‘Global Health Themes’ include broader briefing papers and background articles on selected cross-cutting global health issues that we think need more attention.
Our themes include briefing papers on Non-Communicable Diseases, Primary Health Care and mHealth and background articles on Public Health in Post-Conflict States, Global Health and Education or Health.
Non-communicable diseases (NCDs) are a leading global killer affecting populations in both rich and poor countries and across all ages.
GHM Briefing Paper by Jane Brandt Sørensen
NCDs are non-infectious, take a long time to fully develop and are largely preventable. They are chronic in nature and therefore require repeated and long-term contact with the healthcare system. They share common risk factors, often co-exist and thus provide common opportunities for intervention.
The four main NCDs are defined by the United Nations and the World Health Organization as being: cardiovascular diseases, cancer, chronic respiratory diseases, diabetes.
It is acknowledged that other conditions are closely associated with the major four NCDs, namely: (i) other non-communicable diseases such as musculoskeletal and oral diseases; (ii) violence and injuries; (iii) disabilities, including blindness and deafness; and (iv) mental health.
The determinants of these diseases are linked to factors of modern living such as nutrition and physical activity; education; urban planning; trade; ageing of populations; food production; marketing and other cultural and socio-economic factors. To curb this group of diseases through addressing these determinants, collaboration between civil society, the private industry, academia and policy-makers is necessary.
PRIMARY HEALTH CARE
A horizontal approach to health care striving towards equal and universal access to qualified health care services.
GHM Briefing Paper by Liv Nanna Hansson and Per Kallestrup
Primary Health Care (PHC) is the term used for their first level of contact of people with the health system. This part of health care takes different shapes in different health care systems. The concept is also part of larger discussions of how to prioritise within health care systems globally. The importance of the concept within global discussions on health has changed over the years.
PHC has been described as consisting of four main features:
- first-contact access for each new need;
- long-term person- (not disease) focused care;
- comprehensive care for most health needs;
- and coordinated care when it must be sought elsewhere (referrals).
PHC is assessed according to how these four features are fulfilled. A fifth feature that is sometimes included is the orientation toward family and community.
In 1978, WHO and UNICEF held a large conference in Alma-Ata declaration where member states agreed on striving for “Health for All By the Year 2000”. Alma-Ata defined the way of primary health care for the following years, emphasising the importance of primary care and equality in health, trying to tackle the “politically, socially and economically unacceptable” health inequalities seen globally.
The shift in prioritization of the health care system stated in Alma-Ata declaration and emphasized in PHC is from a focus on medicine to focus on health; from curative care to holistic care; from specialized hospital care for the few to local health care for many and from understanding disease as caused not only by biological determinants but also by socio-economic explanations.
A horizontal approach to health care striving towards equal and universal access to qualified health care services
GHM Briefing Paper by Jacqui Møller Larsen and Erling Høg
The last decade has brought an explosion of mobile phones across the world but particularly in low-income countries such as those in Africa. The current 6.8 billion mobile subscriptions in a world population of 7 billion was highlighted in a UN report as an indication that there were more people with access to a mobile phone than access to a toilet or running water!
A fairly shocking revelation for those working in development for the last decade but also a colossal opportunity to be harnessed for those in the business of improving the health of the most disadvantaged populations.
The mobile has been termed a ‘game changer’ in health due to four key factors:
- The sheer volume of people with access to a mobile,
- The incredibly fast pace of technological change,
- The wide global network coverage,
- Its potential as an accelerator of change when supporting proven health interventions and supporting task shifting to community health services.
The World Health Organization (WHO) has defined mHealth as the use of mobile and wireless technologies to support the achievement of health objectives. The word support is noteworthy as it clarifies mHealth as a tool for supporting existing interventions such as promoting healthy behaviours, increasing utilisation of critical services and strengthening health systems.
mHealth may by definition be a subset of eHealth, but in low-income countries mHealth dwarfs it. Its potential is unquestionable and its application seemingly unstoppable.
SICK OF WAR
Public health in post-conflict states
GHM Background Article by Kirsten Larsen
Long after fighting has ended the consequences of conflict lingers on. War and violence impact negatively on public health for years after most of the humanitarians packed up and left, show commonly used health indicators such as child mortality.
Data on death and disability are scarce – during the war as well as after. Lack of research makes it extremely difficult to assess the situation and to make comparisons to the time before the violence. Many of the figures reported are at best not very precise. And thus the effort by the International Community to alleviate the suffering and to support the lives of the population cannot always be the best possible.
Donors are reluctant to invest heavily in expensive health systems in countries coming out of war and do not prioritize data collection and research. As soon as the focus shifts to other hotspots, so does the money and nobody has an interest in highlighting the post-conflict consequences – not even when they are gruesome. Governments want a thriving economy, they want security and they want to stay in power, while people want health care, roads, water, schools – and of course – security.
The key messages of the background article are:
- Conflicts kill more people than most diseases but nobody knows how many.
- Few resources are directed to the study of the long term impact of war on public health.
- Decisions on health in post- conflict states are made by donors outside the country.
- Investing in health could enhance chances for a peaceful future and resilience to conflict.
GLOBAL HEALTH: WHAT AND WHY?
GHM Background Article by Mette Holm
Global health is a broad new concept, a multi- disciplinary, holistic and even political approach, to health, or perhaps more precisely, to life. As of yet, there is no clear definition of global health.
Global health is much more than the two words that make up the term; it is the highly interdisciplinary intersection of epidemiology, policy and politics, law, environment, economics, demographics, climate change and sociology – to name but a few factors.
Global health knows no national borders; it covers complex issues that are interdependent and often unfold far from their causes. Natural disaster, man-made conflict, climate change and unequal distribution all contribute negatively to global health.
In a globalised world disease travels almost at the speed of light; diseases travel with people, cargo, migratory animals as well as with human life styles. Historically, peoples and nations have been separated by e.g. distance, geography, climate and perhaps religion or ideology. Over recent decades increased travel, trade and communication have increasingly bridged these factors of separation.
Hence the health of everyone and every nation can be affected, some to a large, some to a lesser extent as some have more resources and resilience and some less. Poverty and disease in one country can affect the health status of people in other countries. Chronic disease like obesity, diabetes, mental disorder, traffic injury, and abuse of alcohol and tobacco that used to affect mainly the industrialised world are now truly global. While some factors relate strictly to health, others stem from social behaviour and circumstances, e.g. poverty and/or lack of education.
EDUCATION OR HEALTH? EITHER OR?
GHM Background Article By Mette Holm
According to the recent UNESCO EFA-report, 6.6 million children died before their 5th birthday in 2012. The report also points out that education is one of the most powerful ways of improving people’s health. Where should we focus our efforts? On education or health?
Most of the world agrees on the benefits of education. Education saves millions of mothers’ and children’s lives: it helps prevent and contain disease and is vital to reducing malnutrition. Educated people are simply better informed about diseases, they are better at taking preventive measures, they recognise the signs of illness early and tend to use health care more often, when available.
The Millennium Development Goals called for universal primary education by 2015. Sadly, this will not be reached. Some of the sad figures mentioned in the article:
- Around 250 million children are not learning basic skills, even though half of them have spent four years in school.
- Half of the 57 million children missing primary school in 2011 lived in conflict-afflicted countries.
- Only 23% of poor girls in rural areas in sub-Saharan Africa were completing primary school by 2010; and only in 2086 will the poorest girls catch up.
- In 2011 there were 774 million illiterate adults in the world.
- Almost two thirds of illiterate adults are women. The poorest young women in the developing world may not achieve literacy until 2072.