The first edition of this text has been well received and used throughout the world. After six years we feel a new edition is needed to reflect the changes in global health. As we write this preface with most of the book completed, the new Global Burden of Disease 2010 study has just been published.1 In many ways the health of the world has improved. We see advancement in life expectancy, especially in the developing world, a continued reduction in infectious diseases and malnutrition, and a greater interest among funding agencies and governments in global health. Deaths in children are now much less and 43% of deaths in the world now occur at age 70 or older (compared to 33% in 1990). The HIV/AIDS epidemic has not grown as rapidly as originally predicted, although it remains a major problem in many of the lowest resource areas of the world. Although tuberculosis and malaria still caused 1-2 million deaths each in 2010 and HIV/AIDS caused about 1.5 million deaths, these figures are much less than the burden of the chronic noncommunicable diseases. Two of every three deaths were due to chronic illnesses in 2010. One in four deaths is due to heart disease or stroke (over 13 million). Eight million people died of cancer (38% more than in 1990) and the deaths from diabetes doubled since 1990 to claim 1.3 million lives. Road traffic deaths have increased by almost half.
There are still many areas of concern in global health. Many countries are now caught in the epidemiologic transition. They must continue to direct resources to fighting the old infectious and perinatal causes of morbidity and mortality, while trying to stem the growth of chronic and noncommunicable diseases. The main risk factors continue to be high blood pressure, tobacco, alcohol, and poor diet. Reduction of these risk factors requires much time and effort by public health professionals around the world.
Therefore we are pleased to present this new edition of Understanding Global Health. It is intended for anyone with an interest in this topic and is written especially with students in mind. We have continued to list learning objectives for each chapter with study questions at the end to stimulate thought and discussion. The original chapters have been updated, most of them by the original authors. We are indebted to every author, who has given time and expertise in producing an authoritative and useful text. Each author has done significant work to include the most current information. New chapters have been added to this edition on malaria and neglected tropical diseases; problems that continue to affect millions worldwide. Surgical issues are often at the forefront of needed services and a new chapter on surgery is included from the public health perspective. Mental health issues, especially depression, are major sources of disability-adjusted life years (DALYs) and a new chapter helps us understand this area. There is great interest currently in the problem of human trafficking. This is a global health issue and is addressed expertly in a new chapter. Finally new authors have been added to several chapters and have brought added expertise to the book.
It is with a sad heart that we must report the death of one of the editors, Dr. Ray Smego. He passed away suddenly December 15, 2012 in South Africa. Ray was serving as Dean of the School of Medicine, Faculty of Health Sciences at the University of the Free State in Bloemfontein at the time of his death. He had a long career in international medical education and had taught at schools in many countries around the world. He had served as a Fulbright scholar to Pakistan in the field of tropical medicine and public health and was the founding director of the international health program at West Virginia University. Ray had a true heart to improve health care for all peoples around the world and especially underserved peoples wherever they may be. The other editors have missed his expertise in the final stages of this book and wish to dedicate this book to him. He will be greatly missed by all who knew him.
We appreciate the help from the staff at McGraw-Hill, especially Jim Shanahan, Cindy Yoo, and Laura Libretti for their help and assistance. We hope this book will continue to contribute to better understanding of people around the world and better health for all.
William H. Markle, MD
Melanie Fisher, MD
Ray Smego, MD†