NURS 4015 – Public and Global Health Essay Paper

NURS 4015 – Public and Global Health Essay Paper

NURS 4015 – Public and Global Health Essay Paper

Global health encompasses multiple concepts, derived from public health concepts and international health that were originally based in infectious disease control. However, the definition has evolved due to such factors as global trade, travel, and relations. Additionally, the very inter-disciplinary nature of global health within the context of social, political, environmental, and economic factors constantly shapes the context in which health is attained, maintained, and lost in a world of differential resources, approaches, and beliefs. At its core, focusing on “health” global health operates under the premise that health (defined as freedom from illness and the achievement of total physical and mental well being) is a social good to be enjoyed by all as a human right is based in the element of justice, above equity. This nuance recognizes that, in order to participate fully in society, inputs to individuals/countries may not necessarily be equal, as some individuals or countries may need more or different resources  NURS 4015 – Public and Global Health Essay Paper



The health of the U.S. population can be affected by public health threats or events across the globe. Recent examples of this include the Ebola Virus outbreak that began in 2014, the 2003 SARS epidemic, and the 2009 spread of novel H1N1 influenza. Improving global health can improve health in the United States and support national and global security interests by fostering political stability, diplomacy, and economic growth worldwide. NURS 4015 – Public and Global Health Essay Paper

Why Is Global Health Important?

Global health plays an increasingly crucial role in both global security and the security of the U.S. population. As the world and its economies become increasingly globalized, including extensive international travel and commerce, it is necessary to think about health in a global context. Rarely a week goes by without a headline about the emergence or re-emergence of an infectious disease or other health threat somewhere in the world. The 2007 World Health Report1 notes that, “since the 1970s, newly emerging diseases have been identified at the unprecedented rate of one or more per year.” The Institute of Medicine’s 2003 report Microbial Threats to Health2 stresses that the United States should enhance the global capacity for responding to infectious disease threats and should take a leadership role in promoting a comprehensive, global, real-time infectious disease surveillance system. NURS 4015 – Public and Global Health Essay Paper

Rapid identification and control of emerging infectious diseases helps:

Promote health abroad
Prevent the international spread of disease
Protect the health of the U.S. population

The large scope of potential global public health threats is recognized in the revised International Health Regulations (IHR [2005])3 with its all-hazards approach to assessing serious public health threats. These regulations are designed to prevent the international spread of diseases, while minimizing interruption of world travel and trade. They encourage countries to work together to share information about known diseases and public health events of international concern. NURS 4015 – Public and Global Health Essay Paper

Emerging Issues in Global Health

Globally, the rate of deaths from noncommunicable causes, such as heart disease, stroke, and injuries, is growing. At the same time, the number of deaths from infectious diseases, such as malaria, tuberculosis, and vaccine-preventable diseases, is decreasing. Many developing countries must now deal with a “dual burden” of disease: they must continue to prevent and control infectious diseases, while also addressing the health threats from noncommunicable diseases and environmental health risks. As social and economic conditions in developing countries change and their health systems and surveillance improve, more focus will be needed to address noncommunicable diseases, mental health, substance abuse disorders, and, especially, injuries (both intentional and unintentional). Some countries are beginning to establish programs to address these issues. For example, Kenya has implemented programs for road traffic safety and violence prevention. NURS 4015 – Public and Global Health Essay Paper

Expanding international trade introduces new health risks. A complex international distribution chain has resulted in potential international outbreaks due to food borne infections, poor quality pharmaceuticals, and contaminated consumer goods.

The world community is finding better ways to confront major health threats. WHO, through the 2005 IHR, proposes new guidance and promotes cooperation between developed and developing countries on emerging health issues of global importance. The IHR require countries to develop appropriate surveillance and response capacities to address these health concerns. All of these issues will require enhanced U.S. collaboration with other countries to protect and promote better health for all. NURS 4015 – Public and Global Health Essay Paper

Public health has been defined as “the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals”.[1] Analyzing the health of a population and the threats it faces is the basis for public health.[2] The public can be as small as a handful of people or as large as a village or an entire city; in the case of a pandemic it may encompass several continents. The concept of health takes into account physical, psychological and social well-being. As such, according to the World Health Organization, it is not merely the absence of disease or infirmity.[3] NURS 4015 – Public and Global Health Essay Paper

Public health is an interdisciplinary field. For example, epidemiology, bio statistics and management of health services are all relevant. Other important sub fields include environmental health, community health, behavioral health, health economics, public policy, mental health, occupational safety, gender issues in health, and sexual and reproductive health.

