Chapter 76: International and Global Health

INTRODUCTION

International Health is a well-established branch of public health, with origins in the health situation of developing nations and the efforts of industrialized countries to assist them. It has always considered issues transcending national jurisdiction, for example, quarantine regulations. However, the field has recently extended to Global Health, emphasizing global cooperation for solutions. While problems like unsafe drinking water affect mainly local communities within countries, others have worldwide impact, for example, air pollution, drug trafficking, and tobacco marketing. Although local and national actions are essential, these also require additional global action, for example, Framework Convention on Tobacco Control.¹ Regardless of the levels of solutions (local, national, international, global), at the core of the world's health problems lie enormous inequities in economic and social conditions, and the right to health remains unfulfilled for most of the world's people.

Coherent country-specific, regional, or global health initiatives depend on priority setting that considers the magnitude of problems, and the availability of effective, affordable, and acceptable solutions. The process requires reliable health information to inform decisionmakers and guide managers in implementing sustainable programs. Many industrialized countries do not perform this process well, despite their resources and availability of choices. In developing countries, making the best possible decisions with more limited resources is even more critical, and requires building a research capacity to produce such health information.² The 1990 Commission on Health Research for Development argued that developing countries allocate 2% of their health budgets on Essential National Health Research.³ The Global Forum for Health Research in 1999 noted the “10/90 disequilibrium”: only 10% of research is devoted to the health problems of 90% of the world's population.⁴

This disequilibrium mirrors inequities in health worldwide: in 2003, the under-five mortality rate was 123 deaths per 1000 live births for low-income countries (LICs), while in high-income countries (HICs), the rate was 7 (Table 76-1). For all countries experiencing violent conflicts, child mortality rates have worsened: preventable infectious diseases (IDs) and malnutrition, often in combination, are the predominant underlying causes. Women are over 100 times more likely to die of pregnancy-related causes in developing than in developed countries. Of people in developing countries, more than half lack access to sanitation, a quarter lack clean water, a fifth lack access to health care of any kind, and a fifth experience inadequate nutrition. Economic disparities within and between countries are growing.⁵ Over a billion people live in extreme poverty despite the global economy doubling over the past 25 years to more than $25 trillion.