15 Terms to Know in Global Health
In an expanded version of the definition, the Institute of Medicine of the National Academies (IOM) defines global health as "health problems, issues and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions."
Globalization is creating an increasingly connected world, making it more important for public health practitioners to better understand global health. As the Healthy People 2020 initiative notes, the health of the population in the United States can easily be affected by health threats in other parts of the world: "Global health plays an increasingly crucial role in both global security and the security of the U.S. population. As the world and its economies become increasingly globalized, including extensive international travel and commerce, it is necessary to think about health in a global context."
Are you considering a career in global health? We've mapped out 15 key terms you need to know if you work or plan to work in the global health field. Although this list is far from exhaustive, it provides a window into the major concepts global health professionals encounter on a daily basis.
- Development Goals
- Developing Nations
- Endemic, Epidemic/Outbreak and Pandemic
- Global Disease Burden
- Global Health Community
- Global Health Security
- Health Equity
- Health Indicator
- Morbidity and Mortality
- Nongovernmental Organization (NGO)
- Primary Health Care
- Social Determinants of Health
In September 2000, the United Nations issued its Millennium Declaration in support of its world development goals, which are aimed at combating poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women. There are two major United Nations initiatives in place that support this declaration: the eight Millennium Development Goals established in 2000 that had a goal year of 2015 and the 17 Sustainable Development Goals that are a transition from the millennium goals to catalyze continued development through 2030. As the U.N. notes, "The eight Millennium Development Goals (MDGs) — which range from halving extreme poverty rates to halting the spread of HIV/AIDS and providing universal primary education...form a blueprint agreed to by all the world's countries and all the world's leading development institutions. They have galvanized unprecedented efforts to meet the needs of the world's poorest." The U.N. launched the 17 Sustainable Development Goals in January of 2016.
The term "developing nations" refers to countries with "a low standard of living, generally indicated by severe poverty, low income and education levels, high birth rate, and poorly developed social, economic, and technological infrastructure." Many countries in Africa, Asia, Latin America and Oceania are referred to in this context. According to the World Health Organization, environmental factors in developing nations are a root cause of "a significant burden of death, disease and disability." Such factors include "poor water quality, availability and sanitation; vector-borne diseases; poor ambient and indoor air quality; toxic substances; and global environmental change."
The term "disease" encompasses a broad category of illness that is typically defined in either the mode of transmission and/or the nature in which the disease progresses. For instance, the terms infectious and communicable diseases are often interchanged and refer to diseases that "can be transmitted from one human to another by physical contact or close proximity." As the World Health Organization notes, "Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another. Zoonotic diseases are infectious diseases of animals that can cause disease when transmitted to humans." Chronic diseases, such as heart disease, diabetes, arthritis and certain types of cancers, are usually more long term and progressive in nature, and they are often linked to lifestyle decisions — such as the choice to smoke or consume an unhealthy diet.
Political upheaval around the world has created unprecedented rates of global forced displacement — meaning that individuals are required to leave their homes and/or homelands for any number of reasons. In fact, a 2013 United Nations High Commissioner for Refugees (UNHCR) report said that during 2012, nearly 7.6 million people became newly displaced — at a rate that equaled "a new refugee or internally displaced person every 4.1 seconds." The World Health Organization says, "In the context of emergencies, displaced people are people who have had to leave their homes as a result of a natural, technological or deliberate event." The resulting exodus of individuals from their homes, whether they are internally displaced within their own countries or required to cross international borders like those in the midst of the Syrian refugee crisis, means that large groups of people end up in camps where environmental health measures are inadequate and basic health care is largely unavailable.
These terms are often used in the same context but actually have different meanings. The term “endemic” refers to that which is “natural to, prevalent within, and confined to a particular area.” Malaria is a good example of an endemic disease since it is found only in the tropics. An “epidemic” is synonymous with the term “outbreak” and refers to the “relatively rapid spread of a disease to large numbers of a population or to areas where it is not normally prevalent.” The flu epidemic that occurs each winter is one example. A “pandemic” refers to “the spread of disease throughout a country, continent or the world.” In February of this year, the World Health Organization declared the rapid international spread of the Zika virus and its suspected link to birth defects to be an international public health emergency — perhaps in hopes that a pandemic can be prevented. It was a move that many experts supported, including Dr. Ron Waldman, a professor of global health at George Washington University's Milken Institute School of Public Health.
