nelmes into the arm of James Phipps, the son of his gardener, Jenner observed that Phipps had developed immunity to smallpox after exposure to the variola virus. This major discovery led to the development of the first vaccine against smallpox derived from cowpox.  Smallpox – a (once deadly) disease Better Managers for a Better World WHO began in 1959, but the campaign fell short due to a lack of resources, funding In 1967, efforts were revived through the Intensified Eradication Program and vaccine research developments, advances in surveillance, and mass vaccination programs In 1980, the 33rd World Health Assembly officially declared: ‘The world and all its peoples have won freedom from smallpox.’ It was ended, thanks to a 10-year global effort, spearheaded by the World Health Organization, that involved thousands of health workers around the world to administer half a billion vaccinations to stamp out smallpox.  The fight against Polio Better Managers for a Better World Polio, short for poliomyelitis, is an infectious disease that is caused and transmitted by a virus called the poliovirus. Can lead to the permanent paralysis and can ultimately cause death by immobilizing the patient’s breathing muscles Spreads especially well in conditions of poor sanitation The virus can only survive in humans (and no other animals) and no cure exists for the symptoms Large outbreaks continued around the world. As a response the "Global Polio Eradication Initiative" (GPEI) was founded in 1988 Since then, the world has made rapid progress against the disease. Two of the three types of wild poliovirus have been eradicated worldwide, and one remains. The fight against Polio Better Managers for a Better World Paralytic polio: estimated cases by world region, 1980 to 2023 Share of one-year-olds who are vaccinated against polio, 2021  The challenges to global health Better Managers for a Better World In general, systems are more and more under pressure Better Managers for a Better World Healthcare spend and Macro- Widening investments economic disparities issues Healthcare Scientific workers Urbanisation advancements shortages Anti- Ageing Digital innovation microbial population resistance Alternative care models Scientific advancement Better Managers for a Better World FDA NCE and NBE approvals Digital innovation Better Managers for a Better World Disease Identification/algorithms Personalised treatment/pattern and biomarkers recognition Drug discovery/manufacturing Robotic surgery (DaVinci) Clinical trial research Executing routine jobs  Macroeconomic issues Better Managers for a Better World Annual real growth in Health Expenditure and GDP (OECD average) Health Care expenditure as % of GDP https://ourworldindata.org/financing-healthcare OECD Health statistics Widening disparities Better Managers for a Better World  Widening disparities Better Managers for a Better World Life expectancy 51 82 84 at birth Lesotho Italy Japan Under-five 120 2.4 1.7 mortality rate Niger Italy Estonia Polio 46 95 99 immunisation at 1 year old Yemen Italy Portugal Mortality rate 5 0.25 0.1 of unintended poisoning Somalia Italy Israel (100.000 inh) Widening disparities Better Managers for a Better World Burden of disease, 2021 Disability-Adjusted Life Years (DALYs) per 100,000 individuals from all causes. DALYs are calculated as the sum of the years of life lost due to premature mortality (YLLs) from that cause and the years of years of healthy life lost due to disability (YLDs) for people living in states of less than good health resulting from the specific cause. The loss function is based on the frontier national life expectancy projected for the year 2050 by the World Population Prospects 2012 (UN Population Division, 2013), with a life expectancy at birth of 92 years.  Healthcare workers shortage Better Managers for a Better World Health systems can only function with health % of primary care phisicians who plan to stop seeing patients workers WHO estimates shortfall of 10 million health workers by 2030, mostly in low- and lower-middle income countries Chronic under-investment in education and training & difficulties in deploying health workers to rural, remote and underserved areas and increasing international migration Lack of capacity by the public sector to absorb the supply of health workers due to budgetary constraints. Munira Gunja et al., Stressed Out and Burned Out: The Global Primary Care Crisis — Findings from the 2022 International Health Policy Survey of Primary Care Physicians (Commonwealth Fund, Nov. 2022) Urbanisation Better Managers for a Better World TEXT Urbanisation Better Managers for a Better World Urbanization: the process by which humans form dense settlements constructed of buildings, roads, and supporting infrastructure By 2050, 6.4 billion (two-thirds of the world’s entire