Global Health - An incomplete Introduction
Austen Davis
Agenda
Session I (9:30 – 10:15)
A History of Ideas of Global Health Key Drivers of Global Health
What is Aid?
Q/A
---BREAK---
Session II (10.30 – 11:15) Development Aid 4 Health NCDs and Climate Change
A Bit of History
(The more things change the more they stay the same Alphonse Karr)❑
❑ 13th C Plague – killed about 1/3rd of population
❑ 19 th C Industrialization
❑ 19th C Colonization
❑ 1830 – 1847 european cholera epidemics
❑ 1918/1919 Spanish Flu (40 M)
❑ WWII
❑ 1980s HIV/AIDS
❑ 2014 Ebola
❑ COVID-19
• 14th C Concept of quarantine
• 1850s – Public Health
• 1890 – 1950 Tropical Medicine
• International Sanitary Convention (1892 – cholera, 1897 Plague)
• 1947 Formation of WHO
• 1951 Intl Sanitary Regulations
• 1950 – 2000 Intl. Health
• 2000 - 2017 Global Health
• 2005 International Health Regulations
• 2014 Global Health Security
From «US and THEM» to US
Quarantine Protection of the public from infectious diseases from outside Public Health (1) Decision making based on evidence
(2) A focus on populations over individuals (3) A goal of social justice and equity
(4) An emphasis on prevention rather than curative care (5) Multi-disciplinary action
Tropical Medicine
(1) A focus on diseases of the tropics
(2) Not addressing the social determinants of health of native populations (3) Individual focus
(4) Curative
International Health
(1) Focussed on the developing world – helping the poor
(2) Focussed on the health priorities of local inhabitants – MNCH nutrition, WASH + infectious and tropical diseases
(3) Prevention and Cure (4) Appropriate Technology Global Health (1) Transnational
(2) Collaborative implementation (3) Prevention and curative
(4) Seeks equity among nations (5) Highly inter-disciplinary
Global Health – a Definition
«A priority on improving health and achieving equity in health for all people worldwide.
Global health emphasises trans-national health issues, determinants and solutions: involves
many disciplines within and beyond the health sciences and promotes inter-disciplinary
collaboration; and is a synthesis of population-
based prevention with individual level clinical
care.»
Evolution of an Idea
Quarantine ISR Tropical
Medicine WHO International
Health/PHC Global
Health
1. POPULATION
Figure
Source: The Lancet 2014; 384:730-732(DOI:10.1016/S0140-6736(14)61331-3)
Terms and Conditions https://www.visualcapitalist.com/animation-global-population-by-region-1950-2100/
1. Population
– from NATO to
IPTO?
2. Technology
2. Technology
3. Urbanisation
4. Globalisation
Trade Capital Travel Data
5. Climate Change
The New Public
Health?
ODA: A Brief History of Aid
Era Aim
Colonial Development Act - 1929, £1 million focus - Infrastructure :- transport, electrical, water in colonies for the furtherance of imperial trade
The Colonial Development and Welfare Act - 1940 £5 million per year to the British West Indies for the purpose of long-term development + forgive 10M debt
The Colonial Development and Welfare Act - 1945. increased the level of aid to £120m (20yrs)
Further Acts followed in 1948, 1959 and 1963 dramatically increasing monetary assistance, favourable interest free loans and development assistance programs.
MODERN AID SYSTEM FROM WWII –1942 Declaration of the UNITED NATIONS
- 1944 Bretton Woods - IMF/IBRD (ICU and ITO failed)
the European Recovery Program, or Marshall Plan–1948 + NATO ties to the W. European states to contain the influence of the USSR (M.E. and Asia included)
Foreign Assistance Act of 1961 Establish USAID and protect ODA as an independent objective 1960s –Institutional development of ODA bureaucracies Major increase in aid from all western countries and USSR
- Cold War
1970s –3rd worldism and «Development» activism NGOs
1980s SAP WB and IMF –infrastructure and governance reform (anti-welfare)
1990s WAR Rwanda, Bosnia
2000 HIV + MDGs Targets
2015 SDGs –end of AID? Cooperation
Post WWII Atlantic
Charter
FOR ALL
COUNTRIES AND PEOPLES
IMPROVED LABOUR STANDARDS,
ECONOMIC ADVANCEMENT AND SOCIAL SECURITY
Official development assistance (ODA) is defined by the OECD Development Assistance Committee (DAC) as government aid that promotes and specifically targets the economic development and welfare of developing countries.
