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The Challenges in Global Health/Public Health

Submitted by on August 22, 2012 – 5:27 AM 153 Comments

In the past two centuries, global public health has witnessed enormous achievements in control of infectious diseases because previously, the leading cause of death in large measure has been reduced due to improved sanitation and food safety, vaccines, antibiotics and improved nutrition. This has led people to put their faith in the notion that medical science would succeed in overcoming the obstacles of diseases.

Furthermore, new knowledge of the microbiological origins of cancers such as that of the cervix, stomach and liver have strengthened primary prevention and brought hope that new cures will be found for other chronic diseases of infectious origin (CDC 1999, Dowdle 1999).

However, new diseases such as HIV and new forms of influenza have taken both professional and popular opinion by surprise and have renewed the challenges before the world public health community (Fauci 2005). More so, the emergence of antibiotic-resistant strains of common organisms due to overuse of antibiotics and lack of vaccines for many dangerous microorganisms poses problems to humanity. This stresses the need for new vaccines, effective antibiotics and strengthened environmental control measures.

Though gains are being made in control of many tropical diseases, but malaria, tuberculosis and other infectious diseases remain enormous global problems especially for developing African countries (Fauci 2005, Ursula 2009). Tragically long delays in adopting “new” and cost effective vaccines cause hundreds of thousands of preventable deaths each year in developing and mid-level developed countries (Antonie 2009).

However, in the face of the enormous challenges faced by global public health, some of the most critical issues in global health are; lack of resources available to combat the multiple scourges ravaging the world’s poor, lifestyle and the sick, unskilled public health workers, approach of global health initiative, bureaucracy within the health sector, the distance between the systems and the financial streams, leadership, the complexity of the modern social, economic and political determinants of health and most importantly is the explosion of actors working in health and development.

On the issue of financial, there has been recent extraordinary and unprecedented rise from world leaders, public and private givers, now more money is being directed toward pressing health challenges than ever before (World Bank, 1994, WHO 2000, Than 2002). In recent times, tackling the developing world’s diseases has become a key feature of many nations’ foreign policies over the last decade for a variety of reasons. For instance, African countries are battling with issues of infant and maternal mortality rates, curbing the spread of HIV/AIDS, tuberculosis (TB), malaria, avian influenza, some other opportunistic infections and other major killers as a moral duty. Also because of lifestyle and urbanization, especially in high and middle-income countries, the burden of illness has shifted from acute childhood infections to chronic non-communicable diseases.

The poor health status in these subpopulations can be attributed to problems such as poverty, malnutrition, illiteracy, and unsafe drinking water, lack of access to health services, social discrimination, and political conflict (Sanders, 2001, Kiskbusch 2010). However, the efforts this money is paying for are largely uncoordinated and directed mostly at specific high-profile diseases rather than at public health in general. Also, there is a grave danger that the current age of generosity could not only fall short of expectations but actually make things worse on the ground.

Secondly, global public health is faced with the challenge of unskilled public health workers because the public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance (Kiskbusch 2010, Jain Sc 2000). Another challenge of global health is the focus or approach of global health initiative which according to Kickbusch, she argues that global health is not just about disease based initiatives rather it’s about strengthening systems and institutions for delivering health and this doesn’t just only refer to strengthening health systems but rather also on understanding of global health, global health governance which takes responsibility for the determinants of health.

This she further argued that the approach of health initiatives should not only be “vertical approach” which focuses more on treating and preventing a single disease, but rather consider “horizontal approach” which would help to build health systems, prevent disease and provide a range of other services (McMicheal 2000, Kiskbusch 2010). In their study, they concluded by advocating for a holistic approaches that incorporate vertical and horizontal projects that looks outward from the health sector to other policy fields such as trade, agriculture, transport, environment, rule of law and social justice where many of the determinants of health lie. This means that efforts much stretch beyond building institutions to deliver health care, to institutions and mechanism that can build coherence within health and between health and other sectors.

Furthermore, in doing the health sector must change its own mind-set. This is because, most active players in the health sector see health mainly as a national issue, and also see global health as a special niche of public health that is focused on addressing the diseases of poverty. This mind-set approach makes global public health as narrow, in contract, global public health issues need to be seen in a regional and global context otherwise policies and actions to address these issues will be ineffective.

The third challenge is the gap that exists between the systems and the financial streams which have been established between sphere of development cooperation and the sphere of the provision of global public goods (Kiskbusch 2010). For instance at country level, practically all the money for international health is with development agencies. This situation makes funding of some sectors to actually be active in relation to governing interdependence while creating laws, norms and standards, ensuring the implementation of international agreements difficult. In such situations, we see countries coming together to accept binding international treaties for health protection of populations worldwide, such as the International Health Regulations, but there is no money to help poor countries to establish the infrastructures to actually fulfill their obligations.