population) will live in urban areas Urbanization process is characterized rapid and unstructured in-migration of people to cities. This important social process underpinning the dynamics of human society is especially impactful in the 21st century, with profound repercussions on: –the natural and biotic environment due to deforestation, fragmented habitation, –air, noise and light pollution. –Numerous non-native species (rabies, bird flu, Ebola, zika, chikungunya, dengue, rickettsiosis, leptospirosis and others) may start to proliferate, due to their adaptative ability in response Urbanisation is becoming object of research and public debate Better Managers for a Better World Ageing of population Better Managers for a Better World Cardiovascular diseases Chronic respiratory diseases Communicable, maternal, neonatal, and nutritional diseases Diarrhoeal diseases; encephalitis; lower respiratory infections; pneumococcal meningitis; trachoma Diabetes and kidney diseases Chronic kidney disease Digestive diseases Cirrhosis Injuries Neoplasms Neurological disorders Other non-communicable diseases Age-related and other hearing loss; age-related macular degeneration; cataract; glaucoma; other sense organ diseases; other vision loss; refraction disorders Skin and subcutaneous diseases Cellulitis; decubitus ulcer; fungal skin diseases; other skin and subcutaneous diseases; pyoderma Anti-microbial resistance Better Managers for a Better World Antibiotic resistance rate Anti-microbial resistance Better Managers for a Better World Microbial resistance, particularly antimicrobial resistance (AMR), is critical and escalating threat Overuse and misuse of antimicrobial drugs in human health, animal agriculture, and the environment have led to the emergence of bacteria, viruses, parasites, and fungi that are increasingly resistant The rise of resistant pathogens undermines the effectiveness of standard treatments for common infections, complicates medical procedures such as surgeries and chemotherapy, and poses a significant challenge in managing infectious diseases. Addressing microbial resistance requires a multifaceted approach, encompassing improved infection prevention and control, responsible use of antimicrobial agents, research and development of new antimicrobial drugs, and global collaboration to mitigate the impact of this growing threat on public health systems worldwide.  The current & future priorities Better Managers for a Better World Future health challenges on NCDs Better Managers for a Better World  Future health challenges on NCDs Better Managers for a Better World Burden of disease, 1990 Burden of disease, 2021 Disability-Adjusted Life Years (DALYs) Disability-Adjusted Life Years (DALYs). VizHub - GBD Compare  Future health challenges on NCDs Better Managers for a Better World Low income countries – 1990 and 2021 comparison Mid-High income countries – 1990 and 2021 comparison Disability-Adjusted Life Years (DALYs) Disability-Adjusted Life Years (DALYs). VizHub - GBD Compare Future health challenges Better Managers for a Better World Structural Climate crisis Environment & pollution Health systems Lifestyle and communicable diseases Malnutrition and food Substance abuse Infectious disease Sexual and reproductive health Non Communicable diseases Mental health Cancer Diabetes and obesity  Climate change Better Managers for a Better World Annual Temperature Anomaly The WHO identifies climate change as the most significant health threat facing humanity in the intermediate term More infectious diseases are emerging and/or reemerging in certain regions, such as dengue in North and South America and Ebola in Africa. Growth of disease vectors such as Aedes aegypti, with transmission increasing by almost 10% between 1950 and 2018 More frequent and severe environmental disasters - Heat waves are associated with greater risks of respiratory and cardiovascular diseases, Global Temperature Report for 2023 - Berkeley Earth  Environmental pollution Better Managers for a Better World Spatial distribution of 3-year PM10 average concentrations and percentage of 7 million deaths are attributable to the joint relative perceived likelihood and impact on the individual effects of environmental and household air pollution. The ingestion of microplastics and plasticizers in humans may be associated with infertility, obesity, endocrine dysfunctions, and malignancy The health impacts of using toxic heavy metals such as mercury and lead in fuel and paint products continue to be a significant problem This is just one aspect of the larger issue of anthropogenic pollution, or pollution stemming from human activity Public risk perception of air pollution in the general population of Italy and Sweden during the COVID-19 pandemic: Environmental and socio-demographic drivers Public risk perception of air pollution in the general population of Italy and Sweden during the COVID-19 pandemic: Environmental and socio-demographic drivers - ScienceDirect  Health systems Better Managers for a Better World Health care spending as % of GDP Crucial in implementing health actions that promote population health and SDGs. Weaknesses and overburden in many health systems across high-, middle-and low-income countries. 