Hi class. I hope that you are doing well today. This is our first lecture in The Challenge of Global Health. And today I'm going to be covering one basic question: why is global health important? We're going to go over some basic definitions and concepts as a way to orient you into this exciting field. It's also my first formal lecture that I'm giving to you, my first talk. So I'm a little bit nervous. So please bear with me as we sit in my office and begin to learn. When we talk about global health, I think that it is important to understand exactly what we mean when we use that term. Now we do have a formal definition for global health and we call it an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. This is an important definition but even more important are some of the key emphases about global health embedded inside this definition. So, let's take a closer look at these emphases. First is the notion of health. Now, what is health? Well, health is not simply absence of disease, or not feeling sick, or just feeling good. We actually define health as a state of complete physical, mental and social well-being and not merely the absence of disease. Now this is an important concept because health is not just physical, it is mental and it is actually social. Our social relations, as we will see later, can have a great impact on an individuals health status as well as the health status of a family, a community, or a population. Our second emphasis is the global health covers transnational health issues. In other words, we're not just concerned about health issues that might be taking place within a particular country. Whether that may be I don't know, diabetes, whether it may be malaria, whether it may be tuberculosis. Whether it may be a impact of radiation or a tsunami. But we're also concerned with issues that have an impact over the entire world. For example, many infectious diseases as we will see don't require passports. They travel easily from one country to the other. And many health conditions that we would consider noncommunicable, or even chronic diseases, are also issues that affect many populations around the world. Finally, what we try to emphasize within this notion of global health is the idea of cooperation and exchange. In other words, as a global phenomenon, global health can only be improved by not only populations and communities within countries cooperating with each other and exchanging information, but also with countries cooperating and exchanging information. And this cooperation and exchange must take place from a global perspective. I've put some terms on this slide, you noticed north and south. And that's, you know, global health shorthand. And by global north, in general when we say this, we mean the developed world. We'll come back to this in a little bit later. And by global south, we're talking about the developing world. Now, the reason that we say cooperation and exchange much take place globally is that there must be exchange between the global north countries in the global north, countries in the global south and exchange among the global north and the global south. As we've learned increasingly in global health over the last few decades, all countries developed or developing can provide important lessons and advice for each other on how to manage particular health issues. Global health as an idea is really a synthesis of two different concepts. First is the concept of public health. And when we talk about public health, we mean thinking about and working with and trying to improve health from a population-based perspective. When we talk about medicine, we're really talking about providing health care on an individual level, right? You go see your doctor, you get health advice. With global health we actually try to synthesize and use both approaches. Sometimes focusing on population-based strategies and solutions might be best for a particular condition. Other times providing individual level care might be, as, if not more, important. Taking and using both of these as needed is one of the hallmarks of global health, as it tries to be flexible in approaching and resolving health issues. Now within global health, there are many different functions that we try to, or functions that we try to perform. One is to monitor and evaluate health status and health conditions throughout the world. We also, by gathering information, try to inform and educate and empower, not only countries, but communities and individuals. Try to make changes, right? Or to create, in fact, structures in which better health can take place. We focus on creating and mobilizing partnerships. Whether that is with, with governments. Or whether that's with governments and non-governmental organizations. Philanthropic organizations. Whatever partnerships may be most important in order to mobilize communities and improve health. We provide information to guide policy, laws, and regulations. We work to ensure adequate healthcare coverage. We focus on research and innovation. Like understanding problems, understanding and innovating new solutions. And finally also on finding ways to implement new strategies and best practices and to find the best ways to intervene to improve health outcomes. All of these become powerful functions that all work together in a variety of ways to reach our goal. As you can imagine, this goal of global health is important for quite a few reasons. First, human rights and the right to health. We know that it is very well established among most countries that there should be a right to health for populations, and we know that health is an integral component of human rights. Second, for security and diplomacy. Global health is an important security phenomenon. Populations that are not healthy, where disease can ravage the can ravage groups, can actually create political insecurity, political instability. We also can use global health, not only to improve stability, but as diplomatic tools and many countries do this. Global health is also important because of globalization. Increasingly we live in a highly globalized world. Where just as people move easily over boundaries so, economics is now shifts among countries. Some countries benefit, some do not. Health, disease, everything becomes more global. And as this transition into a globalized world takes place, it's more important that we think about health, not just as a national phenomenon, but as a global one. We also know that global health and health in general are both, are important for development. A population that has a lot of illness is not a population that can as easily develop economically as other populations. So frequently, by improving health, we can help improve development. Finally, public goods. Health, as I said, is a human right, but health is also a public good. It is something that actually should be in the public domain. Something that, it, it's something that actually improves the public, public well-being as a whole. You can imagine by my saying this, that there are multiple rationales for why we want to focus on global health and its challenges. One is an idea firmly embedded in public health and health in general, and that is social justice. And providing the highest attainable standard of health to all people, without distinction. Second is altruism. It's part of our ethical obligation to help others. But also self-interest. Not only is it our obligation to help others, it is actually in our interests to do so, right? As I said, since infectious disease knows no boundaries, right? It make quite a lot of sense for your country to provide aid to another country when there's an infectious disease outbreak. Or if you want to establish a trading partner, it's important that that trading partner have certain levels of economic development for which health becomes necessary. So all these rationales actually work together. And underlying these rationales we find particular ethics. You know, we talk about individual medical ethics of notions of autonomy, beneficence, non-maleficence, and justice. By autonomy I mean the people's ability to make individual decisions. To decide their destiny, to make their own health care decisions. Maleficence of helping individuals, non-maleficence meaning doing no harm, and the notion of justice, right? Or social justice, right? The equitable distribution of, of the health and health care. But we also think about this, these notions of global health from a population perspective. Thinking about making population-based decisions and keeping in mind their consequences or the outcomes that they might have. Understanding, from a cosmopolitan perspective, that the impact of any health event in one country can have an impact on others, and that we're all part of this larger world. Finally, the notion of cultural competence. We come from many different cultures, many different belief systems. So we do have to take those beliefs into account when we're trying to find solutions for health outcomes. Empowerment, finding ways to use health to, as a way of empowering individuals, right? To to live the fullest life possible. And then again, this idea of social justice. Now, it might occur to you that many of these things here, perhaps being culturally competent, respecting cultural differences, might actually not always work well with notions of empowering individuals or social justice. Well, there actually can be conflicts here and one of our challenges with global health is to put all of these different ethical imperatives together, and to negotiate them to find the best solutions. Finally, I think I can summarize this by asking once again, why is global health important? And I think I can summarize it in a drawing that an artist made for this course. And that really is, my friends, we are all one big world. Animal, vegetable, mineral, human, environment, you name it, we all function interdependently. And that's something we'll go into in just a little bit as we continue our lectures over this course. Until then, until next time, Dr. Boyd signing out.