In this situation, there seem to be a conflict of interest because the financial resources for investing in such infrastructures are with the development agencies whose interests are not in provision of public goods at the global level but rather on ameliorating the suffering of populations at the local level (Mills A, 2000, Chen et al, 1999, Smith et al, 2003). This they argued that though such action is undeniably necessary, it also needs to be complimented by building institutions and mechanisms to fund and provide public goods at the global level; otherwise we are in many cases treating the disease while ignoring its causes.

The fourth challenge is that of the question of who actually takes leadership for global health, which is actually close to challenge three and where financial resources for global health lie. Taking leadership for global health can be helpful, but it can also be difficult this is because it answers the questions of who speaks for whom, who has taken the leadership, who has the power, money or the technical knowledge (Kiskbusch 2010, Than S 2002 and Wall S 2002). In many cases as seen from developing countries that it is mostly the development agencies that take the leadership.

This is because they have the money and the result is that, technical people in health are not involved or left behind because they have neither the power nor the money. These opinion leaders, stakeholders and researchers say that it should be addressed at global governance level. Another issues closely linked to this is that of managing the complexity of the modern social, economic and political determinants of health (Bertrand 1999). This is because there is absolutely no use talking about global health governance if we haven’t got our act together at home to address some of the leadership challenges. Good global health governance begins at home, and that means we need strategies, policies and mechanisms to bring together various sectors and stakeholders.

Just as the challenges countries faced can no longer be addressed from behind the nation-state’s sovereign borders, the same is true for traditional policy fields (Cardenas et al, 2002). This gap that exist in global health governance is even seen in our modern government were institutions are ministries are created to address a single category of issues. For instance, Tobacco regulation provides several examples where Ministries are caught between public health interests and industry interests which both have legitimate claims over government action.

The fifth challenge is one that reflects two sides of the same coin. In recent times, there has been an explosion of actors working in health and development in the last two decades, some actors are old, new and others are only newly engaging in heath. A side of the coin refers to the implication of this at national level, and specifically in developing countries which are often on the receiving end of these actors (WHO 2000, Mills A, 2000 and Kiskbusch 2010).

In fact, this is indeed a challenge generally to the field of foreign affairs and development cooperation which poses a challenge of “How can a country at national level create coherence among all these well-doers who come into your country and don’t only give you money but also take up your time and create vertical programmes rather than help you build a health system?” Though some organizations that have country office and working within some of these countries have had positive results but still, it doesn’t address a plethora of some other actors who organize projects and send delegations for country governments to receive.

This rapid increase in the number of actors is also a challenge at the global level. Though there have been initiatives to promote coherence, coordination and complimentarity such at the International Health Partnership (IHP), the Health 8 (H8) at the global level, however, these activities are mainly coordinated within the area of the vertical global health initiatives which are not in the area of global public goods. In view of this, Kickbusch suggest that coordination for global public goods is also needed. She also suggested that we need to see how this can be done and in what ways these coordination mechanisms can also be more accountable sighting Treaty processes as a coherence mechanism. Also, we need to think in what ways existing treaty processes can be moved forward in new ways and this coherence process should be linked again to the World Health Assembly.

In summary, from a developing and developed country perspective, global public health has various political, regional, socio-economical and religious challenges and limitation which includes the traditional approaches to public health training, the emphasis on epidemiology, biostatistics, communicable diseases, health protection, the relative neglect of other public health sciences and the lack of attention to emerging public health problems, the isolation of other health providers- local communities and other scientific disciplines from the ministries of health, the emphasis on institution based teaching, didactic training and the lack of direct field experience, the lack of experienced field based senior public health practitioners as role models and the absence of apprenticeship experience, also the view that public health is a medical specialty, funding and the slow realization that the leadership of public health programmes, leadership of medical training programmes, challenges of global health governance, and the uncoordinated philanthropy of recent years which has led to what some call market multilateralism

About the author: Emmanuel Kidochukwu Uzum is the  Lead Consultant, Public Health and Social Development at EM & PH Consult, Ltd., Nigeria and is focused on health advocacy, monitoring and evaluation, project management, operational research and fund raising for youths, women and other vulnerable populations especially in the areas of Health, Education and Community Development. The author can be reached at:  [email protected]

About this article: This article is competing for the JPMS International Medical Writing Contest 2012 for the theme: Medical Education

 

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  • Francis

    Great job

    • uzum

      tnx

  • Eneye Dania

    Nice One Boss,A wonderful piece of work

    • uzum

      tnx

  • Enifo

    Nice…..

  • Ochije

    A very insightful and intellectual article. Mr Uzum sums up the entirety of what needs to be done in the area of public health in our dear country. Kudos

    • uzum

      tnx bros

  • seyiton

    nice piece

    • uzum

      i appreciate

  • didi

    An intelligent work.