Public health aims to improve the quality of life through prevention and treatment of disease, including mental health. This is done through the surveillance of cases and health indicators, and through the promotion of healthy behaviors. Common public health initiatives include promotion of hand washing and breastfeeding, delivery of vaccinations, suicide prevention, and distribution of condoms to control the spread of sexually transmitted diseases. NURS 4015 – Public and Global Health Essay Paper

Modern public health practice requires multidisciplinary teams of public health workers and professionals. Teams might include epidemiologists, bio statisticians, medical assistants, public health nurses, midwives, medical microbiologists, economists, sociologists, geneticists, data managers, and physicians. Depending on the need, environmental health officers or public health inspectors, bioethics, and even veterinarians, gender experts, or sexual and reproductive health specialists might be called on.[4]

Global health is the health of populations in the global context;[1] it has been defined as “the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide”.[2] Problems that transcend national borders or have a global political and economic impact are often emphasized.[3] Thus, global health is about worldwide health improvement (including mental health), reduction of disparities, and protection against global threats that disregard national borders.[4] Global health is not to be confused with international health, which is defined as the branch of public health focusing on developing nations and foreign aid efforts by industrialized countries.[5] Global health can be measured as a function of various global diseases and their prevalence in the world and threat to decrease life in the present day. NURS 4015 – Public and Global Health Essay Paper

The predominant agency associated with global health (and international health) is the World Health Organization (WHO). Other important agencies impacting global health include UNICEF and World Food Program me. The United Nations system has also played a part with cross-pectoral actions to address global health and its underlying socioeconomic determinants with the declaration of the Millennium Development Goals[6] and the more recent Sustainable Development Goals. NURS 4015 – Public and Global Health Essay Paper


Public Health

For the purpose of having a common language, we broadly define public health as focusing on the science, practice, and art of collective efforts to prevent disease, promote health, and prolong quality of life among populations, while assuring conditions in which all people can be healthy.

Rather than being a single discipline, public health as a profession includes the contributions of many disciplines/fields that impact the health of a population including, but not limited to epidemiology, behavioral science, medicine, social work, engineering, communication, business, law, and global health (CDC 1994, ASPH 2006, & WHO 2002). NURS 4015 – Public and Global Health Essay Paper

Global Health

Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. It emphasizes transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences; and is a synthesis of population-based prevention with individual-level clinical care. Although global health places greater priority on prevention, it also embraces curative, rehabilitative, and other aspects of clinical medicine and the study of basic sciences (Koplan 2009).

