Global Health 101
What is “Global Health”? A brief history of a big idea.
Global health is a big idea that has a relatively recent history. Having its roots in ‘public health’ and ‘international health’, the evolution of global health involves the continuing development of philosophies, attitudes and practice. It has become a somewhat ‘sexy’ term that has been employed for a variety of uses (and misuses). Here is the most widely accepted definition.
“Global health is an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasises transnational 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.”
Global health has justice and human rights as its foundation. It reminds us of the ambitious ‘health for all’ goal articulated at Alma Ata, and the declarations on human rights that include the right to health and the equality of all members of humanity.
Global health aims to highlight health issues that transcend nation states, their underlying determinants and their solutions. It provides a framework for understanding the health of populations in a global context, one that goes beyond the perspectives and concerns of individual countries.
Global health is a multidisciplinary arena, extending well beyond the traditional health care professions. Engineers, economists, develop practitioners, researchers, anthropologists, politicians, sociologists, logisticians, and many other professions, have an important role.
Global health is an exciting and challenging area to study, research and practice within. It is a privilege, and comes with great responsibility.
Ethical Considerations in Global Health
Global health really is an exciting field to be involved in and brings with it many privileges as we work and study alongside diverse people from communities around the globe. Cultivating an ‘ethical sensibility’ is not about taking the fun out of what we do, but about ensuring that above all we do no harm – to ourselves, to other individuals and to the communities within which we work. Embrace these principles and use them to take your experiences in global health to a whole new level!
1. Recognise that patients’ rights are universal
Patients’ rights are based on the concept of fundamental human rights – as articulated in the 1948 Declaration of Human Rights and enshrined in international law. The World Health Organization (WHO) has achieved international consensus on a minimum standard: “that all patients have a right to privacy, to the confidentiality of their medical information, to consent to or to refuse treatment, and to be informed about relevant risk to them of medical procedures”.
2. Put your host community’s interests first
Ultimately it is your hosts that invite you to practise in their community. It is they who should define your role, and it is essential that you ask a few key questions before you undertake professional activity: What are the community’s needs? Is there a gap that needs filling? Practising in this way will make your work abroad meaningful for both you and your hosts.
3. Give local trainees, practitioners and researchers priority
Health workers have a huge opportunity to use and develop their skills in a global health context, however this should never be at the expense of local trainees. For researchers, involve local staff in as much of the research as possible, giving them ownership over the process from planning to publication (and always cite their contributions appropriately).
4. Emphasise education
Frequently the biggest contribution that can be made by health workers is in leaving their skills behind. Make an effort to work with local staff to identify, and then fill, skills and information gaps. There should be an educational and capacity-building element to all of your professional activities.
5. Think long-term sustainability
Just as you will take new knowledge and skills home, there will be opportunities for you to have an impact on your host community beyond your departure. Think about ‘big picture’ issues (eg, prescribing choices, clinical decision-making, resource management, staff recruitment and training and data collection) and how, based on your Australian experience, you can empower local staff to create enduring structural change. Whatever your role, consider how you can promote local ownership and self-reliance.
6. Do not use the ‘developing world’ for practicing
The ‘developing world’ provides health workers with a unique opportunity to learn new and innovative ways of understanding health and illness and using their clinical skills. But this does not mean you should use your host community as ‘guinea pigs’ on which to hone your skills. If you wouldn’t do it back home, don’t do it in other communities.
7. Practise quality global health
Working in an under-resourced setting invariably means that you will have to work differently. For clinicians, the aim should always be to provide the highest standard of care to the greatest number of patients with the human, pharmaceutical and equipment resources available. For researchers, don’t compromise ethical standards and always be sure to cite the contribution of local researchers appropriately. Be creative in how you approach problems and use local colleagues to guide you towards the best decisions.
8. Know your limits
You should never expect to have all the answers and, for the safety of you, your local colleagues and the community, you need to know when you are reaching your limits – both personally and professionally.
9. Have a focus
The clearer your role is, the better you will be able to fulfil the needs and expectations of your host community. Define a job description before starting, and review and refine your responsibilities as your placement continues. It is easy to fall into the trap of doing ‘a little bit of everything’, but it is to everyone’s advantage that you focus on your strengths, and where the community need is greatest.
10. Consider the broader implications of your presence
The presence of a foreign health worker in a foreign community has implications – perhaps far beyond what you might expect. Cultural, social and educational differences all result in power imbalances and a degree of social disruption. Acknowledging this reality is the first step to pre-empting and identifying relevant issues. Remember: first do no harm.
- Kaplan J, Bond T, Merson m, et al. Consortium of Universities for Global Health. Towards a common definition of global health. Lancet 2009; 373: 1993-1995
- Crump J, Sugarman J and the Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg. 2010; 83:1178–1182.
- United Nations. The Universal Declaration on Human Rights
- World Health Organization. Patient Rights
- World Medical Association. Declaration on the Rights of the Patient
- World Medical Association. International Code of Medical Ethics
Why are you interested in Global Health?
Global health is a diverse field of practice. At this moment, there are doctors, nurses and allied health professionals providing humanitarian assistance in refugee camps, performing surgery in desert tents, consulting at remote village clinics, running immunisation campaigns with nomadic populations, as well as walking the corridors of large specialised urban hospitals. There are public health professionals and medical researchers around the globe reviewing epidemiological data in the wake of an emerging pandemic, revising protocols for pregnancy care in remote clinics, debating field data, investigating attitudes to HIV / AIDS, and submitting evident to governments to improve policy around the world.
A big attraction of global health is the opportunity to work in interesting international settings. But whilst this can be incredibly rewarding, unconsidered placements can be a disaster. By closely examining your own reasons for undertaking this, you will be in the best position to further explore the many options open to you (and make it a good experience for yourself and your host community).
Here are a few questions to ask yourself. You don’t need to have all the answers right away, but hopefully they will get you thinking – and make it easier to communicate what you want to mentors and potential employers.
- Why am I interested in working or volunteering in global health?
- Why am I thinking about this NOW?
- What type of work am I interested in?
- Where would I like to do this? Domestically or internationally?
- In what type of setting would I like to undertake this?
- Which organisation(s) would I like to work?
- What do I hope to achieve by undertaking this?
- How will it benefit me personally and professionally?
- What will the rewards and the challenges be?
- What knowledge and skills are required?
- What are the practicalities I must consider?
The importance of making efforts to understand, respect and learn from your hosts cannot be emphasized enough! When working abroad, relationship really is everything! Sadly, the experiences of host communities are too often neglected. The Global Health Gateway hopes that the information provided here resonates with the acknowledgement of host community needs, expectations and experiences. But we recognise that so much more could be said.