Trends in
ODA
Critiques of AID
“an excellent method for transferring money from poor people in rich countries to rich people in poor countries” (Peter Bauer).
Conditionality
Inappropriate technology
Project bias – not process oriented Unsustainable
Wrong accountabilities Corruption
Dependency Fungibility
Session II
Development Aid 4
Health
The MDGs and focus areas
Goal 1:
Eradicate Extreme Poverty and Hunger
Goal 2:
Achieve Universal Primary Education
Goal 3:
Promote Gender Equality and Empower Women
Goal 4:
Reduce Child Mortality
Goal 5:
Improve Maternal Health
Goal 6:
Combat HIV/AIDS, Malaria and other diseases
Goal 7:
Ensure Environmental Sustainability
Goal 8:
Develop a Global Partnership for Development
Significant progress but insufficient to meet MDGs 4 and 5
NEW INFECTIONS HALVED
SINCE PEAK OF EPIDEMIC
Trends in New HIV Infections, 1990-2012
0 0,2 0,4 0,6 0,8 1 1,2 1,4
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 North America Western & Central Europe
Sub-Saharan Africa
Critique of the MDGs
50% of health improvement resulting from actions outside of health
Equity
Domestic responsibility One size fits all
Systems and sustainability
The SDGs
Health and Welfare Economic Development
Climate and Environment
Global
Governance
Goal 1. End poverty
Goal 2. End hunger, (food security, improved nutrition, and sust. Ag.)
Goal 3. Ensure healthy lives (+well-being all)
Goal 4. Ensure quality education (+ opp)
Goal 5. Achieve gender equality
Goal 6. Ensure water and sanitation
Goal 7. Ensure access to sustainable, energy for all
Goal 8. Promote sustainable economic growth,
(employment and decent work)
Goal 9. Build resilient infrastructure
(industrialization and innovation)
Goal 10. Reduce inequality within and among countries Goal 11. Make cities safe and sustainable
Goal 12. Ensure sustainable consumption and
production patterns
Goal 13. Combat climate change and its impacts*.
Goal 14. Conserve the oceans, seas and marine resources
Goal 15. Sustainable use of terrestrial ecosystems,
(forests, desertification, land degradation and halt
biodiversity loss)
Goal 16. Promote
peace, provide access to justice for all and build effective, accountable and inclusive institutions Goal 17. Strengthen global partnership for sustainable
development
MDGs -> SDGs
Mortality Goals Service Coverage Risk Factor Reduction
• Reduction of under 5 mortality
• Reduction of Maternal Mortality
• Reduction of Mortality from HIV, TB, Malaria
• Reduction of Morbidity from Hepatitis–water born disease and other infectious diseases
• Reduction of Deaths from Traffic Accidents
• Reduction of Deaths from NCDs (<70 yrs age)
• Skilled Birth Attendance
• Access to voluntary use of modern contraceptives
• Universal Health Coverage
= Basic package of health services + Financial
protection from catastrophic health expenditure
• Tobacco
• Alcohol
• Drugs
• Traffic
• Pollution and Waste (air, water, soil)
The Cube - UHC
Aid Fungibility 28
Developed Developing? Vs
Life Expectancy Vs Income Gapminder Tools New Research indicates 77% of global poverty could be addressed through better distribution of national resources. Regressive fuel subidies alone cover 70% of all global poverty
Poverty – How Many and Where Are they? 2020 Year in Review: The impact of COVID-19 in 12 charts (worldbank.org)
Aid Financing Context has Changed Dramatically
30
0 10 20 30 40 50 60 70
1994 2015
Number of LICs
Chatham House – Fair Finance
How Much
do Governments
Spend on the
Health of their
People?