Public Health and Personal Health
Public Health and Personal Health Health has many dimensions. Two of these dimensions are public health and personal health. Public health is defined by the Centers for Disease Control Foundation (2014) as “the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases.” Public health is concentrated on providing protection against disease of entire populations. Populations can range in size from a small population to an entire country or world region. NURS 4015 – Public and Global Health Essay Paper Policies and regulations are recommended by public health professionals to prevent illness and address reoccurring health issues by implementing educational programs on illness and prevention methods. Public policy also administers services and conduct research and promotes healthcare equity, quality, and accessibility (CDC Foundation, 2014). Public health differs from personal health in many ways. Public health involves taking care of a community as a whole, whereas personal health involves taking care of an individual’s health only. Public health officials and law makers implement rules and regulations that help to improve the health of a community, but physician’s and other healthcare workers treat individuals for a variety of illness. Public health incorporates programs to treat and educate the community on illnesses, but personal health involves physicians and healthcare workers educating and treating illnesses in individual patients (Harvard School of Public Health, 2014). To understand community needs, public health officials and policymakers conduct community health assessments. It helps the officials and policymakers identify the most important needs of the community. Understanding these needs help these professionals to make informed decisions on services and programs. Policymakers and other officials are able to prioritize health problems and to develop and implement community health improvement plans (Robert Wood Johnson Foundation, 2011). Although public health assessments have many benefits in determining what policies and programs to implement, it does have their disadvantages. Public health assessments are usually done by surveys. These surveys are usually the opinion of the people who are filling out the surveys. Results may not be representative of everyone in the community. NURS 4015 – Public and Global Health Essay Paper Complex issues are not explored in depth thought these types of assessments, and the complete opinion of the respondent may not be fully represented because of limited answer choices (North Carolina Government Public Health, 2012). The disadvantages can cause conflict within the community as a result of public health assessments. One of these conflict is the relationship between protecting and promoting the health of individuals and protecting and promoting the health of community. For instance, public policy may have to address how allocate resources and who will receive these services. If a pandemic flu breaks out in a community, officials have to determine the criteria for administering medications to those affected. Those who are able to pay are more likely to receive treatment. To help resolve these issues, prevention through vaccines can be given to those who are still healthy and at risk for contracting the flu and treat those who are ill and whose immune system is most compromised, such as those who have HIV or the elderly (Centers for Disease Control and Prevention, 2009). Public health assessments allow policymakers and public health officials to identify the health needs of a community. Through this identification, healthcare policies, such as No Smoking Bans, can be implemented for the health of the community. NURS 4015 – Public and Global Health Essay Paper

