The research community and pharmaceutical industry have made many life-saving and life-improving advances in global health over the past 20 years, and that’s certainly life-affirming news.
But the time has come to ask ourselves a very pointed, and perhaps uncomfortable, question: “Are we defining ‘global health’ the right way?”
And, more specifically, “How do we define each of these two words when they are used together as ‘global health?’” I believe, under its commonly used definition, that this is one example where the combination is not greater than the sum of the parts.
From my perspective, “global” health means “global” in the truest sense—the entire world’s health, the health of people in both developed and developing nations; and “health” means addressing whatever disease or medical condition afflicts the world’s population.
This is actually much more than mere semantics.
In terms of time, attention and funding, it seems that we’ve labeled infectious diseases as developing world maladies, while chronic diseases (like heart attacks, strokes or diabetes) and mental health issues have been characterized as developed world illnesses. This division of diseases has become the source of growing discussion, as it should. I believe, however, that we must also have an honest conversation about the geographic limitations that have been imposed on the term “global” when we’re talking about “global health.”
It’s incorrect, and does a disservice to many researchers and a vast patient population, to restrict the definition of “global health” to diseases largely affecting people within developing countries. But, sadly, it’s now commonplace when we’re discussing global health to focus on the development of vaccines, drugs, and diagnostics that help people in developing countries address infectious diseases.
If we view the planet in apolitical terms, it’s clear that our world today has, effectively, become borderless; and, as a result, disease travels freely and indiscriminately from one nation to another, regardless of Gross Domestic Product or standard of living.
“We live in a world where human populations are increasingly interconnected with one another and with animals—both wildlife and livestock—that host novel pathogens,” says Katherine Smith, Assistant Professor of Ecology and Evolutionary Biology at Brown University and the co-lead author of a recent database study of more than 12,000 disease outbreaks affecting 44 million people worldwide over the last 33 years. “These connections create opportunities for pathogens to switch hosts, cross borders, and evolve new strains that are stronger than what we have seen in the past.”
The Global Health Technologies Coalition (GHTC) echoes this view in its 2015 Policy Report “No matter how geographically distant a threat may seem, a threat to some is a threat to all,” says the analysis. “Even infectious diseases thought to be readily containable can have devastating regional and international impact if we do not have the necessary tools or systems in place.”
Without question, we’ve seen the powerful and profound risk that infectious diseases like Ebola, Swine Flu or Avian Flu have posed to people and health systems in recent years within both the poorest and richest countries—as well as all the nations in between.
This is a skewed and short-sighted medical map that we’re drawing.
Tuberculosis (TB) is a good case study that illustrates this point.
According to the World Health Organization, TB could drain $1 trillion-$3 trillion from the poorest countries on the planet over the next decade.
But TB isn’t constrained by national boundaries; as the theme for past observances of World TB Day states, “tuberculosis anywhere is tuberculosis everywhere.”
In recent years, for example, there have been significant outbreaks of TB in Europe and the United States. London is arguably the TB center of Europe. And a number of U.S. cities—including Los Angeles, Seattle, and Indianapolis—have had to address worrisome TB anxieties.
It’s true that TB incidence in the United States has been declining, but this decrease has been punctuated by TB diagnoses among foreign-born U.S. residents—and there were still nearly 10,000 cases of TB in the U.S. during 2013. Recently, in Brooklyn, NY, an outbreak of tuberculosis appeared to center on young adults born in China. Fortunately, all have drug-susceptible pulmonary TB, so they responded to the available drugs. Europe’s TB incidence is worth noting here as well. In 2012, it was 13.5 per 100,000, versus 3.2 per 100,000 in the U.S.
Of equal concern is the outbreak of the chikungunya virus, a mosquito-borne disease that causes high fever and debilitating joint pain.
By the end of February 2015, there were 1.24 million cases of chikungunya in the Americas. In the United States, there have been a cumulative total of about 2,500 cases of chikungunya since 2013. Most of the U.S. cases come from epidemics raging elsewhere. But the U.S. numbers might be an under-estimate, because, until this year, the virus was not a nationally notifiable disease. I anticipate that there will be a dramatic and well-reported increase in the number of chikungunya cases suffered in the U.S. over the next couple years—particularly from Florida up through the Eastern Seaboard.
Leprosy—a cruel disease that leaves its victims maimed, crippled, disfigured and blind, often with terrible quality of life—is worth citing here as well.
The severity of this infection is reflected all over the globe—in the Philippines, Ethiopia, Brazil and India, for example. And there are approximately 250,000 new leprosy cases worldwide each year. Nearly 100 of these cases are reported annually in the United States, with the bulk of the illness in the South, according to the Centers for Disease Control.
Researchers and health officials believe that armadillos may be the source of leprosy in the United States, but people in the U.S. are getting leprosy where there are no armadillos, so we really don’t know how it’s entering our country—but it’s clearly among us in the U.S., and the full extent of the impending pain and suffering are unknown at this time.
Unfortunately, we’re not zeroing in on this potential domestic health care problem—or other problems like it—because, too often, we assume that diseases like TB, chikungunya or leprosy are “global” dangers, only affecting poor people in developing countries, rather than threats to the U.S.
We also can’t ignore the fact that, while these diseases threaten human health, they also take a massive toll on animal health. This imperils our food supply and causes an economic burden on farmers. In Minnesota, the nation’s largest turkey-producing state, for example, Avian Flu has reached a crisis level for turkey farmers. Fearing the worst, Minnesota has already spent $7 million trying to prevent the spread of disease. Meanwhile, Iowa, the nation’s largest producer of eggs, has declared a state of emergency following a major outbreak of Avian Flu.
We should know better after the Ebola virus outbreak. And we shouldn’t forget the speed with which that disease traveled around the world and into the U.S. That’s why we have to keep investing in the research and tools that will help us detect, treat and prevent the possibility of future epidemics from unfolding right here in our own country.
“Global” health is our health, too.