Towards a Global Public Health.

Co-authored by Professor Patricia Hibberd

Global health—originally known as international health—has grown considerably as an interest in the past several decades, its evolution nearly parallel to that of public health. This growth is reflected by the increasing academic focus on the field. The Consortium of Universities for Global Health (CUGH), which began in 2008, now includes about 100 North American colleges and universities. It approximates the amount of “comprehensive” global health programs at universities—programs that include collaborators from more than one school, working in both research and education, in partnership with at least one institution located in the Global South—which rose from 6 in 2001 to more than 78 in 2011. Additionally, CUGH estimates that 250 North American universities now offer some form of global health education. As academic global health has evolved, so have the institutions tasked with promoting health on the world stage—notably last summer, when Tedros Adhanom Ghebreyesus took office as the new director-general of the WHO. This transition affords an opportunity to reflect on the priorities of global health, how these priorities intertwine with the core aspirations of public health, and why a global public health focus is necessary in our increasingly interconnected world.

Global health is public health. This means global health seeks not only to improve the health of populations, but to eliminate health inequities, promoting health as a human right. This view is consistent with the WHO’s definition of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” A global public health must improve the social, economic, and environmental conditions that shape the health of populations, locally and around the world. This goal was suggested by the United Nations Millennium Development Goals (MDGs), and refined by their successor, the Sustainable Development Goals (SDGs). The MDGs were signed in 2000 by all UN member states. While they addressed the link between health and its broader determinants, such as education, their implementation was primarily vertical, targeting specific diseases like HIV/AIDS, rather than the conditions that shape health. The SDGs, however, are broader in scope. They address the structures that underlie health, as well as the pursuit of justice that ensures all are empowered to live healthy lives. Examples of NGOs whose work is informed by these goals include Tostan, which works to improve health through “community-led change,” influencing cultural norms around issues such as child marriage, female genital cutting, and early childhood development. GiveDirectly is another innovative program, which allows donors to send money directly to people living in extreme poverty, addressing the critical link between income and health. These organizations each speak to the fundamental causes of health, suggesting that the new global health paradigm will increasingly mirror public health’s longstanding concern with improving the social, economic, and environmental conditions of health, rather than just treating disease when it occurs.

A vision for public health that has global health at its heart is animated by the same core principles of equity and justice that have long informed the work of our field. This argues for a movement towards improving the socioeconomic structures that underlie global challenges like climate change, population aging, and urbanization. While global health has in the past been viewed as primarily a matter of aid—of rich countries providing assistance to poor ones—a deeper awareness of the complex networks that shape health has led to a more collaborative model, with countries working together to address emerging challenges, to build a healthier world. This engagement is especially important at our present moment. At the start of the Trump presidency, I wrote a Dean’s Note arguing for greater global engagement, in response to the administration’s early steps to move the US away from playing an active international role. The administration has since doubled down on these efforts, announcing America’s withdrawal from the Paris Climate Agreement, and pulling the US out of the United Nations Educational, Scientific and Cultural Organization (UNESCO), among other actions. Faced with what is hopefully just a temporary lapse in America’s engagement with the conditions that shape global health, an internationally focused public health agenda represents a critical counterbalance to the isolationist policies we are seeing at the federal level.

How does SPH engage with the values of global public health, to promote this critical engagement? It strikes me that we do so in three key ways. First, through our new MPH, which roots each of our study areas in the forces that shape health worldwide. I have written previously about how our program is designed to help students meet the challenge of emerging global trends. This program reflects the evolution of public health education over the last century towards a greater emphasis on interdisciplinary collaboration, equity, and shaping the conditions of health—changes which have also characterized the evolution of global health.

Second, our students, faculty, and alums continue to be public health leaders on the local and world stage, working in a range of countries, and within the international bodies that guide global health policy. This month, for example, SPH alumna Shenaaz El-Halabi began her new role as an advisor in the office of the WHO’s director-general. Her success exemplifies the values of global engagement we seek to instill in all our students.

It is, finally, through our expression of these values that we work towards a truly global public health. At core, this work rests on the principles of equity, pluralism, and justice that are necessary to create a healthier world. By working to promote these values beyond our borders, as well as within them—for example, by advocating for the rights of immigrants when they are challenged—we highlight the fundamental interconnectedness of the conditions that shape health. Climate change, the spread of pandemic disease, and economic and political inequality—these challenges affect us all. In an era when countries are grappling with whether to engage with our changing world, or to withdraw from its complexities, it is more important than ever that we maintain a global focus, in our common pursuit of health.

I hope everyone has a terrific week. Until next week.

Warm regards,

Sandro and Patricia

Patricia Hibberd, MD, PhD
Chair, Department of Global Health
Boston University School of Public Health

Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Boston University School of Public Health
Twitter: @sandrogalea

Acknowledgement: We are grateful to Salma Abdalla MD, MPH and Eric DelGizzo for their contributions to this Dean’s Note.

Previous Dean’s Notes are archived at: https://www.bu.edu/sph/tag/deans-note/