Global Health – emergence, hegemonic trends and biomedical reductionism

Abstract

Background: Global Health has increasingly gained international visibility and prominence. First and foremost, the spread of cross-border infectious disease arouses a great deal of media and public interest, just as it drives research priorities of faculty and academic programmes. At the same time, Global Health has become a major area of philanthropic action. Despite the importance it has acquired over the last two decades, the complex collective term "Global Health" still lacks a uniform use today.Objectives: The objective of this paper is to present the existing definitions of Global Health, and analyse their meaning and implications. The paper emphasises that the term "Global Health" goes beyond the territorial meaning of "global", connects local and global, and refers to an explicitly political concept. Global Health regards health as a rights-based, universal good; it takes into account social inequalities, power asymmetries, the uneven distribution of resources and governance challenges. Thus, it represents the necessary continuance of Public Health in the face of diverse and ubiquitous global challenges. A growing number of international players, however, focus on publicprivate partnerships and privatisation and tend to promote biomedical reductionism through predominantly technological solutions. Moreover, the predominant Global Health concept reflects the inherited hegemony of the Global North. It takes insufficient account of the global burden of disease, which is mainly characterised by noncommunicable conditions, and the underlying social determinants of health. Conclusions: Beyond resilience and epidemiological preparedness for preventing cross-border disease threats, Global Health must focus on the social, economic and political determinants of health. Biomedical and technocratic reductionism might be justified in times of acute health crises but entails the risk of selective access to health care. Consistent health-in-all policies are required for ensuring Health for All and sustainably reducing health inequalities within and among countries. Global Health must first and foremost pursue the enforcement of the universal right to health and contribute to overcoming global hegemony.

COVID-19: Besondere Herausforderungen an Public Health in Theorie und Praxis

“…Die vorrangige Bedeutung, die Entscheidungsträger biomedizinischen und biotechnologischen Lösungen und nicht den sozialen Determinanten von Gesundheit zuweisen, spiegelt sich in den beträchtlichen Geldsummen, die sie in die Entwicklung von COVID-19-Impfstoffen investieren [9], ebenso wider wie in der WHO-initiierten Megastudie zur beschleunigten Erforschung von Arzneimitteln gegen das neuartige Coronavirus [10]. Ein vergleichbarer Forschungsfonds zur Untersuchung der hochgradig relevanten Determinanten der Pandemie sind hingegen nicht in Sicht [11].…”

“…Bei der Corona-Bewältigung ist nicht so sehr vom Einfluss der Lebens-, Arbeits-, Bildungs-und Einkommensbedingungen auf die Gesundheit der Menschen die Rede, sondern vielmehr von den Effekten der Pandemie auf die Gesellschaft und vor allem auf die Wirtschaft. Entsprechend dient Gesundheitssicherheit heute offener denn je dem Schutz der Industrie vor den Folgen schlechter Gesundheit und weniger dem Schutz der Gesundheit der Menschen vor Infektionskrankheiten oder gar vor den schädlichen Auswirkungen des wirtschaftlichen Handelns [11]. Hier sind Theorie und die Praxis von Public Health gleichermaßen gefordert: Stärker als bisher muss es darum gehen, die Wechselbeziehungen zwischen politischen, ökonomischen, ökologischen und allen anderen gesellschaftlichen Determinanten und der Gesundheit der Bevölkerung herauszustellen und in der aktuellen Krisenbewältigung ebenso wie danach für eine Health-in-All-Politik zu kämpfen [32].…”

Global Health needs more than International Health Regulations – the case of Covid-19

“…Germany presents itself as a supporter of multilateralism and WHO reform [8]. To fulfill this role, Germany urgently needs to update and revise its global health policy [21], taking into account concerns about the present policy's narrow view of Global Health [22,23].…”

“…Health in All Policies thus inevitably extends to policies at global level. To take this argument further, the delimitation between Global health and public health that some authors uphold [23] seems increasingly artificial. In today's world, even with recurring nationalism, Global Health is public health, and vice versa.…”

Limitations in a rapid environmental scan of global health research expertise point to the need for more open data

“…This points to the need to develop and validate optimised search strategies and comprehensive catalogues for global health research, as has been done for other fields [ 5 ]. However, such an effort will be complicated by the lack of an operational definition of ‘global health’ and disagreement on what the field encompasses [ 6 , 7 ].…”