The phrase “global burden of disease” (GBD) is attributed to the World Health Organization and is an indicator that “measures burden of disease using the disability-adjusted-life-year (DALY). This time-based measure combines years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health.” The WHO’s GBD project is an ongoing initiative that provides a framework within which countries can make use of GBD data to inform policies and help set their health agendas.
One definition for the term “global health community” relates to those who are involved in global health initiatives, such as advocates, implementers and stakeholders, and who are advancing the agenda for global health priorities around the world. One organization that supports the global health community is the Global Health Council, which touts itself as “The Collective Voice of the Global Health Community.” In a broader sense, the global health community can be defined as that which includes each of us as individuals and as communities that increasingly interact with one another as advancing globalization reduces the boundaries we experience in global health.
According to the Centers for Disease Control and Prevention (CDC), global health security refers to “a world safe and secure from infectious disease threats.” The CDC is helping to lead the way toward such efforts through its Global Health Security Agenda (GHSA) — an initiative that’s in partnership with U.S. government sister agencies, other nations, international organizations, and public and private stakeholders. The three pillars of the GHSA include preventing and reducing “the likelihood of outbreaks — natural, accidental or intentional”; early threat detection; and rapid and effective response “using multi-sectorial, international coordination and communication.”
The term “health equity” is different from health equality since treating everyone the same doesn’t ensure that their individual needs will be met. The World Health Organizations defines health equity as “the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically.” The WHO highlights the importance of health equity in the context of health as a “fundamental human right” and notes that when individuals realize improved health, inequalities will be reduced and the opportunity to “enjoy life and pursue one’s life plans” will be enhanced.
Health indicators are “measures that reflect or indicate the state of health of persons in a defined population.” Such indicators can be used to compare health care in various parts of the world to better understand how countries are faring and what factors may be affecting progress. Some key public health indicators by the World Health Organization include per capita health expenditure; life expectancy at birth; immunization coverage rates; populations using improved drinking water sources; and the density of the physician health workforce.
While morbidity and mortality are often used together within discussions about global health, they are definitely not the same. Morbidity is another term for illness — or the incidence of disease or being unhealthy. Individuals can have multiple illnesses at the same time, which are then referred to as co-morbidities. However, mortality is another term for death — with the mortality rate reflective of the number of deaths due to a specific disease within a specified population. The World Health Organization’s description of how such data is reported helps clarify how this term is used in global health: “Mortality data indicate numbers of deaths by place, time and cause. WHO’s mortality data reflect deaths registered by national civil registration systems of deaths, with the underlying cause of death coded by the national authority.”
An NGO is defined as a “nonprofit group largely funded by private contributions that operates outside of institutionalized government or political structures.” NGOs play a key role in global health — helping to provide valuable tools, resources and funding for global health research and acting as channels for government funding to implement global health programs. NGOs may work on very specific global health issues — such as HIV, family planning and reproductive health, and sanitation — or broader development issues. A 2014 Kaiser Family Foundation report that evaluated NGO funding by the U.S. Agency for International Development (USAID) noted that in 2013, 135 U.S.-based NGOs received global health funding through the agency to implement global health activities in 72 countries and across multiple regions.
Disease prevention is a term that is used in health care throughout the world and focuses on “prevention strategies to reduce the risk of developing chronic diseases and other morbidities.” In the context of global health, the World Health Organization links disease prevention to health promotion, which it defines as, “The process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions.” Social determinants of health (see definition below) have a major influence on health prevention and must be addressed along with changes to individual behavior in order to make a significant impact on both individual and community health.
In global health, the term “primary health care” refers to a broader context than having care coordinated by primary health care providers, such as physicians and nurse practitioners. According to the World Health Organization, the 1978 Declaration of Alma-Ata was the “first international declaration advocating primary health care as the main strategy for achieving WHO’s goal of ‘health for all.’” In the declaration, primary health care is defined as, “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.”
According to the CDC, social determinants of health refer to “conditions in the places where people live, learn, work, and play [that] affect a wide range of health risks and outcomes.” In both local and global health, social determinants of health are affected by how money, power and resources are distributed — all of which are influenced by policy choices in a given country or region. They are seen to be a primary cause of health inequities worldwide, which is why the World Health Organization has a specific social determinants of health unit that is responsible for “coordinating WHO support to countries to take action on [social determinants of health] to address health inequities.”
As you can see, global health is a dynamic affair. The terms related to it will continue to expand and evolve — as will the need for individuals who specialize in this field and offer much-needed expertise to address the growing concerns we see. If any of these concepts resonate with you, then you may want to consider a career in global health that will enable you to become part of the solution that the world will increasingly need.