    • uzum

      tnx

  • Boye

    Excellent work, original work. Congratulation!

    • uzum

      i am flattered

  • Mr E. Emegha

    Great insight and informative journal. Health is Wealth

    • uzum

      tnx

  • NETCODE

    Great piece

    • uzum

      tnx bruv

  • Dawa

    Well done Mr Emmanuel. This article gives a realistic calibration of the present chemistry and challenges of the public health sector. Kudos!

    • uzum

      tnx i appreciate all the grammer

  • uzum

    Nice work

    • uzum

      tnx bros

  • Kathy

    Well done! Great piece Emmanuel Congrats!

    • uzum

      tnx ma, am delighted

  • Engr Ucheca Vincent Nweke

    Great article Mr Emmanuel, it gives an insight into public health issues in third world countries. I am very impressed with this work, especially as a novice in this area. I now understand so much from reading this, it shows a lot more work needed to be done by everybody for not only development of the health sector, but also creating awareness on our every day lives. Keep the flag flying my friend.

  • Evans

    what a piece of work…..well don Mr. Emmanuel. it’s very insightful, enlightening and educating. More grease to your elbow. This is very revealing as it borders on the health challenges in developing countries. Thanks for such a beautiful piece of work.

    • uzum

      i wud kip it up and hp u kip reading my links

  • Martins Emeke U

    This a very nice piece of works.It has elaborated the global challenges individuals, corporate bodies and even the Goverment has been facing in improving public health.Keep the flag flying and i say congrats.

    • emma

      tnx for the couragement

  • Rhio

    Really educating, I look forward to reading more from you

    • uzum

      i hp to educate u more

  • Esty

    Good write up, well done Emma

    • uzum

      tnx madam

  • Jethro

    This is a wonderful piece of work. Its very educating and enlightening. I really like to see more of your works in future. Nice one.

    • uzum

      am flattered

  • http://www.facebook.com/Aizman Bashiru Bd Shaibu

    nice one bro, looking forward to more of your articles

    • uzum

      sure, wud kip u posted

  • Dno

    Good one

    • uzum

      i appreciate

  • Ojeiu

    Nice work Uzum. Quite insightful. Continue the good works.

    • emma

      tnx bros

  • aMosoVic

    nice article..couldn’t have been said any better..av always pondered how we get to profess public health with the little effect around us..as all I’v noticed for long is the show of donations on tv…well,now I know why It’s been dragging. Now I see It’s all been in d hallucination of a supposed notion … insightful piece…

    • uzum

      tnx i apprecaite

  • Christopher Okozi

    this text is very rich…..i must commend you Mr Uzum……thumbs up and well done. Now i have an idea on the challenges of global health even if am not in the medical field.

    • uzum

      neva knew u cud speak such nice grammer.tnx

  • Abule Patience

    wonderful article,very educating,nice work.

    • uzum

      am most grateful

  • Deej’

    Beautiful piece Emma.

    • uzum

      tnx, i appreciate

  • Obiora Eneanya

    Great article. Fantastic thought process. Good reasoning. Bureaucracy and corruption are two major practices that way heavily on governments ability to fight emerging diseases. Also, the group diseases usually known as the “Neglected Tropical Diseases” receive very little attention from government and health care providers. It is true that these diseases do not normally cause high mortality, however, they cause great morbidity. Thus, the economic impact due to lost man-hours is enormous. For instance, a person suffering from Oncocerciasis (River blindness) becomes permanently blind and in addition to having zero productivity, he/she usually would need round the clock attention, thus holding back another individuals productivity.

    Being aware of some of this salient issues is good for development. Emmanuel, congratulation on this piece!

    • uzum

      tnx my prof, wud kip it up and also include those other issues in my next publicatn

  • Jide

    An eye opener to current issues. I am hopefully that governments, NGO’s, WHO and all bodies that are involved in giving care to people to who do more so that we could have a healthy world for our generations to inherit.

    • uzum

      tnx bros, i apprecaite

  • jovi

    Nice one there emma

    • uzum

      elder tnx, u too much

  • eric

    Good research man….love this

    • uzum

      tnx bros i appreciate

  • Ijeoma

    Nice piece! Informative and well detailed. Obviously, you did your research well. Thumbs up!

    • uzum

      tnx ma, i appreciate

  • James O

    Great Article, keep up the good work

    • uzum

      trying to kip up wit the AFDB standard we were taught.tnx

  • okiemute

    Thats good one

    • uzum

      tnx bros

    • uzum

      cheers bros, i appreciate

  • okiemute

    Thats a good one, keep it up

    • uzum

      sure wud, tnx

  • Chijioke

    Nice one, really explicit

    • uzum

      tnx and i promise to kip the gud wrk

  • Ekakitie Omamoke

    i think people like emma should be encouraged by our federal government to bring out the star potential in them in order to make our country Nigeria a proud nation in the health sector

    • uzum

      tnx my able physiologist

  • Christopher Okozi

    i can’t seem to get tired of reading this piece of article…..ur research work is extraordinary…thumbs up

    • uzum

      tnx boss, i am trying to be like u guys

  • Christopher Okozi

    did you get any assistance from heavy weight academicians? don’t mean to burst your bubble bro, its just that this article is top class and it deserves to win

    • uzum

      its my pleasure to hv u read my article. tnx

  • funky

    Welldone Kido nice article more grease to ur elbow.

