Progress and setbacks since 2000

In 2000, the United Nations Summit and Declaration agreed on eight Millennium Development Goals (MDGs) to be achieved in the 191 member nations by 2015. During this time, global poverty fell but most countries missed the health-related goals. Next came the even broader and more ambitious Sustainable Development Goals (SDGs)—17 objectives for a better world, to be achieved by 2030.  Some have described the MDGs as “halfway goals” and SDGs as “destination goals” towards a coordinated world effort to create an era without poverty, hunger and inequality while protecting the planet.  However, all progress made was derailed by the unforeseen COVID-19 pandemic causing an estimated, nearly 20 million deaths and reduced life expectancy globally for the first time ever in both 2020 and 2021. COVID increased poverty and amplified health and economic inequalities, although air quality temporarily improved. Added to this, global food insecurity re-emerged because of the Russian war in Ukraine, and the climate change tipping point seems to have been reached. 

Even though the SDGs are still off-track, it is on those of us working in Global Health to refocus our attention on all. At Boston University School of Public Health’s Department of Global Health (DGH), we are focusing on three goals in particular that motivate much of our research, teaching and public health practice. 

1. Global Health Equity & Universal Healthcare for All

Global Health has long been focused on the epidemiology of emerging and resurgent diseases.  What’s newer, is an increased focus on the social determinants of inequity and how that feeds population differences in disease morbidity and mortality.    

More accurate data are critical to the design of studies that provide evidence for effective ways to disrupt inequities within resilient healthcare systems. These include providing access to quality care for all, for the diagnosis, prevention, and treatment of diseases of public health importance. An example of this is showing that community-based treatment of poor, rural populations improves pneumonia outcomes compared with better resourced urban dwellers.

At BUSPH, we are investing in new approaches to improve the accuracy and validity of data from hard-to-reach, often highly disadvantaged populations, including novel data science methods, innovative analytical approaches and new data streams, etc., to evaluate more traditional data collection methods. One example is Andrew Stokes’ study to understand the racial, political and geographic implications of undercounting COVID-related deaths in the US due to misclassification of the cause of death. Our faculty are also working to understand the real burden of respiratory disease in poorly accessed populations by assessing community deaths due to Respiratory Syncytial Virus or COVID.

2. Fair and Equal Partnerships

A critical self-assessment of the need to “decolonize global health” or address the power inequities that exist between global health researchers in the “Global North” (high-income countries) and “Global South” (not high-income countries) is underway among global health scholars. 

At BUSPH, our Global Health Working Group on Fairer Partnership in Global Health is actively addressing this question, in collaboration with our numerous international partner scientists and health professionals. Our continuing goal is to critically self-study our current and future field work to ensure that we are meeting a rigid standard of equity and fairness in our collaborations. We are creating a DGH community framework that attempts to assess the degree of any unfairness in partnerships with our global collaborators, and deliberately work towards concrete solutions. Topics covered include international partner involvement in decisions about research topics, participation in all steps in the design and conduct of research, preparation and oversight of the budget and research management, joint and equal ownership of research data and fair, transparent authorship roles for all publications. 

We have several examples of the success of this approach in the Department, including the 20+ year partnership between BUSPH’s Sydney Rosen, Matthew Fox and the Health Economics and Epidemiology Research Office in Johannesburg, South Africa. We also have a 27+ year partnership with the Lata Medical Research Foundation in Nagpur, India.

3. Climate Change

The direct and indirect health consequences of climate change is considered the biggest threat to global health in the foreseeable future, and one that is existentially urgent.  The direct effects include heat waves, floods, drought, wildfire associated pollution, loss of arable land and failing crops, rising sea levels, and depleted and exhausted fisheries. But the indirect effects can be even more extensive. These include longer seasons and greater distribution of vector-borne diseases, contaminated food, water and crops, undernutrition and forced displacement.  These effects disproportionally affect the most disadvantaged populations and those with chronic illnesses, especially in the heat and rainfall-stressed global South.

While public health measures themselves can have minute effects on the overall climate challenge, meaningful mitigation of heat-related disease processes can save many lives. Solutions need to be comprehensive and multifactorial, but climate resiliency of healthcare systems is a top priority. Nina Brooks is evaluating the environmental and health consequences of brick manufacturing in Bangladesh and how extreme heat affects fertility in sub-Saharan Africa. 

Moving forward

We believe fresh topics and approaches like the ones above are an imperative for the field of Global Health. They are necessary as we work towards accomplishing the core SDG goals, directly or indirectly.    

Importantly, we welcome collaborators from across disciplines and the world to engage on these topics topics of interest—to not only hold us to account, but also be the inspiration for new approaches to global health equity and more.