Sunday, December 7, 2014

Uncertain Health in an Insecure World - 14


Sir Bertrand Russell, British philosopher, ethicist and social critic said, “Everything is vague to a degree you do not realize until you have tried to make it precise” (The Philosophy of Logical Atomism, 1919).

Definitions of widely used terms vary widely.

Excessive definition variability causes a pathological inflammation of essential organ systems – a.k.a. “definition-itis”.

International medical and public health communities are increasingly interested in global health. Unfortunately, these actors have widely differing and overly complex definitions for global health.

Global health is defined as research and practices that prioritize improving health and achieving health equity for all people in the world. Because these issues transcend national boundaries and domestic governmental capabilities, they are often the purview of non-governmental organizations (NGO’s) like the World Health Organization (WHO), the United Nations (U.N.), the World Bank, etc. High income countries with well-established public health institutions are home to these global health NGO’s (WHO Geneva, Switzerland, U.N. New York City & World Bank Washington, DC). 

Other definitions of global health call communities to action around the planet to collaborate effectively to make global health promotion research & evidence-based actions a trans-national policy priority. The 2007 Oslo Declaration identified global health as "a pressing foreign policy issue of our time'". 

Still others suggest that public health is actually global health for the public good (c.f. the 1978 Alma Ata Declaration of “health for all”).

International health, including tropical medicine, is not global health. It emphasizes public health solutions for infectious diseases and maternal-child health issues in low and middle-income countries. National governments often embed international NGO’s within their ministries of health in order to more effectively channel medical aid and humanitarian assistance.  The U.N. Children’s Fund (UNICEF) has 190 country programs and national committees. UNICEF country offices facilitate foreign aid efforts by developed countries, exerting a public health benefit through field work inside developing countries.

What could be wrong with the lack of a shared definition for global health?

This space has become muddy, and definitions get bent out of shape to suit the actors' purposes. If these related terms really have different meanings, then why isn’t there an effort to make that clear? Are there common core ideas that  help to explain the continuing overlap? 

Is there anything wrong with defending the use of two related terms?

It has been asserted that a common definition of global health is essential to shaping national strategic direction, which can then inform actions by the global health community. In 2009, an expert panel led by Jeffrey Koplan reached a consensus on a common definition for global health through natural language processing of the extensive published literature. Among other G-8 countries, Canada was an early adopter of this definition as a to guide their national global health strategy in 2011.


If the core relevance of global health is being widely misunderstood, then related research and actions may end up being less potent, despite the best intentions of the actors.

So let's be perfectly clear.

The global health Square is not located in Babel.

Help stamp out "definion-itis"!

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