International and global public health

Introduction

Although public health is often carried out at the level of a local or national population (e.g. by the NHS and HPA in the UK), many issues are not confined to individual countries but affect populations throughout the world.

A summary of major current international public health problems follows, with links to further information.

Infectious diseases

Infectious diseases remain a major cause of mortality (death) and morbidity throughout the world. The majority of illness occurs in poorer nations. Many of the threats have been recognised for a long time, including malaria, tuberculosis (TB) and, in the last 20 years, HIV/Aids. Emerging infectious diseases, such as SARS in 2003, are also a concern; and international efforts have recently focused on managing the swine flu (H1N1) pandemic, as well as preventing spread of XDR-TB (extensively/extremely drug resistant TB).

Although a lot of research money has traditionally gone into the so-called 'big three' - HIV/Aids, TB and malaria - it has been argued that, in fact, larger health gains may be had by investing in treatments for diseases such as parasitic infections, and basic healthcare infrastructure.

Links

'Rapid-impact interventions': how a policy of integrated control for Africa's neglected tropical diseases could benefit the poor, Molyneux et al, PLoS [DOI] (PLoS, 2005)

Health systems financing: putting together the 'back office', Dare et al, BMJ [DOI] (BMJ, 2005)

Climate change & global warming

There is now general acceptance that the earth's atmosphere is warming. That this is partially or wholly due to human activity - principally the explosion in use of fossil fuels - is also gaining widespread support, and an ever-increasing evidence base.

Although there may be some small benefits associated with a slight rise in temperatures (for example, lower winter mortality in Europe), it is predicted that these will be outweighed by a slew of effects, from improved conditions for insect vectors to reproduce (e.g. causing an increase in malaria deaths), to huge numbers of people displaced by natural disasters and sea-level rises.

The challenge for global public health is firstly to try to slow down and, if possible, stop any further atmospheric change by promoting awareness of the issues (for example in transport policy) and, secondly, anticipate and plan for the predicted effects of climate change.

Links

WHO, Climate change and human health - risks and responses (WHO, 2003)
Climate change and health (WHO)
Stern review on the economics of climate change (HM Treasury, October 2006)Climate Change (Royal Society)
Intergovernmental panel on climate change (WMO)
Climate Care UK organisation promoting personal offsetting of carbon emissions

Committee on the science of climate change, Climate change science: an analysis of some key questions, National Academy Press (NAP, 2001)

Roberts, P. The End of Oil, Bloomsbury (2005) Very interesting and balanced book about how much oil is left in the world, when it may run out, and how a new energy economy (such as a hydrogen economy) may work. For more details see recommended books.

Poverty and famine

Clearly poverty underpins almost all aspects of health and contributes to all the other issues listed here. International public health policies should strive to reduce inequalities within and between societies in order to reduce morbidity and mortality. Poverty is a vastly complex issue with many causes and therefore remedies, including the reduction of corruption in society.

Insufficient food (famine), which again may be due to many factors (including climate, poverty, war and corruption), is also a major cause of ill health and the focus of many aid organisations.

Links

World Bank Specialist agency of the UN
Department for international development (DFID) UK Government department
Global Health Council US-based nonprofit organisation
Oxfam UK-based aid charity
VSO Voluntary Service Overseas, UK-based development charity
Disasters Emergency Committee (DEC) Alliance of UK aid charities

Access to potable water

Over two million people die from water-borne disease each year, almost all of these in the developing world. Everyone in the world should have access to potable (drinking) water and achieving this is a major public health aim.

Links

Water Aid Charity dedicated to providing safe water to communities throughout the world
Drinking water (WHO)
Health in your hands Public-private partnership to encourage handwashing to prevent diarrhoeal illnesses

Conflict and war

It may be a truism that war is harmful to human health, but quite apart from direct morbidity and mortality caused by conflict there are also problems associated with displacement of civilian populations from the conflict zone, and damage to basic infrastructure in the war zone (including basic communications, supplies, healthcare and water).

Many countries around the world now have contingency plans for acts of terrorism, including bioterrorism, the health effects of which fall under public health.

Links

International Committee of the Red Cross (ICRC) International aid charity
Medecins Sans Frontieres (MSF) International medical relief charity
Merlin International medical relief charity
Medact UK-based charity focusing on global health, including the politics of conflict
WHO - bioterrorism (WHO)
HPA emergency preparedness and response - deliberate release (HPA)
United Nations High Commissioner for Refugees (UNHCR)

Tobacco control

There is overwhelming evidence that tobacco causes severe morbidity and mortality (e.g. Doll, Peto et al, 2004, BMJ DOI: 10.1136/bmj.38142.554479.AE [?]). This evidence has been accumulating since 1950 but despite this tobacco use remains popular. Legislation restricting tobacco advertising and sponsorship, cigarette packet warnings and, more recently, restrictions on smoking in public places have started to have an impact on smoking rates in the developed world. However, cigarette manufacturers have, as a result, turned their attention to developing economies to try to maintain sales.

Reducing the prevalence of smoking remains a huge public health challenge, made more difficult by the determination of the tobacco companies to promote their product in emerging markets.

Links

Tobacco-free initiative (WHO) | Framework convention on tobacco control (WHO)
Action on Smoking and Health (UK) (ASH)

Gender inequality

Apart from unequal political representation by women in many countries, domestic violence, rape and forced marriage remain huge public health issues globally, often compounded by a lack of recognition of their seriousness and prevalence.

Links

WHO Department of gender, women and health (WHO)
WHO multi-country study on women's health and domestic violence against women (WHO, 2005)
Women's aid UK charity with a focus on domestic violence against women and children
Madre International women's rights charity

Lack of basic education

Basic primary-level education helps children to understand the concepts of health and society including families and relationships, and a sense of their own individuality and rights. This is extremely important in preventing and reducing gender inequality, unsafe sexual practices (and thus HIV/Aids), and helping limit family sizes. In many countries this basic education is not available at all, or is only open to some (e.g. only for boys).

Links

Basic education and gender equality (UNICEF)
Education for all (UNESCO)
Millenium Development Goals #2: achieve universal primary education (WHO)

Chronic disease

Chronic diseases which have become the main focus - and spend - of health systems in developed countries over the past few decades including heart disease, stroke, diabetes and cancer (and, more recently, obesity), are now becoming increasingly significant in poorer nations also.

Links

Department of chronic diseases and health promotion (WHO)
WHO, Preventing chronic diseases: a vital investment (WHO, 2005)
Obesity (WHO)
CancerMondial (IARC, a unit of WHO)

'Brain drain'

Many countries, particularly poorer nations, have a severe shortage of health professionals for a number of reasons. This is often exacerbated by the so-called 'brain drain' of individuals trained locally, but practising in richer nations.