50% of the world’s population does not have access to the essential healthcare services they need A crisis that is relevant for both developed and developing countries – Developing countries: Health financing, health workforce development, infrastructures, supplies, healthcare information systems, and other vital aspects – Developed countries: gaps in health systems concerning prescription drugs, the high costs of long-term care, mental health services, dental services, and eye care  Infectious diseases Better Managers for a Better World COVID-19 cases per 100,000 inhabitants Pandemics can occur unexpectedly and spread rapidly - COVID-19 pandemic example of importance of preparedness and rapid response to emerging microbial threats Socioeconomic determinants: poverty and limited access to clean water and sanitation can contribute to the spread of infectious diseases such as cholera and diarrheal diseases High-burden countries such as Africa face unique challenges in responding to HIV, (risk of transmission through injection drug use, lack of accessibility to antiretroviral therapy, and continued social stigma associated with drug use)  Substance abuse Better Managers for a Better World Substance use, excluding alcohol and tobacco, is responsible for approximately 500,000 deaths annually, with tobacco and alcohol estimated to result in over 8 million deaths annually Recreational drug use was also estimated to be responsible for over 42 million years of healthy life loss (disability-adjusted life years, DALYs) in 2017, making up approximately 1.3% of the global burden of disease Substance abuse and its associated harms have contributed significantly to the shift from infectious diseases to noninfectious diseases in the GBD The traditional ways of criminalization and punishment have not been effective.  Mental Health Better Managers for a Better World Mental health and disorders were not a global health priority Growing concern for multifactorial reasons - The 2022 WHO World Mental Health report indicated that the COVID-19 pandemic triggered a 25% increase in the global prevalence of anxiety and depression In many countries, the management of mental health disorders has been isolated from conventional healthcare, with little funding relative to the disease burden Multifactorial risk: rising cost of living, ongoing global conflicts, and the impact of climate change  Malnutrition and food Better Managers for a Better World Number of people estimated suffering from food insecurity Malnutrition affects 2.36 billion adults (29% of the global population) Stunting (too short for age) incidents reached 149 million children under 5 (21%), whereas wasting (too thin for height) incidents reached 45 million (6%) 45% of mortality under the age of 5 is linked to undernutrition, mostly occurring in LMICS Overnutrition has also become a threat to public health. Globally, approximately 39% of adults aged 18 years and over were overweight, and 13% were obese Food safety 1 in 10 people becoming ill after consuming contaminated food every year. Alarming number of people worldwide suffer high levels of acute food insecurity - European Commission  Sexual and reproductive health Better Managers for a Better World Inadequate comprehensive sexuality education (CSE), gender-based violence, teenage pregnancy, early marriage, sexually transmitted infections (STIs), maternal health, unsafe abortion, unmet needs of family planning, infertility and reproductive cancers, and poor access to services Adolescent pregnancies, estimated to occur annually in 21 million girls aged 15–19, more than 12 million girls each year get married before reaching the age Approximately 800 women die daily from pregnancy and childbirth-related causes, around 45% of all abortions are unsafe Each day, more than 1 million people become infected from four curable STIs: Syphilis, Gonorrhea, Chlamydia, and Trichomoniasis 38.4 million people are living with HIV, two thirds from Africa  Cancer Better Managers for a Better World Number of deaths, percentage of total deaths, and age-adjusted death rate for 19.3 million new cancer cases and almost 10.0 the 10 leading causes of death in 2022: United States, 2021 and 2022 million cancer deaths in 2020 The burden of cancer incidence and mortality is influenced by various risk factors, including lifestyle habits, environmental factors, and genetics The lack of access to cancer