Global health has been getting much more attention lately, in settings as varied as the World Economic Forum, TIME Magazine, and even rock concerts—and for good reason. There is a new global determination to address the great disparity in health status between rich and poor people, communities, and nations, and this determination is reflected in explicit commitments of political will and substantial financial and intellectual resources. With the emergence of institutions such as the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the exceptional commitments of the G8 nations, and the unprecedented generosity of Bill and Melinda Gates and Warren Buffet, the global health community is finally matching its ambitions to the challenges at hand.
To ensure that health is within reach of everyone requires substantial creativity—doing more of what we have done for years will never produce solutions fast enough or on the scale needed to close the gap between rich and poor. One of the first steps in this process is simply to ask different questions—to stop debating whether to develop new tools or to deploy the ones we have, to stop dwelling on the false choice between “hard” technologies, such as vaccines, and “softer” behavioral interventions. It is time to re frame the debate. NURS 4015 – Public and Global Health Essay Paper Only solutions that creatively integrate the need for new and culturally relevant technologies with stronger systems and substantial behaviour change have a chance of reducing the health inequity between rich and poor countries.
The pace of scientific innovation continues to accelerate. Each year we learn the names of rapidly advancing new approaches—genomics, Proterozoic, nanotechnology. We often assume that these frontiers of science will benefit only the richer nations of the world—but creative design can harness them to meet the needs of the world’s poorest communities. In fact, resource-poor settings can actually drive innovation, demanding ingenious product designs that are less expensive, are easier to use, and require less infrastructure. It is also sometimes easier to disrupt the technological status quo in the absence of entrenched commercial interests organized around existing products and systems.
The high-tech, high-cost centralized laboratory model that is ubiquitous in more developed countries is of limited use in poorer countries. Where these facilities exist, they serve mainly affluent populations; at the periphery, most health-care services have basic equipment, health-care workers have little training, power and water supplies are tenuous, and capacity is limited for maintaining complex equipment and handling fragile reagents. Design specifications that meet these challenging conditions might ultimately even leapfrog the health technologies available in industrialized regions, where a surfeit of resources means that we sometimes tolerate very expensive and inefficient tools.
Consider, for example, the lab-on-a-card technology that PATH is pursuing with several partners (see margin). NURS 4015 – Public and Global Health Essay Paper This approach uses new developments in microfloppies and nanotechnology to produce multinational, point-of-care diagnostics to help identify sexually transmitted infections and manage the care of patients with fever or diarrhea in poor communities. It is designed to lower costs and curtail the time and infrastructure required to transport specimens and return test results. Such technology could reduce over treatment (and thus drug resistance); help shorten the duration of illnesses; and, in childhood diarrhea, combined with responsive treatment improve nutritional status and child development overall. Once fully developed, the technology will have broad application, in rich countries as well as poor.
As more resources become available for global health, product-development partnerships are bringing the innovation capacity of the private sector to bear on some of the thorniest problems of poor countries. Weak supply chains and fragile health systems in resource-poor environments produce unpredictable and unstable markets, discouraging private-sector interests from investing in the research and development needed to produce new technologies for diseases that disproportionately affect the poor. Development of technologies for these markets is simply too expensive and uncertain to attract investment from traditional capital markets. NURS 4015 – Public and Global Health Essay Paper Leadership and resources from governments, civil society, and philanthropy are needed to stimulate action.
Product-development partnerships provide a creative means for industry to participate in solving some of the world’s most important problems—vaccines for malaria and other neglected diseases, new tuberculosis drugs, and specialized diagnostics and delivery devices—while remaining true to its commercial purpose. These partnerships take many forms and typically involve highly creative approaches to management of intellectual property rights, negotiation of affordable access, and shared risk taking. All are based on a core win-win proposition—the public sector supports some (typically not all) of the costs of product development or helps lower some of the risk (eg, by building capacity at clinical trial sites and facilitating regulatory approval), and the private sector commits to manufacturing the products and making them accessible to low-resource markets (eg, through dedicated product supply or preferential pricing). Such partnerships save the public sector money and, importantly, time in championing the development of innovative solutions for resource-poor communities.
Product development depends on user testing to indicate design flaws, suggest refinements, and produce new features. In transferring technology from the industrial world to developing countries, user testing is even more vital, because of the great distance, cultural and otherwise, between designers and users. Industrial-world designers must have feedback from developing-world users to create appropriate technologies. And the unexpected responses of end users are an ideal driver of creativity and ingenuity. An example is the novel “one size fits most” SILCS contraceptive diaphragm (see margin). Designed to eliminate the need for fitting by a specialized clinician, this device went through more than 50 cycles of feedback and refinement. Co lour, not at first a design target, turned out to be a key factor in user acceptability, and the result is an unexpected lilac color that is preferred across cultures and age groups. NURS 4015 – Public and Global Health Essay Paper
Globalization is commonly defined as the worldwide integration of economies in the face of substantially increased trans border trade and investment [1]. It is generally addressed in the context of economics and information technologies. Globalization has brought wealth and modernity to many of the world’s peoples. Frequently overlooked in the classroom, unfortunately, are the new vulnerabilities now exposed by globalization, including the spread of natural disease and the use of disease as possible instruments of terror. It is important to understand how globalization may be affecting global public health policies, and what implications that has for global control of infectious diseases.
From a public health point of view, it is imperative that we bear in mind that infectious diseases do not recognize borders, as evidenced by the current HIV/AIDS pandemic. The two main results of globalization have been expanding international travel and increased trade. Increased trade includes the exporting and importing of foodstuffs, which are probable carriers of pathogenic microbes. Some fresh foods may be contaminated during picking, packaging, transport, or delivery [2]. Another factor that may facilitate the international spread of food borne disease is the centralized processing of human and animal foods, followed by widespread distribution. For example, if a component of animal feed is contaminated with a pathogen, a food animal could ingest the pathogen. This food animal could then pass the pathogen to anyone who consumes a part of the animal which could cause a global outbreak. NURS 4015 – Public and Global Health Essay Paper
The global health crisis has been a major problem in recent years, probably the worst it has been in modern history. The least developed countries are the main victims of this problem, and many people believe that more powerful developed countries are not doing enough or helping out to try and eradicate this problem. The most deadly infectious diseases that are taking over the populations and killing millions of people are malaria, pneumonia, tuberculosis, HIV/AIDS, influenza, diarrhea l diseases such as cholera and dysentery, and respiratory infections. These diseases are seriously threatening the political and economic structures of many LDC’s, such as South Africa, Latin America, South and Southeast Asia. These infectious diseases are also increasingly affecting Russia, China, Europe and the United States. NURS 4015 – Public and Global Health Essay Paper

Despite being often overlooked within the discipline of International Relations (Lee, 2004: 29; Bambra et al., 2005: 187), the governance of health has become central to international politics. As recent spatial, temporal and cognitive transformations have developed from accelerated globalization, the determinants of health have become increasingly global and thus beyond the control of any individual nation-state.

