Global public health is a field of study that focuses on public health issues that are international in scope.
The purpose of global public health programs is to conduct research on worldwide health problems, develop potential solutions for those problems, disseminate information and technologies relating to solutions, and reduce disparities among various populations in the pursuit of healthy peoples around the world.
The origin of global public health concerns can be traced to the ability to travel internationally beginning particularly in the late eighteenth and early nineteenth centuries. Tropical disease medicine followed the new mobility of people across water and continents. Immediately following the end of World War II, the United Nations and other international agencies were created. Foremost of those international health agencies was the World Health Organization (WHO), created on April 7, 1948, to deal with health problems within individual nations and across international boundaries. WHO has been a leader in global health issues since then, although a number of international, regional, and national health organizations, universities, and nonprofit organizations have also become active in the field. As an example, a number of universities in the United States offer undergraduate and graduate degrees in the field of global public health.
The field of global public health includes a wide array of topics of concern at the local, state, and national levels, as well as the international level. These can include disease, environmental issues, and overall wellbeing in an increasingly connected world.
One universal issue in the field of global public health is the lower status of women in most parts of the world. This disparity has led to a reduced interest in and attention to the health of women in general, particularly regarding uniquely female issues, such as contraception, family planning, pregnancy, and childbirth. Virtually all global public health programs allocate significant resources to study the social, economic, and medical roots of women's health problems and the ways these factors can be changed to provide better health care to individuals regardless of gender. These efforts include programs for helping women better understand their own potential and develop methods for empowering their efforts in controlling their own health options. Developing a better understanding of the causes of violence to women and ways to combat this problem is an essential element of global public health programs. Addressing the disparity between health care for women and men involves better training and education for men and for governmental and private agencies that provide health care in a community.
Advances in precision medicine and use of molecular technology and precise genetic information has led to improved understanding of diseases and disease outbreaks. With new technology and ways of tracking and recording, public health agencies can better diagnose infections, investigate outbreaks, describe patterns of transmission, and monitor and develop treatment or prevention efforts.
Some regions of the world are challenged with what has been called the double burden of disease, that is, facing deaths and disabilities from both infectious and non-infectious (degenerative) diseases. In many parts of the world, for example, nations are still confronted with unacceptable rates of infectious disease among their poorest citizens, while also having to face the challenge of caring for older residents who develop diseases such as cancer, cardiovascular disease, diabetes, and chronic pulmonary disease. These diseases can be linked to lifestyle and dietary choices as well as environmental factors such as pollution or water scarcity. Global public health agencies are looking for ways that nations and regions can develop multifaceted programs that recognize and address this wide range of health challenges.
A key element involved in addressing any global public health problem is collecting data related to the source and dissemination of the problem. In the case of an infectious disease epidemic, for example, the most fundamental questions are those that can be answered by epidemiology: where was the disease first seen, how was it first identified, what were the signs and symptoms that characterized the disease, and how did it spread through the population? Answering these questions involves the collection of quantitative data—biostatistics—as well as qualitative observations. Biostatistics involves the collection of data, analysis of those data, interpretation of their results, and the development of policies and practices based on the results of that interpretation. Global public health also involves setting targets for detecting and responding to disease outbreaks or other health issues, and data are collected to measure progress toward these targets.
Economic issues are an inherent part of public health problems worldwide. Indeed, many of these problems exist or survive simply because governmental agencies lack the financial resources to manage them successfully. In the case of infectious diseases, for example, drugs may be available for use in the prevention and treatment of many conditions, but individuals and health agencies in many parts of the world do not have the money to purchase and distribute those drugs. Likewise, water quality and scarcity problems often are worsened by poverty and lack of funds to put the needed systems in place to deliver healthy drinking water to residents of communities. Health problems are not restricted to science and technology, then, but often involve economics.
A similar point can be made for political factors when a nation might have the economic and technical resources to address a health problem but lacks the political will to do so. Those in political power around the world may set or ignore policies that can improve global public health. Power and politics affect how countries prioritize health efforts and how decisions are made about how to address environmental and other health issues on a global scale.
