Is it too early to talk of global health?

Global ill-health can render even health-secure nations vulnerable in a seamless world. An insight by Bharathi Ghanashyam, Founder & Editor, Journalists against TB

Two major international health conferences were held in the past few months where some of the best brains from across the world converged to share the latest research and significant achievements in the healthcare sector. In these conferences, global health also came up for discussion. It was exciting to be part of the discussions as it held out hope that ‘health for all’ across the world, might soon become a reality.

Ironically, at the same time, in Jharkhand, in India, there were reports of people dying of hunger because their Aadhaar Cards were not linked to their ration cards. This meant they did not get their monthly quota of subsidised food-grains from the public distribution system (PDS). To state the obvious, food is a vital and indeed the most basic requisite for health. Juxtaposed against the discussions on global health, the hunger deaths were stark reminders of how far we are from achieving global health, and how many obstacles were yet to be overcome. That there are still people in the world who are denied access to a very basic resource such as food highlighted the inequities that can render any discussions on global health empty rhetoric. But let’s begin at the beginning.

Equity and otherwise

The most commonly accepted definition of global health is the “…health of populations in the global context; it has been defined as “the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide…” – Koplan JP, Bond TC, Merson MH, et al. (June 2009).

Definitions notwithstanding, in place of equity in health, we have two realities – one for the developed and another for the developing world. It begins with birth, continues into life and living, and ends with death. In place of health for all, what we have is actually a patchy, uneven and even unjust palette.

We begin with equity which we cannot take credit for; it is the order of the Universe – every living being – plant, animal or human, goes through the cycle of birth, life and death. The inequities begin after that. Developed countries, having achieved health for all are finding ways to conquer diseases like cancer, or finding ways to enable better quality of lives for ageing populations because they are living longer. Developing nations are still struggling to gain victory over vector borne and water borne diseases, and other basic issues such as safe drinking water and food for all.

Through the life cycle

It begins with birth – there are countries in the world where it is possible for every woman, regardless of whether she is living with diabetes, hypertension, HIV or cancer, can dream of safe motherhood because the medical system guarantees them access to the best healthcare. In others, even otherwise healthy women often don’t survive childbirth simply because they did not have access to quality care. The world is a safe place for babies born in the developed world, and an obstacle-ridden place for babies in developing countries, where they have to defy great odds to live beyond their fifth year.

Life for those in developing countries is a struggle all the way. Shelter, assured livelihoods, adequate nutrition and primary healthcare, which constitute the requisites for a healthy and productive life are a dream for large sections of developing countries. Little wonder than that end of life too is fraught with inequity.

Pessimism or hard talk?

This piece might be painting a grim picture, but it is important to recognise that while global health is a good goal to aspire to, it is difficult to achieve. It takes a lot more than coming together to discuss it.

Why does this situation exist? Why do some countries make such good progress while other leave large sections of their people behind? Is it size? Is it huge populations belonging to hugely varying economic strata? If yes, then it confounds because theories abound about the ease of working to scale. Why is that not applicable to health?

In a somewhat conceptual, even philosophical article such as this, it might be out of place to talk figures and data. But the answers might just lie in allocation of resources, percentage of GDP and political will. Inequities exist here too – while there are countries which invest as much as 11 per cent of GDP or more on health, there are countries which spend as little as 2 per cent, and grudgingly at that. Little wonder then that global health is proving hard to achieve.

What mechanisms do we have in place to change the situation?

It is yet another anomaly that for an issue as vital as health, we have soft options to bring the world together. With an issue that concerns the well-being of millions of people we only have declarations, pledges, commitments etc. etc. There are absolutely no actions that can put errant nations on the carpet. By the same yardstick, we show collective paranoia while policing nations that supposedly (or in reality), build or stock nuclear weapons. We impose sanctions and isolate these nations to keep them in check, when in reality it is not nuclear war but disease that will kill more people.

In conclusion, global ‘ill-health’ is a bigger worry than the lack of global health. Because global ill-health can render even health-secure nations vulnerable in a seamless world. TB is a classic example. The refugee situations across the world, people travelling across borders on business and holidays provide an ideal situation for the disease to spread. No country is really safe in this context and it is only ‘global health’ in the real sense than can help. The cost of not getting tough on health is too high. So the discussions that have begun are relevant and timely. They need to be amplified and converted to action.