International Public health
Introduction
What is global health?
• Health problems and issues that transcend national boundaries and may be best
addressed by cooperative actions
• Focused on improving the health of the entire population
• Issues that extend beyond national borders
• Specific attention to social justice
• Much attention to low- and middle-income countries where morbidity and mortality are
high and health system functions are fragile
• Focused on delivering health services that are: accessible, affordable, appropriate,
acceptable and with good quality
• Considers the social, political, and economic forces that increases the risk of poor health
outcomes (structural violence)
• Acknowledges the cultural differences that lead to varying health outcomes
• An interdisciplinary approach to understanding health outcomes
• Considers the role of international NGOs, private philanthropists, and community-based
organizations
History of Public/Global Health
1750 - 1850
Industrial Revolution – bad working conditions and environmental pollution
Urbanization – unhygienic living conditions in cities
Epidemics – Cholera, smallpox, TB and other infectious diseases that resulted in high
infant mortality
Improvement of water supply, sanitation & sewerage
Start of formal public health policy
,1850 - 1900
First international meeting on public health problems in 1851 - start international
cooperation
Substantial increase in knowledge about infectious diseases, including cause and
transmission
Insight into possible intervention strategies
Start targeted intervention programs
1900 - 1945
Substantial decrease in (child) mortality
Antibiotics and medications
Start of academic training in health sciences
First international organization: Health Organization of the League of Nations in
Geneva,1920
Creation of charity organizations, such as Rockefeller Foundation
1945 - 1980
Establishment of UN, with WHO and UNICEF as public mandate
Intervention strategies targeting:
o Family-planning
o Infectious diseases
EPI (Expanded Program on Immunization) initiated in 1974
Smallpox eradicated (1966-1980)
PHC (Primary Health Care) strategy - Alma Ata Conference 1978
Research programs on emerging diseases
1980 - 1990
UN organizations The World Bank and IMF become important
Economic crisis leads to health reforms
Increasing role of NGOs in providing health services
Focus on non-communicable diseases
UNICEF's campaign for child survival (GOBI FFF):
o Included interventions for: Growth monitoring, Oral rehydration, Breastfeeding,
Immunization
o Then added: sexual health (female) education, Family spacing, Food supplements
HIV/AIDS epidemic and establishment UNAIDS
1990 - now
Focus on cost effectiveness
PPP (public-private partnership)
Attention to CBPR (Community-Based Participatory Research)
More attention to other health issues: Chronic diseases, gun violence, injuries, neglected
tropical diseases and more
,Sustainable Development Goals
• Sustainable Development Goals
were developed and supported
by governments and the
international community
• The goals apply equally to all
countries
• The goal is to reduce health
inequalities through processes,
policies and programmes
Critical Global Health
• Determinants of health
• Global burden of disease
• Measurement of health status
• Importance of culture
• Demographic and epidemiologic transitions
• Organization and function of health systems
• Health equity and social justice
, Lecture 2: Social determinants of health
Determinants of Health
• Physical environment
• Medical care
• Genetics and biology
• Social circumstances
• Individual behavior
Reflections from Dahlgren and Whitehead (2021):
“The rainbow model appears to broaden horizons – encouraging people to think beyond
health services and the health sector to the wider social determinants of health in local
environments and society as a whole.”
“The model has proved useful in getting people in different sectors to work together on a
common goal. It seems to give each sector an ownership.”
“Holistic view of the main determinants of health.”
“It is quite easy to understand, compared with other models with many boxes and
arrows going in different directions.”
Social Determinants of Health (SDH)
• The social determinants of health are the conditions in which people are born, grow, live,
work and age
• These circumstances are shaped by the distribution of money, power and resources at
global, national and local levels
Social gradient
a term used to describe the phenomenon whereby people who are less advantaged in terms
of socioeconomic position have worse health (and shorter lives) than those who are more
advantaged
Health equity (WHO definition)
Equity is the absence of unfair, avoidable or remediable differences among groups of people,
whether those groups are defined socially, economically, demographically, or geographically
or by other dimensions of inequality (e.g. sex, gender, ethnicity, disability, or sexual
orientation). Health is a fundamental human right. Health equity is achieved when everyone
can attain their full potential for health and well-being.