    • uzum

      tnx for ur encouragement

  • chymes

    Nice article! Hit the nail on the head with some salient points. Keep up the good work

    • uzum

      tnx bruv

  • linda

    Very good work! very valid points made.really impressed! keep it up.

    • uzum

      tnx ma

  • Chigozie

    Great work dear, keep it up.

  • http://www.facebook.com/oghenekaro.agbure Karo Francis

    nice piece of work.

    • uzum

      tnx bruv

  • eugene

    this is a world class piece…….i am impressed

    • uzum

      i am flattered

  • franklyna

    this is really impressive

    • uzum

      tnx ma

  • lucas

    this is a fantastic piece

    • uzum

      tnx bruv

  • promise

    young professor………nice work keep it up

    • uzum

      madam u said so ooooooo, not me

  • ada

    so u knw book like this?……awesome

    • uzum

      mama…….tnx 4 ur time to read my article

  • benjamin ebose

    i can see that your education is nt a waste………keep it up

    • uzum

      at least for once you have seen sumtin gud in me

  • emmnauel

    waoh………..this is awesome i neva knew all this……….tnx to u

    • uzum

      tnx boss

  • udoka

    u are a young genius………..am vry happy wit u.

    • uzum

      tnx bruv

  • edwin

    that my boy……………ride on u re on track. proud of u

    • uzum

      tnx sir

  • atako

    nice 1……..dont lose sight of the vision

  • nwaopara

    i must say i am proud to be called your lecturer…………..u are making me proud.

    • uzum

      i am proud to hv been ur student……..cos u re a awesome

  • onyemachi

    this is a good 1

    • uzum

      tnx sir

  • Dr onoja

    nice work young man…….the sky is the limit

    • uzum

      tnx sir……

  • Mrs Aisha

    Emma, well done nice work

    • uzum

      tnx ma

  • Dr Kathryn

    Boss you are going places……….good work

    • uzum

      i cant a boss yet, u are my teacher…………..lol

  • pope

    so rich an article…….am impressed

    • uzum

      i am trying to be like u

  • mr shaibu

    huh, i can see u are on it………well done

    • uzum

      tnx sir

  • butho

    great one there kiddo keep up cause u are on top one love nice write up

    • uzum

      tnx boos, wud do my best sir

  • http://www.facebook.com/joybotu Ebiteme Botu

    you are inspiring me, keep up d goodwork

    • uzum

      tnx ma

  • jete

    wow! just stumbled on this now..thrilling

    • uzum

      tnx bros

  • Hector

    eye opener…love it

    • uzum

      tnx dat u hv been educated

  • suarez Louis

    you articles are great…love ur passion

    • uzum

      tnx bros…….i appreciate

  • Guest

    Beautifully articulated…this article does not only expose the effect of the abuse of antibiotics,it also addresses the challenges that surround global health today.It is a must read….

    • uzum

      tnx for the commendation

  • Cletrezo

    beautifully articulated…this article exposes the effect of the abuse of antibiotics and also addresses the challenges that surround global health.With the huge neglect in public health today,it is a must read.Nice work

    • uzum

      tnx bros………….i am only a pen in the hand of the creator

  • Rita

    This is really beautiful and educating….great article

    • uzum

      am an ur service ma

  • jerry ochuko

    Nice one bro

    • uzum

      tnx bros

  • JACOB

    WAT A FANTASTIC PIECE

    • uzum

      tnx bros

  • aone

    more height

    • uzum

      i wud thru God that strengthen me

  • Enasor Inweh

    Great article, very insightful pls keep using your platform to educate the world

    • uzum

      i hp to reach all other parts of the world soon…….tnx

  • martino

    Nice article,Its really educating.

    • uzum

      wud kip it up sir

  • yemmy

    Good write up .kudos

    • uzum

      tnx sir

  • sylvia ak ehizojie

    Great wrk….very enlightening

    • uzum

      tnx ma, cos i learnt all i knw frm u pple

  • Annie

    good stuff..keep it up bro

    • uzum

      bros………i am so grateful for ur time to read thru.

  • goldie

    its good that someone cares

    • uzum

      learning to really

  • don p

    frankly put..nice

    • uzum

      tnx sir, its my pleasure

  • john

    inspiring…u are tight

    • uzum

      tnx sir