The aim of this essay is to examine developments within global health governance in order to illuminate the structural and political dynamics of how health has become a matter of global concern. I argue that although the transformation of global health governance has partially been driven by the structural imperatives of globalization, the highly unequal attention and resources devoted to certain health issues suggest such systemic forces are not alone in shaping the global health agenda. NURS 4015 – Public and Global Health Essay Paper

An account of the processes of political contestant between a wide variety of state and non-state actors is needed to explain differential responses to global health issues as well as the persistence of unequal health outcomes, reflecting the inherently political nature of global health governance.

Understanding how both structures and actors influence global health can also illuminate the dynamics of global governance more generally, allowing for the identification of new strategies for international political contestant and collaboration. Recognizing the political nature of the globalization of health, rather than viewing it as an unstoppable natural force, paves the way for positive and equitable change in global health outcomes. NURS 4015 – Public and Global Health Essay Paper

Global health governance is often traced back to the mid-nineteenth century, when European states participated in the International Sanitary Conference of 1851 in order to standardize quarantine regulations, constituting one of the earliest multilateral responses to an international health issue (McKee et al., 2001: 7). Technological innovations and the confirmation of germ theory contributed to increased international cooperation in the late nineteenth and early twentieth centuries in order to prevent the spread of disease across national borders, leading to the creation of the International Sanitary Regulations in 1903 and the Office International hygiene Oblique in 1907 (Harman, 2014: 657). NURS 4015 – Public and Global Health Essay Paper

Such initiatives paved the way for broad interstate cooperation to tackle international health issues via the League of Nations Health Organization in the inter-war period, and eventually the creation of an agglomeration of United Nations organizations, including the World Health Organization (WHO) as ‘the global health institution’ in 1948 (Ibid.: 658, original emphasis), to promote better health outcomes globally after the Second World War. Global health governance, then, is by no means a recent development. However, the late twentieth and early twenty-first centuries have seen a significant increase in the rate and scope of changes brought about by globalization, affecting the nature of health determinants and outcomes, and consequently transforming the global health agenda. NURS 4015 – Public and Global Health Essay Paper

The acceleration of globalization towards the end of the twentieth century is evident in spatial, temporal and cognitive transformations, all of which affect health outcomes globally, and thus present challenges to the effective governance of health within and across states (Lee, 2004: 21). Innovations in transport and communications technologies, together with the post-1970s Liberal world order marked by the promotion of free trade policies, have led to a spatial and temporal shrinking of the world, in which it has become difficult for individual states to control increasingly immense, complex and rapid trans-border flows of goods and people (Lee, 2001: 15-17). Such flows affect health both directly, by furthering the spread of pathogens across borders along with the movement of goods and individuals, and indirectly, as international trade contributes to economic development across the world, with obvious impacts on the capacity of states to ensure access to health care and address broader determinants of health such as poverty and education levels (Frenk et al., 2001: 31). NURS 4015 – Public and Global Health Essay Paper

Developed countries have experienced much more significant improvements in health outcomes than developing countries, and health gaps between high- and low-income population segments within countries persist.

The cognitive dimension of globalization is reflected in the sharing of ideas and knowledge, thus deeply affecting how health issues are conceptualized and approached globally (Lee, 2001: 21). The challenges posed by globalization to health have been evident in the global scope and rapid spread of food, energy and economic crises in the twenty-first century, and the ways in which such crises have adversely affected health outcomes in various countries (Fidler, 2009). This is not to say that the effects of globalization on the governance of health have been entirely negative, as the transformations of the past few decades have also paved the way for positive developments in terms of knowledge and technology sharing, data gathering, and coordinated responses to global health crises (Garner & McKee, 2001: 202). NURS 4015 – Public and Global Health Essay Paper

Indeed, both the challenges and opportunities presented by the systemic forces of globalization must be taken into account in order to understand the dynamics of global health governance today. However, focusing solely on these structural imperatives can obscure the very unequal nature of the globalization of health, an understanding of which is crucial in order to explain why certain issues become privileged over others on the global health agenda.