Introduction
What is global health?
• Health problems and issues that transcend national boundaries and may be best
addressed by cooperative actions
• Focused on improving the health of the entire population
• Issues that extend beyond national borders
• Specific attention to social justice
• Much attention to low- and middle-income countries where morbidity and mortality are
high and health system functions are fragile
• Focused on delivering health services that are: accessible, affordable, appropriate,
acceptable and with good quality
• Considers the social, political, and economic forces that increases the risk of poor health
outcomes (structural violence)
• Acknowledges the cultural differences that lead to varying health outcomes
• An interdisciplinary approach to understanding health outcomes
• Considers the role of international NGOs, private philanthropists, and community-based
organizations
History of Public/Global Health
1750 - 1850
Industrial Revolution – bad working conditions and environmental pollution
Urbanization – unhygienic living conditions in cities
Epidemics – Cholera, smallpox, TB and other infectious diseases that resulted in high
infant mortality
Improvement of water supply, sanitation & sewerage
Start of formal public health policy
,1850 - 1900
First international meeting on public health problems in 1851 - start international
cooperation
Substantial increase in knowledge about infectious diseases, including cause and
transmission
Insight into possible intervention strategies
Start targeted intervention programs
1900 - 1945
Substantial decrease in (child) mortality
Antibiotics and medications
Start of academic training in health sciences
First international organization: Health Organization of the League of Nations in
Geneva,1920
Creation of charity organizations, such as Rockefeller Foundation
1945 - 1980
Establishment of UN, with WHO and UNICEF as public mandate
Intervention strategies targeting:
o Family-planning
o Infectious diseases
EPI (Expanded Program on Immunization) initiated in 1974
Smallpox eradicated (1966-1980)
PHC (Primary Health Care) strategy - Alma Ata Conference 1978
Research programs on emerging diseases
1980 - 1990
UN organizations The World Bank and IMF become important
Economic crisis leads to health reforms
Increasing role of NGOs in providing health services
Focus on non-communicable diseases
UNICEF's campaign for child survival (GOBI FFF):
o Included interventions for: Growth monitoring, Oral rehydration, Breastfeeding,
Immunization
o Then added: sexual health (female) education, Family spacing, Food supplements
HIV/AIDS epidemic and establishment UNAIDS
1990 - now
Focus on cost effectiveness
PPP (public-private partnership)
Attention to CBPR (Community-Based Participatory Research)
More attention to other health issues: Chronic diseases, gun violence, injuries, neglected
tropical diseases and more
,Sustainable Development Goals
• Sustainable Development Goals
were developed and supported
by governments and the
international community
• The goals apply equally to all
countries
• The goal is to reduce health
inequalities through processes,
policies and programmes
Critical Global Health
• Determinants of health
• Global burden of disease
• Measurement of health status
• Importance of culture
• Demographic and epidemiologic transitions
• Organization and function of health systems
• Health equity and social justice
, Lecture 2: Social determinants of health
Determinants of Health
• Physical environment
• Medical care
• Genetics and biology
• Social circumstances
• Individual behavior
Reflections from Dahlgren and Whitehead (2021):
“The rainbow model appears to broaden horizons – encouraging people to think beyond
health services and the health sector to the wider social determinants of health in local
environments and society as a whole.”
“The model has proved useful in getting people in different sectors to work together on a
common goal. It seems to give each sector an ownership.”
“Holistic view of the main determinants of health.”
“It is quite easy to understand, compared with other models with many boxes and
arrows going in different directions.”
Social Determinants of Health (SDH)
• The social determinants of health are the conditions in which people are born, grow, live,
work and age
• These circumstances are shaped by the distribution of money, power and resources at
global, national and local levels
Social gradient
a term used to describe the phenomenon whereby people who are less advantaged in terms
of socioeconomic position have worse health (and shorter lives) than those who are more
advantaged
Health equity (WHO definition)
Equity is the absence of unfair, avoidable or remediable differences among groups of people,
whether those groups are defined socially, economically, demographically, or geographically
or by other dimensions of inequality (e.g. sex, gender, ethnicity, disability, or sexual
orientation). Health is a fundamental human right. Health equity is achieved when everyone
can attain their full potential for health and well-being.