The Emerging Challenge of Non-
Communiable
Diseases
Modern Pandemics
OUTBREAK Dates Est. No. Deaths Presumed Host
Spanish Flu 1918-1920 100 million Domestic pigs (USA)
Asian Bird Flu 1957-1958 1 million Domestic Poultry
(Asia) Tuberculosis
(King’s Evil) >9000 years
old 1,5 million per year Domestic Cattle ?
HIV 1980s - Now >35 million Wild Primates (West
Africa)
H1N1 Swine flu 2009-2010 150,000 – 600,000 Domestic Pigs (Mexico)
SARS 2002-2003 800 Palm Civet? (China)
MERS 2012 - Now 860 Camels? (Saudi
Arabia) EBOLA 2014-2016 11,500 (many smaller outbreaks
since origin in 1970s) Wild Bats (Sudan)
Zika 2015-Now ? Latin America
Covid-19 2019 - Now 2,975,000 and counting Wild Bats (China)
Epidemics
have been with humanity essentially since the rise of agriculture and international trade (for example the black death). They result from :-
1. Increased contact with animals,
2. Increased population density
3. Increased migration/trade/contact between populations.
4. Destruction of Natural environments and Climate stress
The covid-19 pandemic was expected – more will follow. We do not know what pathogen, or from which animal or which region – but it is a STATISTICAL INEVITABILITY.
Qualitative Surveys: Outreach and Outpatient Most Hit
UNICEF, S.E. Impact Survey (N=77)
3 15
16 14 3
15 16 2
13 11 5 2
4 5 1
2
31 19 16 14 21
9 10 11
4 6 8 3
4 5 5
5 4
4 7 6 7 8 5
4 8
3 1 2 8
7 5 6 3 2
8 5 6 5 3 2
1 6 3 2 1 3
5 3 2 4 5 2 1 3
1 1 1 1 1
68%
68%
63%
59%
52%
44%
44%
38%
30%
26%
23%
22%
21%
21%
17%
13%
8%
0 10 20 30 40 50 60
Wellness checks for children and/or adults…
Immunization Antenatal check-ups Post-natal care Family planning (sexual and reproductive…
Obstetric care Essential newborn care Other health-related community services
NCD treatment services (e.g. dialysis,…
Clinical care for GBV victims Emergency obstetric care services Support for Mental, Psychosocial, Addiction…
Other emergency care HIV treatment Malaria treatment or ITN distribution TB treatment Water, sanitation and hygiene services in…
< 10% drop 10-25% drop 25-50% drop 50-75% drop 75-100% drop Immunization
Antenatal Care Postnatal care
Number of Countries reporting (N= 77 Countries)
Covid Economy
The Global Race to Vaccinate
Norway and UK block consensus in OECD on
reporting COVID19 vaccine research grants as aid
News January 26, 2021 / By: Ann Danaiya Usher
As vaccine inequality grows, donors continue to argue over how much of their funding for COVID19 vaccine research via the epidemic response agency CEPI can be financed from their aid budgets. The OECD says only about half of these grants can be reported as aid since vaccines also benefit rich countries. Norway and the United Kingdom want to report more as aid, and are blocking consensus on the issue.
The G20 establishes a High Level Independent Panel on financing the Global Commons
for Pandemic Preparedness and Response
Yesterday, Tuesday 26 January, G20 Members agreed to establish aHigh Level Independent Panel (HLIP) on financing the global commons for pandemic preparedness and response. The decision was taken by the membership at the first G20 Finance and Central Bank Deputies meetings.
Whose Interest
Domestic Poverty Transfer
Climate
GPGs Poverty
GDP Shrinks
Allocation Shrinks
Evolution of an Idea
ISR
Tropical Medicine
International Health Global
Health Quarantine
New Trends
Relative importance of Poverty Demographic transition
Epidemiological Transition Health System Change (UHC) Climate Change
AMR
Pandemics
Other Global Public Goods