screening, detection, and treatment in many countries contributes to the high mortality rate associated with cancer Infections also play a significant role in cancer incidence, and cancers related to infections are potentially preventable. Helicobacter pylori, human papillomavirus, and hepatitis B and C viruses are common infectious agents https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm Diabetes Better Managers for a Better World Worldwide prevalence of diabetes 46% increase in number of adults with diabetes 2045 adults with diabetes2 537 million 2021 adults with diabetes2 285 million 2010 adults with diabetes1  Diabetes Better Managers for a Better World Type 1 diabetes Acute complications Autoimmune disease causing the pancreas to produce little or Develop in minutes, hours or days no insulin Results in lifelong dependence on exogenous insulin. Hyperglycaemia, DKA and HHS 5 – 10% of diabetes Type 2 diabetes Chronic complications Target tissues stop responding to the insulin produced and pancreas stops producing sufficient insulin 90 – 95% of diabetes Develop over years Gestational diabetes Microvascular: retinopathy, nephropathy and neuropathy Temporary form of diabetes which may develop during Macrovascular: heart disease, stroke, PVD pregnancy and lead to complications during and after the pregnancy Unable to make or release enough effective insulin to keep the blood glucose concentration in an optimal range  Obesity Better Managers for a Better World Adapted from Sharma AM. Obes Rev. 2010;11:808-9; Guh et al. BMC Public Health 2009;9:88; Luppino et al. Arch Gen Psychiatry 2010;67:220–9; Simon et al. Arch Gen Psychiatry 2006;63:824–30; Church et al. Gastroenterology 2006;130:2023–30; Li et al. Prev Med 2010;51:18–23; Hosler. Prev Chronic Dis 2009;6:A48  Obesity Better Managers for a Better World 100 Normal BMI = 80 almost 80% chance of reaching age 70 Proportion still alive (%) 60 BMI 35–40 = 40 ~60% chance of reaching age BMI range (kg/m2) 22.5–25 70 25–30 20 30–35 35–40 40–50 BMI 40–50 = 0 ~50% chance of reaching age 70 35 40 50 60 70 80 90 100 Age (years) Prospective Studies Collaboration. Lancet 2009;373:1083–96.  Sustainable Development Goals Better Managers for a Better World Better Managers for a Better World  SDGs Better Managers for a Better World The 2030 Agenda for Sustainable Development, adopted by all United Nations (UN) members in 2015, created 17 world Sustainable Development Goals (SDGs). The aim of these global goals is "peace and prosperity for people and the planet” – while tackling climate change and working to preserve oceans and forests. The SDGs highlight the connections between the environmental, social and economic aspects of sustainable development. Sustainability is at the center of the SDGs, as the term sustainable development implies. The short titles of the 17 SDGs are: No poverty (SDG 1), Zero hunger (SDG 2), Good health and well-being (SDG 3), Quality education (SDG 4), Gender equality (SDG 5), Clean water and sanitation (SDG 6), Affordable and clean energy (SDG 7), Decent work and economic growth (SDG 8), Industry, innovation and infrastructure (SDG 9), Reduced inequalities (SDG 10), Sustainable cities and communities (SDG 11), Responsible consumption and production (SDG 12), Climate action (SDG 13), Life below water (SDG 14), Life on land (SDG 15), Peace, justice, and strong institutions (SDG 16), and Partnerships for the goals (SDG 17).  SDG 3 Ensure healthy lives and promote well-being for all at all ages Better Managers for a Better World 13 targets and 28 indicators to measure progress toward targets. reducing maternal mortality ending all preventable deaths under five years of age fighting communicable diseases reducing mortality from non-communicable diseases and promoting mental health preventing and treating substance abuse reducing road injuries and deaths granting universal access to sexual and reproductive care, family planning and education achieving universal health coverage reducing illnesses and deaths from hazardous chemicals and pollution. The four means of implementation targets are: implementing the WHO Framework Convention on Tobacco Control supporting research, development, and universal access to affordable vaccines and medicines increasing health financing and support the health workforce in developing countries improving early warning systems for global health risks.  