Two other related and critical elements of virtually all global public health programs are education and changes in behavior. No matter the specific health problem, getting people to understand the causes of that problem and the changes in behavior needed to solve it are fundamental. Whether the issue is HIV/AIDS, sexually transmitted infections, firearm violence, violence against women, binge drinking, seatbelt use, or any other public health concern, effective progress cannot be made without programs to educate individuals at risk for the particular harmful behavior. Reducing the rate of HIV infections, for example, ultimately has depended almost entirely on individuals' understanding the ways in which the virus is spread and the changes in sexual habits needed to reduce the risk of transmission.
An issue of growing concern worldwide is global climate change and the effects it may have on human health. As regions become warmer or cooler, patterns of infectious disease are almost certainly likely to change in ways that ignore national boundaries. In addition, climate change is likely to result in the movement of populations across national boundaries, carrying with them endemic diseases to regions where such conditions have traditionally been absent. As an extreme example, some small island nations have already begun exploring the possibility of having to move their entire populations to other parts of the world, creating at least the potential for bringing with them their unique health problems. One challenge of global public health programs, then, is identifying populations who are at risk for new health problems and ways of dealing with those problems as they arise. The United Nations Environment Programme (UNEP) leads global efforts on environmental issues and sustainable development goals. The UNEP goal is to provide leadership to nations and peoples to improve the quality of lives without compromising the quality of life for future generations.
One irony of global public health issues is that some of the most developed countries of the world are struggling with problems related to obesity, the excessive intake of calories by citizens, while most developing countries are addressing some level of poor nutrition, an inadequate supply of healthy foods for most of their people. The fundamental nutritional problem facing the world is not a lack of food, but an inability to create a fair and equitable distribution of it. This situation has forced public health agencies in developed nations to establish programs aimed at educating people about the need to control caloric intake and obtain adequate levels of exercise to maintain a healthy body weight and public health agencies in developing countries to find ways of providing their populations with greater access to adequate amounts of healthful foods.
A relatively new global public health problem involves the spread of disease through the distribution of contaminated foods across international boundaries. Food distribution has become an international industry, with foods grown in one part of the world routinely being shipped hundreds or thousands of miles away to other parts of the world. WHO estimates that three-fourths of all new infectious diseases in the world have arisen from pathogens that started in animals and animal products and then were carried to human populations in other parts of the globe. For example, in 1997, a wild bird flu crossed-over and infected domesticated poultry in China. The virus, H5N1, was then spread through the international poultry trade to a least eight countries. Foodborne diseases and malnutrition are thought to be responsible for most of the more than 5 million deaths among young children in the world each year.
The risks posed by bioterrorism to the world's population have been recognized for more than four decades. In 1970, WHO published a manual recommending ways in which nations could prepare for and respond to bioterrorist attacks. An attack using pathogens such as those responsible for anthrax, measles, cholera, malaria, or HIV can be met by essentially the same technologies and methods used against these diseases in everyday public health programs. However, preparing for such attacks adds new dimensions that are not part of the usual public health agenda. Biosecurity and biosafety aim to protect people from unintentional or intentional release of harmful disease pathogens. The highest priority is given to agents that can be disseminated easily and can contribute to high death rates, such as anthrax, plague, or smallpox.
One problem facing people in many parts of the world is a shortage of potable water. Worldwide, about 2 billion people live in areas of water scarcity, and 700 million people in 43 countries are directly affected by water scarcity. Another 1.6 billion people live in areas too poor to distribute available water to populated locations. More than 1.2 billion people lack access to clean drinking water. UNICEF predicts that by 2040, water scarcity will affect 600 million children. A second water problem is sanitation. Much of the water that is readily available for human use is contaminated. As a result, waterborne diseases are among the most serious of all public health problems in the world. Without access to potable water, almost any public health program is doomed to failure.
See also Bioterrorism ; Climate change ; Communicable diseases ; Epidemiology ; Food safety ; Globalization and emerging diseases ; World Health Organization .
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World Health Organization (WHO), Avenue Appia 20, 1202 Geneva, Switzerland, +4122 791 21 11, Fax: +4122 791 31 11, http://www.who.int/en .
David E. Newton, EdD
Revised by Teresa Odle, BA, ELS