Holly Dygert, a lecturer in the Northeastern University College of Professional Studies, describes the challenges she sees facing global health.
This is an exciting time in the field of global health. In the final years of the last century, the rise of social movements demanding recognition of health as a basic human right; emerging philanthropic bodies, such as the Bill and Melinda Gates Foundation; and new collaborative projects and public-private partnerships brought goals that were widely assumed to be unattainable within reach.
For example, antiretroviral therapies were made accessible across the global south, transforming HIV/AIDS into a manageable disease, while preventative measures reduced the rate of new infections dramatically. The Millennium Project—a collaborative project among world leaders to combat poverty in all of its manifestations—helped galvanize efforts in pursuit of these outcomes. According to the 2015 Millennium Development Goals Report, the initiative also contributed to marked improvements in nutrition and reductions in rates of malaria and child and maternal mortality.
These and other achievements have expanded the sense of possibilities in the field, which is promising, because much work still needs to be done.
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Changing patterns of disease and transformations in the field of global health practice have created new challenges for contemporary global health practitioners. Here are some of the most pressing global health problems we face today:
Building Public Health Systems
While, in recent years, the global community has achieved marked successes in areas designated as high-priority, such as HIV/AIDS and malaria, others areas have remained neglected. This has produced stark inequalities in care.
For example, in many communities across the global south, those suffering from HIV/AIDS can now access state-of-the-art care, while those suffering from cancer lack access to the most basic services. These dynamics reflect the limitations of top-down interventions, in which planners often use global indicators of disease prevalence and cost-benefit analyses to set priorities.
By contrast, rights-based approaches to global health adopt a patient perspective, which considers the range of forces that shape health and disease. The nonprofit organization Partners in Health, for example, developed a particularly successful holistic, rights-based approach to global health in Haiti, and then used the lessons learned from that project to develop a similar initiative in Rwanda.
The challenge: One of the most pressing challenges today is to invest in patient-centered public health systems that can respond to the range of forces that shape patterns of health and illness.
Coordinating Global Health Initiatives
Today’s disjunctive landscapes of care have emerged as new philanthropic entities and public-private partnerships (PPPs) have taken on an increasingly significant role in global health. The private sector has been celebrated not just for investing massive amounts of funding in the field, but also for contributing entrepreneurial logics. Here, flexibility—particularly in terms of freedom from bureaucratic rules and regulations—is seen as the basis for maximizing efficiency. In the field of global health, however, this flexibility has often come at the cost of effective coordination, contributing to the redundancies and areas of neglect discussed above.
The challenge: In order to address this problem, we need innovative mechanisms to facilitate the coordination of this increasingly diverse field.
Beyond Aid: Facilitating Participation
While human rights-based perspectives on health privilege the patient perspective, in practice, targeted populations are often far removed from the conversations through which health priorities are set and strategies to achieve them are designed. Ultimately, this distancing limits the effectiveness of interventions.
The challenge: We need to create innovative governing structures that link the range of contemporary global health practitioners to state and local stakeholders.
Prioritizing the Needs of the Most Marginalized
As in the field of health, the global community has experienced significant achievements in combatting poverty over the last decade. The needs of the most marginalized populations, however, have remained neglected. As a result, declining poverty rates have been accompanied by widening inequalities.
The challenge: In the years to come, we will increasingly need to prioritize the health needs of the most marginalized populations, and to devise innovative initiatives to work with these populations to improve their health outcomes.