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International & global public health
Although Public Health is often carried out at the level of a local or
national population (e.g. by the NHS and HPA in the UK), many issues are not
confined to individual countries but affect populations throughout the world.
A summary of major current international public health problems follows, with
links to further information.
Infectious diseases remain a major cause of mortality (death) and morbidity
throughout the world. The majority of illness occurs in poorer nations.
Many of the threats have been recognised for a long time, including malaria,
tuberculosis (TB) and, in the last 20 years, HIV/Aids. Emerging infectious
diseases, such as SARS in 2003, are also a concern; international efforts are
currently focused on managing a
possible influenza pandemic,
as well as preventing spread of XDR-TB (extensively/extremely drug resistant
TB).
Although a lot of research money has traditionally gone into the so-called
'big three' - HIV/Aids, TB and malaria - it has been argued that, in fact,
larger health gains may be had by investing in treatments for diseases such as
parasitic infections, and basic healthcare infrastructure.
Links
WHO | Stop
TB campaign | Roll back malaria |
HIV/Aids |
SARS |
Avian
influenza
Flu pandemic planning (internal)
Health protection
(internal)
Bill and
Melinda Gates Foundation
International Association of National Public
Health Institutes (IANPHI)
'Rapid-impact
interventions': how a policy of integrated control for Africa's neglected
tropical diseases could benefit the poor, Molyneux et al, PLoS [DOI]
(PLoS, 2005)
Health systems financing: putting together the 'back office', Dare et al, BMJ
[DOI]
(BMJ, 2005)
There is now general acceptance that the earth's atmosphere is warming.
That this is partially or wholly due to human activity - principally the
explosion in use of fossil fuels - is also gaining widespread support, and an
ever-increasing evidence base.
Although there may be some small benefits associated with a slight rise in
temperatures (for example, lower winter mortality in Europe), it is predicted
that these will be outweighed by a slew of effects, from improved conditions for
insect vectors to reproduce (e.g. causing an increase in malaria deaths), to
huge numbers of people displaced by natural disasters and sea-level rises.
The challenge for global public health is firstly to try to slow down and, if
possible, stop any further atmospheric change by promoting awareness of the
issues (for example in transport policy) and, secondly, anticipate and plan for
the predicted effects of climate change.
Links
WHO,
Climate change and human health - risks and responses (WHO, 2003)
Climate change and health
(WHO)
Stern review on the economics of climate change (HM Treasury, October
2006)Climate Change
(Royal Society)
Intergovernmental panel on climate change
(WMO)
Climate Care UK
organisation promoting personal offsetting of carbon emissions
Committee on
the science of climate change, Climate change science: an analysis of some key
questions, National Academy Press (NAP, 2001)
Roberts, P. The End of Oil, Bloomsbury (2005) Very interesting and
balanced book about how much oil is left in the world, when it may run out, and
how a new energy economy (such as a hydrogen economy) may work.
Clearly poverty underpins almost all aspects of health and contributes to all
the other issues listed here. International public health policies should
strive to reduce inequalities within and between societies in order to reduce
morbidity and mortality. Poverty is a vastly complex issue with many
causes and therefore remedies, including the reduction of corruption in society.
Insufficient food (famine), which again may be due to many factors (including
climate, poverty, war and corruption), is also a major cause of ill health and
the focus of many aid organisations.
Links
World Bank Specialist agency of the
UN
Department for international development
(DFID) UK Government department
Global Health Council US-based
nonprofit organisation
Oxfam UK-based aid charity
VSO Voluntary Service Overseas,
UK-based development charity
Disasters Emergency Committee (DEC) Alliance
of UK aid charities
Over two million people die from water-borne disease each year, almost all of
these in the developing world. Everyone in the world should have access to
potable (drinking) water and achieving this is a major public health aim.
Links
Water Aid
Charity dedicated to providing safe water to communities throughout the world
Drinking water (WHO)
Health in your hands
Public-private partnership to encourage handwashing to prevent diarrhoeal
illnesses
It may be a truism that war is harmful to human health, but quite apart from
direct morbidity and mortality caused by conflict there are also problems
associated with displacement of civilian populations from the conflict zone, and
damage to basic infrastructure in the war zone (including basic communications,
supplies, healthcare and water).
Many countries around the world now have contingency plans for acts of
terrorism, including bioterrorism, the health effects of which fall under public
health.
Links
International Committee of the Red Cross (ICRC)
International aid charity
Medecins Sans Frontieres (MSF)
International medical relief charity
Merlin International medical relief
charity
Medact UK-based charity focusing on
global health, including the politics of conflict
WHO - bioterrorism
(WHO)
HPA emergency preparedness and response - deliberate release (HPA)
United Nations High
Commissioner for Refugees (UNHCR)
There is overwhelming evidence that tobacco causes severe morbidity and
mortality (e.g. Doll,
Peto et al, 2004, BMJ DOI: 10.1136/bmj.38142.554479.AE [?]).
This evidence has been accumulating since 1950 but despite this tobacco use
remains popular. Legislation restricting tobacco advertising and
sponsorship, cigarette packet warnings and, more recently, restrictions on
smoking in public places have started to have an impact on smoking rates in the
developed world. However, cigarette manufacturers have, as a result,
turned their attention to developing economies to try to maintain sales.
Reducing the prevalence of smoking remains a huge public health challenge,
made more difficult by the determination of the tobacco companies to promote
their product in emerging markets.
Links
Tobacco-free initiative (WHO) |
Framework convention on tobacco control (WHO)
Action on Smoking and Health (UK) (ASH) |
Health promotion
(internal)
Apart from unequal political representation by women in many countries,
domestic violence, rape and forced marriage remain huge public health issues
globally, often compounded by a lack of recognition of their seriousness and
prevalence.
Links
WHO Department of gender, women and
health (WHO)
WHO multi-country study on women's health and domestic violence against women
(WHO, 2005)
Women's aid UK charity with a focus
on domestic violence against women and children
Madre International women's rights
charity
Basic primary-level education helps children to understand the concepts of
health and society including families and relationships, and a sense of their
own individuality and rights. This is extremely important in preventing
and reducing gender inequality, unsafe sexual practices (and thus HIV/Aids), and
helping limit family sizes. In many countries this basic education is not
available at all, or is only open to some (e.g. only for boys).
Links
Basic education and
gender equality (UNICEF)
Education for all (UNESCO)
Millenium Development
Goals #2: achieve universal primary education (WHO)
Chronic diseases which have become the main focus - and spend - of health
systems in developed countries over the past few decades including heart
disease, stroke, diabetes and cancer (and, more recently, obesity), are now
becoming increasingly significant in poorer nations also.
Links
Department of chronic diseases and
health promotion (WHO)
WHO,
Preventing chronic diseases: a vital investment (WHO, 2005)
Obesity (WHO)
CancerMondial (IARC, a unit of WHO)
Many countries, particularly poorer nations, have a severe shortage of health
professionals for a number of reasons. This is often exacerbated by the
so-called 'brain drain' of individuals trained locally, but practising in richer
nations.
Links
WHO, World Health Report 2006 -
working together for health (WHO)
Links
Population Reference
Bureau International health data
World Health Statistics 2006
(WHO Statistical Information, WHO)
Globalization and Health
journal (BMC)
Global Public
Health journal (Taylor & Francis)
Bulletin of the World Health
Organization (WHO)
FPH - working abroad (Faculty of Public Health)
Alma Mata Global Health Network -
information on careers in international health
Global Healthcare Information network - including the
Healthcare Information for All by 2015 (HIFA2015) campaign