Dr. Amjad Idries

Global & International Health

International Health

Definition• Also referred to as Global Health.

• Is a field of health care, usually with a public health emphasis, dealing with health across regional or national boundaries.

Intergovernmental Health

• Refers to the relationships between the

governments of self-governing nations, with

regard to the policies and practices of public

health.

History• United Nations in 1945 call to create

specialized body to govern the international health situation.

• This was a response for big and disastrous epidemics at that time, e.g. Cholera in Egypt.

• The primary focus at that time was to eradicate or contain this epidemics.

• 1948 the World Health Organizations was established.

“WHO” Role• It is a coordinator, strategic planner, and

leader of global health initiatives as a strategy

of survival in response to transformed international political context.

• Formulation, promotion and facilitation of public health policies and strategies implementation.

Decision Making Mechanisms• The General Assembly of the UN.

• World Health Assembly.

• Information and Surveillance Systems (technical bodies).

World Health Assembly• The governing body, meets once a year to approve

the budget and decide on major matters of health policy.

• All the 190 or so member nations send delegations.

• The World Health Assembly elects 31 member nations to designate health experts for the Executive Board.

• This board meets twice a year and serves as the link between the Assembly and the Secretariat, which carries on the day-to-day work of the WHO.

International Initiatives• International Health Regulations (2005)

• Eradication of Polio Campaign

• Accelerated Child Survival Initiative

• Stop TB Partnership.

• Roll Back Malaria

• 3 by 5 Initiative

• Global Fund

The International Health Regulations (IHR) are an international legal instrument that is binding on 194 countries across the globe, including all the Member States of WHO.

Their aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide.

• The IHR, which entered into force on 15 June 2007, require countries to report certain disease outbreaks and public health events to WHO.

• Building on the unique experience of WHO in global disease surveillance, alert and response, the IHR define the rights and obligations of countries to report public health events, and establish a number of procedures that WHO must follow in its work to uphold global public health security.

What is changing now?

• International health governance as it exists today is facing major structural challenges in view of globalization, the increased transfer of international health risks and the mounting challenge of health inequalities worldwide.

• As a consequence the capacity of nation states to ensure population health and to address major health determinants has been weakened.

Globalization• It is a set of global processes that are changing

the nature of human interaction across a wide

range of social spheres including the

economical, cultural and environmental.

The impact of Globalization on Health1. The impact of globalization on food2. Non Communicable Diseases3. Globalization on emerging infection diseases4. Introduction to the global economy and

health financing5. The world trade organization and public

health6. Global environmental changes/climate

change

Why ?• The term international/global health

comprises consideration of population health in a global context and above the concerns or perspectives of particular nations.

• Including the rise in importance of actors beyond governmental or intergovernmental organizations and agencies.

Global Health

Non Communicable Diseases

• Cultural globalization and its effect on life styles.

• Obesity epidemic associated with:– Intensive marketing;– Lower production cost and overuse of oil-sugar-salt

(associated with low physical activities)– Fast food industry linked to affordability and

accessibility issues– Regulation of the market (regulating the

advertisement)– Health promotion activities

While food production increased the numbers

of hungry people also increased,………

this due to inequalities regarding the

distribution of income and that linked to the

ability to get food, liberalization of the markets

combined with other factors related to this.

• The effect of globalization on (1) food supply chain

system, (2) the consumerism culture and (3) the

need for certain kind of foods.

• This is related to food industries and its role in

shaping the current market and the urbanization

of food imports.

• Despite that the supply chain is saturated and in order to increase profit, it start to focus not on the raw materials of food but rather on the processed foods, replacement of the organic materials into this processed food.

• Food is available but its nutritional value is questionable and its consumption rather may lead to considerable health risks.

Globalization on Emerging Infectious Diseases

• Trans-boarders movement and trade and the tendency to protect it.

• Quarantine and bilateral relations in big epidemics.

• Role of IHR 2005 & its benefits and problems.

• The importance of surveillance systems and its link to capacity of developing countries to detect.

• The role of environmental changes is directly linked to this combined with the ability to massive movement within and b/w countries.

• Global response like the global surveillance networks and linkage b/w the local-regional-global efforts.

• Management of outbreaks at different levels, the consequences (economic and social even political).

• This aspect changed the way how the global health is managed and governed.

Relations b/w Global Economy and Health Financing

HealthEconomyHealthEconomy

• Crossing of boarders (internationalization): between countries, complexity of the systems, related to goods-services-capital-labor.

• Opening of boarders (liberalization): changes in policies, multilateral agreements, development of WB & IMF & WTO, related to trade liberalization.

• Transcendence of boarders (globalization): flow of things, transcendence of boarders, space & geography.

World Trade Organization and Public Health

• Role of WTO history and current, multilateral and bilateral agreements.

• It is key structure in which the negotiations on trade agreements were proposed, drafted, formulated and approved, on cross borders as well as oversees trade.

• Balance b/w reserving the rights of the industry and protecting the public health is challenging

Global Environmental Changes and Climate Change

• Examples:

global climatic changes

desertification

changes in food-producing ecosystem

urbanization

All are human induced changes

Several ways in which these changes happened:

1. long-distance and rapid trade induce the redistribution of some species of animals and insects that which affect the environment.

2. Increase in food production associated with increased use of energy and nitrogenous fertilizers, this lead to some changes in the nitrogen cycle and altering the constitution of the soil.

Several ways in which these changes happened:

3. Westernization of diet together with increased urbanization that increase the demand for certain food types (e.g. meat) which associated usually with, and need, more resources to be produced.

4. The need for foreign currencies lead to adopt strategies to produce cash flow crops that over-valuing these products over local and traditional one altering the food habits and nutrition.