Humans across the globe have become very interconnected–and so has our health.
No matter how we try to slice and dice up our planet with
political and geographical boundaries, health remains a species-wide concern.
In some cases, our health has blurred these boundaries. And in other ways,
human health has been decided by them.
But with over 7 billion people living in about 200 different countries across the planet,
global health can be … complicated. Challenging. Even surprising.
Like, it turns out that the communicable diseases we often think of as the biggest
killers–like malaria or the flu–actually aren’t the leading causes of death in most places.
So then…what is? And, how do entire countries provide care for each other? And what if a country
doesn’t want help from other countries? And what if the “help” actually harms other countries?
Hi, I’m Vanessa Hill, and this is Crash Course Public Health!
INTRO
So one sort of obvious problem with the term
“global health” is that it can feel very big and unspecific.
And this is partly because it needs to be! After all, we’re talking about a whole planet!
In general, we can think of global health as a public health approach that puts
emphasis on improving health for everyone in the world, while eliminating the health
equity gaps that result from things like nationality, income, and gender.
How successful is it at accomplishing those goals? Well…it depends. We’ll get to that.
But first, a little historical context.
The question of when human health became a global phenomenon is really up for debate.
Like, did it begin during the industrial revolution of the 18th century when the
world saw huge spikes in international trade and development? Or was it back in the 13th century,
when Genghis Khan conquered around 9 million square miles of territory? Or, like, was it at
the dawn of the human species, when our early ancestors began their migration out of Africa?
These are all good answers to the question. But let’s fast forward to April 1948,
with the establishment of the World Health Organization, or the W-H-O.
By this point, human civilization was indisputably a very global phenomenon–
as made evident by the fact that we’d just come out of our second World War.
So, the United Nations formed the WHO,
a special agency dedicated to monitoring and improving the world’s health.
The WHO’s Constitution declared that the organization’s objective
“shall be the attainment by all peoples of the highest possible level of health. ”
This was one of the first global movements that
basically established health as an international human right.
Which feels like it should’ve been obvious from the start, but I guess we needed it in writing?
The WHO is basically in charge of making a vision board for the entire planet’s health.
It sets international standards for health,
collects and analyzes data from around the world, monitors concerning new and
old diseases, and helps coordinate emergency responses and research between countries.
When the WHO was formed, the leading cause of global human death was communicable diseases.
These are diseases that are spread–or “communicated,” as it were–
from one living thing to another through pathogens.
These are things like bacteria and viruses
that are spread through respiratory droplets, blood, saliva, and such.
A pathogen knows but two laws: reproduce in an organism and spread to new ones.
It doesn’t notice or care when it crosses the border from Egypt to Libya,
or when it hitches a ride on a redeye flight from Boston to Berlin.
And as people became better at moving around resources and–well–themselves,
they also got better at moving these pathogens around.
Whether it was trade facilitated along the Silk Road, or that spring break trip to Disney World,
people have gotten really good at building germy superhighways of trade, travel, and tourism.
Without a globally coordinated response, eliminating a disease across the face
of the planet is a bit like playing a game of whack-a-mole, with a disease being squashed in
one part of the world, only for it to pop up in another part…and another part…and another part.
One particularly dangerous communicable disease was smallpox.
Scientists have found smallpox-like rashes on Egyptian mummies,
suggesting that humans have been dealing with some form of smallpox for over 3,000 years.
And in the 20th century, smallpox was still a major threat.
Historically, experts estimate that smallpox killed more than
300 million people since 1900 alone.
So in 1959, the WHO added a bold new mission to its vision board: eradicate smallpox.
The virus was killing millions of people each year, with outbreaks
happening all over the world and even spreading between continents.
Eradicating smallpox would mean ensuring that not a single person
on Earth had the disease so it could never be spread again.
So, we got to work.
And after a couple of attempts, thanks to effective interventions in dozens
of countries and mass educational and vaccination campaigns, the WHO,
with the help of many public health workers, succeeded. In 1977, the last confirmed case of
naturally-acquired smallpox was identified in Somalia–and then, smallpox was gone!
The WHO has led similar global responses against other communicable diseases,
such as in the fight against HIV and AIDS, polio, Ebola,
and COVID-19, though none have been as successful as the smallpox campaign.
But global health isn’t just about germs sneaking across international borders.
Today, most deaths are actually caused by non-communicable diseases,
also called non-infectious diseases,
which are diseases that aren’t spread through things like bacteria or viruses.
Instead, these diseases are caused by genetic, environmental, and behavioral factors.
This is because, in general, as we’ve gotten better at decreasing the rate of communicable diseases,
non-communicable diseases have come to make up a greater proportion of deaths.
These are diseases like cancer, heart disease, and diabetes. And health experts address them by
managing them with medications and reducing risk factors that contribute to their development,
like tobacco use, physical inactivity, air pollution, and unhealthy diets.
In 2019, the WHO reported that 7 of the 10 global
leading causes of death were non-communicable diseases.
And together they accounted for 74 percent of deaths around the world.
However, the biggest indicator for whether the leading cause
of death in a country is communicable or non-communicable, is that country’s income.
We see this pattern reflected in countries’ burden of disease, which is a measurement that
reflects the estimated years of life lost from early deaths, injury, and illness from disease.