Main actors in global health Better Managers for a Better World Actors in global health space Better Managers for a Better World Actors map – organisations involved in global health The global health governance: ‘the use of institutions, rules, and processes to deal with challenges to health that require cross-border collective action to be addressed effectively’ Effective governance plays a crucial role in attaining global health objectives. The fragmentation of the global health governance structure has shown weaknesses the global response to the COVID-19 pandemic attainment of the SDGs achieving Universal Health Coverage (UHC) Actors in global health space – challenges Better Managers for a Better World and attempts to strengthen collaboration  Actors in global health space Better Managers for a Better World Inter- Governmental NGOs governmental Department of Health and Human International Scientific Advocacy/Policy Foundations Defense Services Organizations Organizations Organizations World Bank The Global Health The Earth Institute Bill and Melinda Department of CDC's Field Gates Foundation Network Defense HIV/AIDS Epidemiology (and Prevention Laboratory) Center for Strategic UN Foundation WHO International Program (DHAP) Training Programs and International (UNF) Diabetes (FE(L)TP) Studies (CSIS) Federation (IDF) OECD Health Global Health Walter Reed Army Federal Malaria Institute of Research Network Doctors without Policy Center Research Borders  Mandates and transparency vary Better Managers for a Better World Broad Mandate WHO: attainment by all people of the highest possible level of Health World Bank: alleviate poverty and improve quality of life Focused Mandate Global Fund: attract & disburse additional resources to prevent and treat HIV/AIDS, TB and malaria GAVI: increase access to immunization in poor countries  The World Health Organization Better Managers for a Better World Founded in 1948 The main functions of the World Health Organization include: – to promote the control of epidemic and endemic diseases; – to provide and improve the teaching and training in public health, the medical treatment of disease and related matters; – to promote the establishment of international standards for biological products. – To collect data on global health issues – To serve as a forum for scientific or policy discussions related to health WHO – action framework Better Managers for a Better World WHO – action framework Better Managers for a Better World  Center for Disease Control and Prevention Better Managers for a Better World Founded in 1946 The national public health agency of the United States under the Department of Health and Human Services Control and prevention of disease, injury, and disability in the US and worldwide - attention on infectious disease, food borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention, and educational activities designed to improve the health of United States citizens. The CDC also conducts research and provides information on non-infectious diseases, such as obesity and diabetes Globally, the CDC works with other organizations to address global health challenges and contain disease threats at their source. With the WHO to implement the International Health Regulations (IHR), an agreement between 196 countries to prevent, control, and report on the international spread of disease Involved in implementing the U.S. global health initiatives President's Emergency Plan for AIDS Relief (PEPFAR) and President's Malaria Initiative. Center for Disease Control and Prevention Better Managers for a Better World  Global Health Council Better Managers for a Better World The Global Health Council supports and connects advocates, implementers and stakeholders around global health priorities worldwide The Council is the world's largest membership alliance dedicated to advancing policies and programs that improve health around the world. The Council serves and represents thousands of public health professionals from over 150 countries They work "to improve health globally through increased investment, robust policies and the power of the collective voice Funded by grants (primarily from the U.S. Agency for International Development [USAID] and the Centers for Disease Control [CDC]). The Council has received grants of varying sizes from a variety of foundations, including the Gates, Packard, Hewlett MacArthur, and Rockefeller  The Global Fund to Fight AIDS, Tuberculosis and Malaria Better Managers for a Better World The Global Fund to Fight AIDS, Tuberculosis and Malaria (or simply the Global Fund) financing and partnership organization that aims to "attract, leverage and invest additional resources to end the epidemics of HIV/AIDS, tuberculosis and malaria to support attainment of the Sustainable Development Goals established by the United Nations". The Global Fund is the world's largest financier of AIDS, TB, and malaria prevention, treatment, and care programs. As of June 2019, the organization had disbursed more than US$41.6 billion to support these programs. The Global Fund is a financing mechanism rather than an implementing agency. Programs are implemented by in-country partners such as ministries of health, while the Global Fund secretariat, whose staff only have an office in Geneva, monitor the programs. Implementation is overseen by Country Coordinating Mechanisms, country-level committees consisting of in- country stakeholders that need to include, according to Global Fund requirements, a broad spectrum of representatives from government, NGOs, faith-based organizations, the private sector, and people living with the diseases.  