Why is global health a matter of concern?
Health is a broad concept which is determined by economic, social, political and environmental factors. Poor health outcomes are triggered by poverty, lack of access to healthcare, and shortage of quality living conditions.[i] In addition, the global health community deals with unintended and unpredictable epidemics and outbreaks such as Ebola, Severe Acute Respiratory Syndrome (SARS), Cholera and Diphtheria amongst many. Thus, the pressing challenge for global health is finding best practices to ensure that such outbreaks are controlled and prevented in a most efficient manner.[ii]
Various national and international organizations distributed across the globe are in the frontier to tackle global health challenges. Multilateral organizations like the World Health Organization (WHO), United Nations International Children’s Emergency Fund (UNICEF), and the World Bank are involved in this journey of shaping the global health policies to unite the countries in common goals of mitigating health issues. These organizations support the global healthcare system by providing loans, credits, and grants to the needy countries in various sectors and health remain as one of the major fundamentals.[iii] The following sections aim at exploring innovative approach that global health programs can adopt to become fully functional in the spectrum of health care delivery.
Understanding the global health context:
To comprehend the global health situation, one needs to understand the relation between wealth and health outcomes; poverty is one of the major determinant of the health outcomes[iv]. Below are the details of some countries with varying economic development status and their respective healthcare systems:
Underdeveloped and least Developed Countries – Poverty is both a cause and a consequence of poor health:[v]
South Sudan, which is one of the most recently formed countries is facing an economic collapse with output contracting, and inflation and parallel exchange market premium soaring[vi]. With such dire economic situation, the country is facing acute food shortage and many households continue to face severe food insecurity, including potentially large‐scale child malnutrition and stunting[vii] and the already fragile healthcare system is insufficient to tackle this situation.
The health care system in South Sudan confronts a plethora of issues. Generically, one primary health center serves around 50,000 patients[viii]. The country also has a large number of refugees and displaced communities[ix] who are more susceptible to epidemics and other diseases. Among the children aged (6-59) months in the refugee camps, global acute malnutrition stood at 6.2% in 2017[x]. The country was also hit hard by the longest pertaining cholera outbreak[xi] from 2016 to 2018, while malaria still accounts as the pertinent cause of morbidity in the nation. In September 2018 more than 11,000 people in Sudan were reported with the case of Chikungunya which is a viral disease born from mosquito bites.[xii]
Similarly, in Nepal, a country with least developed country status, health is considered as a fundamental right as per its constitution and with the resolute efforts made by the government in the recent past, the country has made substantial progress in the health sector. Furthermore, the private sector has gained a strong foothold in the health sector who have been able to provide quality health care. However, their participation may have been confined to urban and curative services only. Although substantial progress has been made, the country still faces a myriad of problems in the health sector that require significant attention. Some of the many issues that face the health sector in Nepal are[xiii]:
- Unavailability of easy and affordable access to health care to citizens of all localities, levels, classes, groups and communities.
- The government is still not yet able to provide sufficient primary health care programs in urban zones, health of senior citizens, mental disorders, genetic and congenital diseases, environmental health, occupational hazard, sexual and reproductive health of adolescents and health promotion among school-age children and so on.
- Similarly, diseases such as cancer, diabetes, hypertension, and illnesses related to heart, kidneys, liver, lungs along with non-communicable diseases like mental illnesses, dental problems are rising.
Developed Countries – Developed nations such as Australia, Denmark, Finland, and Sweden have a different dimension to their healthcare system. In Australia, the three tiers of government are collectively responsible for the provision of the universal health care. The total health expenditure accounted for almost 10% of GDP in 2014-15[xiv] and is on the rise in the consecutive years.
Concerning Danish health care system, universal access to health care is the underlying principle described in the constitution of Denmark. In 2015, the total expenditures in the health sector accounted for 10.6% of GDP in 2015. The health care is financed mostly through a national health tax set at 8% where amounts are generally accommodated within the regions and municipalities.[xv]
Moreover, the European region as a whole, sets impressive targets to achieve the aims of Health 2020 to ensure well being of their diaspora. It aims at reducing the premature mortality rate from the persisting non- communicable diseases by 1.5% until 2020. To supplement their target, the member states in the European region adopts a life-course approach in order to intervene in projects which will eventually be beneficial to the entire population.
Deciphering the above mentioned context, it is evident that there is a huge gap between the healthcare system of under-developed and developed countries. While underdeveloped countries are facing difficulty to sustain their primary healthcare systems, developed countries are on the verge of building a good healthcare system for their future generations. This implies that international resources should be channeled in such manner that this inequality in terms of healthcare is reduced globally.
There are multiple funds in the global arena and these funds are circulated based on the global goals set by the multilateral organizations. Among these goals, Sustainable Development Goals (SDGs) are the topmost goals that 195 countries within the UN framework are supposed to achieve within 2030 and there are 41 health related SDG indicators[xvi]. International funds are channeled to help countries achieve such goals. Aga Khan Foundation – AKF, Common Wealth Fund, Gates (Bill and Melinda) Foundation, Global Fund, Global Medicine Network, Izumi Foundation are some of the funding agencies for global health opportunities.[xvii]Such funds can help bridge the inequality in global healthcare system.
Bridging the gap and towards Harmonization
The global health issues are multifaceted in nature and demand an interdisciplinary approach to tackle. It is believed that global health being an area of research and practice attempts to improve health status by achieving equity for all people worldwide.
The existing transnational issues of health are arising from health inequities which means the global policy shapers should work on mobilizing government/non-government partners to inform, educate and empower the communities and individuals to make changes. While there are funds that operate to reduce this gap, rigorous research needs to be performed to help countries on a case by case basis. Such research shall inject the knowledge repository in between global South and global North, with the support of logistical, social and political components.[xviii]
2. “Global Health Metrics”.Unite for Sight. http://www.uniteforsight.org/global-health-university/global-health-metrics
12. Sudan reports outbreak of mosquito-borne Chikungunya disease in eastern state.September 26, 2018. https://www.reuters.com/article/us-sudan-health-chikungunya/sudan-reports-outbreak-of-mosquito-borne-chikungunya-disease-in-eastern-state-idUSKCN1M52MB
13. Annual Report: Department of Health Service (2073/74)/(2016/17)
15. International Profiles of Health Care Systems.May 2017 https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2017_may_mossialos_intl_profiles_v5.pdf
18.“The Importance of Global Health Research”.