In high-income nations, non-communicable diseases
generally account for around 80 percent of the disease burden.
Meanwhile, communicable diseases tend to make up somewhere around 5 percent
of this burden. (That last 15% is made up of things like injury and accidents.)
However, the opposite is generally true of low-income nations,
where communicable disease accounts for more than 60 percent of the overall disease burden.
And of course, these numbers were reported in 2019, before COVID-19.
And the solution to this problem feels simple,
right? Low-income countries need more, you know, income.
Similarly, if they need resources like food or doctors, other richer countries
could step in and provide aid by selling food to those countries
at a low-cost or sending doctors to provide more affordable healthcare.
Aid dependency is the proportion of a country’s
government spending that is provided by foreign donors.
Aid is often a simple, short-term solution to what turns out to be a much deeper problem.
When we think about foreign aid, it’s important to remember that
high- and low-income nations didn’t just pop into the world fully formed.
They are almost always influenced by other global, economic, and political forces.
Like, consider Haiti, which in the 18th century was one of the richest
and most productive colonies in the world under French rule.
But after a successful rebellion against the French that resulted in its independence in 1804,
Haiti spent the next 120 years paying reparations to France,
which took up as much as 80% of Haiti’s revenue.
And in the 20th century, Haiti was subject to an almost 20-year U.S. occupation,
where things like forced changes to their agricultural practices led to further instability.
Today, Haiti is one of the poorest countries in the Western hemisphere
with one of the highest rates of food insecurity in the world.
In Haiti, nearly half the population requires
food assistance and 1.2 million people suffer from severe hunger.
But the solution to this food crisis isn’t as simple as we may think.
Let’s go to the Thought Bubble.
So because of this aforementioned history of foreign exploitation, Haiti hasn’t been able
to sustain the agricultural and financial resources necessary to feed its population.
So, Haiti relies on aid from other, richer countries, like the U.S.
Today, over 80 percent of rice and nearly half of all the food consumed in Haiti is imported.
In an attempt to make this food affordable,
the countries exporting it often sell it below standard market price.
However, as a result, local Haitian farmers often can’t compete with the
price of this cheaper imported food, which can eventually put them out of business.
Suddenly, Haiti has even less home-grown food, and so is even more dependent on aid.
Meanwhile, the deeper challenges underlying Haiti’s widespread food insecurity persist,
like lack of jobs, poor education, and ineffective trade policies.
In fact, they might have even gotten worse, since the need for a self-sufficient food
system has declined, disguising the extent of those deeper problems.
This is why in 2010 the Haitian government called for an end to international food aid.
Instead of providing food aid, international institutions can
help to develop the infrastructure and workforce necessary for Haitians
to achieve sustainable long-term economic growth.
For example, the World Food Programme has done this by buying local foods from
Haitian farmers at market price to revitalize the agricultural sector and tackle food insecurity.
Thanks, Thought Bubble. So Haiti has a food problem.
But at a deeper level, it has a system problem,
because it’s struggling to escape the systemic injustices of its history.
Acts of global aid response must simultaneously balance short-term needs, like hunger,
with longer-term considerations, like becoming truly food independent.
When we think about global health,
there can be a tendency to think about it as something that happens somewhere else.
But this is flawed thinking for a few reasons. Like, as we saw in the COVID-19 pandemic,
an “over there” problem can very easily become a “right here” problem.
But there’s also another, deeper sense in which this mindset doesn’t quite hold up.
Across the world, there are health issues that we have proven to be pretty bad at
addressing no matter where we are or how much money we have.
This is the case with mental health. Using WHO data from 2005, researchers estimated
that mental health accounts for as much as 14 percent of the global burden of disease.
And yet, across the world, mental health care receives much less attention than other forms of health care.
In fact, an analysis of funding across 10 years found that health care development funds
dedicated to mental health accounted for just 0.3 percent of all global healthcare spending.
Another area in which we have collectively and consistently
dropped the global health ball is maternal health.
The WHO estimated that in 2017, over 800 women died every day from preventable causes related
to pregnancy, mainly due to a lack of quality care during pregnancy, and during and after childbirth.
And while as of 2019 ninety-four percent of these
deaths occurred in low income and low resource countries,
rich countries like the United States continue to see large variations in maternal health.
When it comes to addressing health at a worldwide level, we must look to global cooperation.
One way we have of doing this is with disease surveillance,
or the systematic process of gathering, analyzing,
and interpreting health data, and then making that data accessible to everyone.
It also means having compassionate, honest, and culturally sensitive conversations.
And it means following up on those conversations with actions to address
the root causes of poverty and injustice that lead to health inequities in disease
distribution and access to life saving resources like vaccines and medications.
As a species, we’re still figuring out what it means to share a planet
and share the responsibility for taking care of one another’s health.
The field of public health is constantly grappling with an important ethical question:
Who do we mean when we say “we”? Our neighborhood? Our country? The whole world?
When we start thinking about our health as a shared and global phenomenon,
we come a bit closer to finding the answer.
Thanks for watching this episode of Crash Course Public Health,
which was produced by Complexly in partnership with the American Public Health Association.
If you want to learn even more about Public Health, head over to APHA’s YouTube channel
to watch “That’s Public Health” a series created by APHA and Complexly.
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