Bill & Melinda Gates Foundation Better Managers for a Better World Launched in 2000 and is reported to be the third largest charitable foundation in the world holding $69 billion in assets as of 2020. The primary stated goals of the foundation are to enhance healthcare and reduce extreme poverty across the world, and to expand educational opportunities and access to information technology in the U.S. The foundation is organized into four program areas under chief executive officer who "sets strategic priorities, monitors results, and facilitates relationships with key partners" Global Development Division Global Health Division United States Division Global Policy & Advocacy Division Global Growth & Opportunity Division The foundation maintains an online database of grants  Gavi, the Vaccine Alliance Better Managers for a Better World Public–private global health partnership with the goal of increasing access to immunization in poor countries. Gavi supports the immunization of almost half the world's children. Gavi has helped immunize over 760 million children, preventing over 13 million deaths worldwide, helping increase diphtheria vaccine coverage in supported countries from 59% in 2000 to 81% in 2019, contributing to reducing child mortality by half. It also seeks to improve the economics of vaccines, negotiating bulk prices, supporting price discrimination, and reducing the commercial risks that manufacturers face when selling vaccines to the poor and developing vaccines In scope: Human Papillomavirus vaccine; Polio vaccine; Japanese Encephalitis vaccine; Meningococcal vaccine (Meningitis A vaccine); Measles and rubella vaccine; Pneumococcal vaccine; Typhoid vaccine; Cholera vaccine; Rotavirus vaccine; Yellow fever vaccine; Pentavalent vaccine (Diphtheria, tetanus, pertussis, haemophilus influenza vaccine (Type B), Hepatitis B); Ebola vaccine  World Diabetes Foundation Better Managers for a Better World Founded in 2002 as an independent foundation by Novo Nordisk A/S Support low- and middle-income countries in improving diabetes prevention and care. Work and promote through partnerships. Support projects that are demand- driven, locally formulated, integrated into local health systems. 201.5 million EUR in funding to 605 partnership projects in 120 countries.  Global Health and ethics Better Managers for a Better World Ethics in global health Better Managers for a Better World  Ethics in global health Better Managers for a Better World Harm prevention, public good and individual liberty How far may governments go in limiting privacy and freedom of movement in the name of infectious disease control? Treatment and/or prevention When resources are limited, devoting greater attention to prevention may take away needed resources from treatment. Determining how to allocate scarce resources between prevention and treatment can therefore raise difficult ethical issues related to distributive justice. Health promotion and equity Adults generally have the right to engage in risky behaviour, as long as their actions do not put other people directly at risk. In this context, to what extent do governments have an ethical obligation to adopt policies that reduce the harm? Public health surveillance How should the need for accurate disease surveillance data be balanced against the principle of individual autonomy? Individual versus population health. Resource allocation across health services and programmes Cultural relativity. It is sometimes asked whether ethical standards are universal, given that different people in different countries may hold different values or place different weights on common values  Better Managers for a Better World Conclusions and take-home messages  Conclusions and take-home messages Whatis“global Health” and theconcept ofhealth Healthdefinitionischanging Key conceptsin global health Multi-factorial Historyofglobal health As oldas mankindbutchangingovertime Global Healthchallengesand challengingfactors Ageing, environmentand urbanisation Future global healthchallenges Focus onNCDs SustanableDevelopmentGoals Worldwidecommitment Governanceand mainactorsin global health A fragmentedspace Global Healthand ethics Somecriticaldilemas are present Copyright No part of the previous contents may be reproduced, copied, modified of adapted, without the prior written consent of the author, unless otherwise indicated for stand-alone materials. 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