Although health outcomes have improved quite significantly on a global scale in terms of life expectancy, child death rates and nutrition levels, as well as access to water, sanitation and antenatal care, the distribution of these positive developments has, in fact, been deeply unequal (WHO, 2008: 6-7). Developed countries have experienced much more significant improvements in health outcomes than developing countries, and health gaps between high- and low-income population segments within countries persist (Bambra et al., 2005: 188). Moreover, vast amounts of resources are mobilized to tackle infectious diseases deemed threatening to developed countries, such as HIV and Influenza A H5N1 (avian flu), while diseases which contribute to many more deaths globally (e.g. diarrhea diseases), but the adverse effects of which are largely confined to developing countries, are neglected (Lee, 2004: 15-17; WHO, 2015). Indeed, only 10% of medical research and development expenditure seeks to address health issues that affect the poorest 90% of the global population (Elbe, 2007: 122). NURS 4015 – Public and Global Health Essay Paper

Such differences are the product of a global health governance regime that focuses on selective, rather than comprehensive, primary health care (Sanders & Chopra, 2003: 107). In other words, program mes of vertical, technocratic intervention in order to tackle specific health issues are privileged over horizontal approaches that aim to strengthen health systems more generally, and to address a wider range of the economic and political determinants of health, such as income, education, and employment conditions, among many other factors (Lee, 2004: 188-189).

Furthermore, the globalization of health governance has been significantly shaped by the post-1970s Liberal approach to health policies, which has sought to promote market forces as the determinants of health care provision and access, thus inevitably privileging the affluent over the poor (Harman, 2012: 5-6). The result of these influences has been a global health governance regime heavily skewed towards market-oriented, vertical approaches to health, in which economic and political power largely shape the global health agenda, and determine who has access to health care and who does not. Therefore, in addition to an account of the structural imperatives of globalization, we must look to the dynamics of political power and contestant involved in global health governance in order to explain differential health outcomes within states and across the globe. NURS 4015 – Public and Global Health Essay Paper

Intergovernmental organizations (IGOs) such as the WHO, the myriad UN organizations, and the World Bank, have played a central role in promoting interstate cooperation and coordination in order to tackle global health issues (Harman, 2012: 27). Such organizations can have an immensely valuable positive impact on health outcomes globally, as in addition to the direct provision of health services, research and aid, IGOs allow states to centralize information and data collection, take coordinated action in response to health issues, standardize procedures and provide frameworks for drafting international law (Harman, 2012: 35-37). Despite rhetoric of health as a global public good and a supposed focus on an equitable approach to health systems strengthening, however, these organizations have been marked by political contestant both within and between them (Davies, 2009: 28). Their relative influence in shaping the global health agenda, and the discourse used therein, is determined by relationships of political and economic power. Composed of member states and largely reliant on state funding, these organizations are often constrained by the national interests of their members. NURS 4015 – Public and Global Health Essay Paper


These inequalities have resulted in a focus on health issues deemed threatening to developed countries, such as infectious diseases (McInnes & Lee, 2006: 5), and a privileging of the economic interests of the industrialized world over the health interests of developing countries, evident in policies by the World Bank and World Trade Organization (WTO), for instance, that work to reduce trade barriers in the developing world, despite often having adverse effects on local health outcomes and the strength of public health systems globally (Parker, 2002; Koivusalo, 2003). State-led organizations and initiatives, as well as interstate economic and political relationships, thus constitute central factors shaping the global health agenda. However, as the structural forces of globalization have created new political spaces for contestant and collaboration by undermining the capabilities of states to address the increasingly global determinants of health, focusing solely on states and IGOs does not allow for a comprehensive understanding of the political dynamics of global health governance. NURS 4015 – Public and Global Health Essay Paper

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