Global health
From Wikipedia, the free encyclopedia
Superscript textGlobal health is a component of the wider discipline of public health that concerns itself particularly with international issues. Examples of global health issues include international law (and its effect on health systems), global warming (and the implications for population health), globalization and health, the Framework Convention on Tobacco Control (FCTC), and The Global Alliance for Vaccines and Immunization (GAVI), among many others.
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[edit] History
The modern era of global health promotion began in World War II with the realization that malaria was taking a significant toll on military personnel. In 1942, the U.S. Public Health Service created the Office of Malaria Control in War Areas to control malaria around military bases in the South and other territories.[1] By 1946, the MCWA had expanded and been renamed the Communicable Disease Center or CDC, which is today called the Centers for Disease Control and Prevention.[2]
In 1948, the member states of the newly formed United Nations gathered together to create the World Health Organization. A cholera epidemic that took 20,000 lives in Egypt in 1947 and 1948 helped spur the international community to action. [3]
One of the greatest accomplishments of the international health community since then was the eradication of smallpox. The last naturally occurring case of the infection was recorded in 1977. But in a strange way, success with smallpox bred overconfidence and subsequent efforts to eradicate malaria and other diseases have not been as effective. Indeed, there is now debate within the global health community as to whether eradication campaigns should be abandoned in favor of less costly and perhaps more effective primary health and containment programs.
For a variety of reasons, fewer resources were made available for global health in the late 1970s and 1980s—just at the moment when the AIDS virus was beginning its worldwide spread.
The beginning of the 21st century, however, saw renewed interest, particularly after Microsoft Chairman Bill Gates started spending billions of dollars on international health initiatives and research.[4] In August 2006 a symposium on health and philanthropy was held at Indiana University, Indianapolis, with a contribution from the World Health Organization's Global Health Histories initiative. This initiative involves professional health historians in tracing the evolution of global health since the foundation of WHO in 1948, with the aim of publishing several books in 2008, which will mark WHO's 60th anniversary.
[edit] Bioethics
Bioethics is the ethics of medical and biological science. As a field of study, it explores the interface between biology, medicine, politics, law, theology, philosophy, economics, and ethics.
However, bioethics can be defined variously, and thus, its origins are debatable. Some argue that its true roots lie in the medical ethics that have existed in various permutations across the globe for thousands of years, and which are very often centered on the juxtaposition of theology, philosophy, and medical care.
Others claim that bioethics initially emerged as a distinct, interdisciplinary field in the United States sometime within the 1960s and 70s, prompted in part by public debates on the rights of the individual in society, like the issue of abortion and the inhumane research methods of the Tuskegee Syphilis Study [5] [6].
Whatever its origins, today the field of bioethics has been increasingly characterized as interdisciplinary and globalized, with scholars from across the world and within each of the aforementioned academic areas (biology, medicine, politics, law, theology, philosophy, economics, and ethics) as well as others.
Bioethics can be organized variously, but some order it into three broad categories: clinical ethics, policy-oriented bioethics, and bioethics as a theoretical pursuit [7]. Despite this delineation, each of these areas may overlap and influence each other.
Clinical bioethics encompasses the use of bioethics in medical practice, as in clinics or hospitals. In this domain, bioethicists may be called on by nurses, doctors, social workers, or patients who need to answer to a practical bioethical question, e.g. decoding the nuances of a Do Not Resuscitate Order.
Unlike clinical bioethicists, who work on the level of individual patients and families, policy-oriented bioethicists are used as resources in the formulation of broadly-applicable policies, from the small scale (e.g. a single hospital's policy) to entire populations (e.g. US Medicare policy). Like the clinical bioethicist, however, the policy-oriented bioethicist works toward practical results.
Theoretical bioethics, however, is not constrained by practicality, time, medical procedure, or law. Academics in this field do not have to answer to hospital directors, government agencies, or other agencies with perhaps conflicting interests. Most philosophical and religious exploration of bioethics occurs on this level, although theoretical bioethicists will often have some consideration for how their discussions might be translated into policy and practice.
[edit] Bioethics on a Global Scale
The expansion of bioethics’ significance on a global scale has been attributed to things like: burgeoning populations, especially in developing countries; emergence of new infectious diseases, like HIV/AIDS, as well as the continued threat of older diseases like tuberculosis and polio; environmental degradation; widening economic disparity; and the increased economic, social, technological, cultural and political ties of people around the world associated with globalization [8], [9]. Indeed, in some ways the emergence of contemporary global bioethics can be seen as paralleling the development of globalization itself, and its various interrelated effects.
Bioethical inquiry covers many issues, including: abortion, cloning, euthanasia, population control, medical paternalism, eugenics, population control, artificial insemination, human and animal test subjects, religious prohibitions, cultural sensitivity, sexuality and gender, transplant, stem cell research, and health care inequalities, amongst others.
Global health brings with it a multitude of specific bioethical questions and concerns, which may be viewed in addition to, or as specified versions of, those on the aforementioned list.
Some of the significant bioethical issues surrounding global health are: -How to address healthcare inequities, especially between developed and developing nations, but also between classes within developed, as well as developing, nations. -Decisions surrounding which country or project will receive (health-related) aid, from both NGOs and governments, i.e. the prioritization of certain populations or diseases. -Negotiating which governing body takes precedence when the health goals of international organizations, national governments, and local forms of organization conflict. -The provision/patenting of drugs needed for treatment of diseases affecting poor, for example, questions about the production of generic forms of anti-retroviral drugs used to treat HIV/AIDS. -Debates surrounding the validity, and consequences, of the idea of a universal right to health care. - Issues of (cross-)cultural and religious sensitivity.
Religion is one of the most frequently discussed areas of bioethics, perhaps because it contains some of most contentious points of disagreement vis-à-vis medicine. Often religious bioethicists develop guidelines for addressing bioethical questions within their own faiths, though they have been criticized for a lack of academic training within secular disciplines like philosophy or medicine.
Religion, however, plays a much broader role in bioethics than particularistic theoretical inquiry; it affects how things play out in practical health care efforts. The potential for conflict between religious belief and secular Western scientific medical practice is made all the more relevant in health on a global scale, as there is an almost infinite variety of local religious belief around the world. These ostensibly conflicting values, however, are not always insurmountable, especially when they are addressed with bioethical sensitivity.
For example, the WHO recently spearheaded strong efforts to eradicate polio from Nigeria, one of the last remaining reservoirs of the disease in the world. However, for a period the vaccine was banned in the state of Kano because Muslim leaders believed that the vaccine was potentially harmful. Only after sending samples to a Muslim-run laboratory in Indonesia did leaders approve of the vaccine. Perhaps if this solution had been devised earlier, the vaccine could have been approved before Polio was reintroduced into other African countries that had previously eradicated the virus [10].
[edit] Current Efforts
As global health emerged only fairly recently as a distinct discipline, specifically global health-focused bioethics research is as yet correspondingly sparse.
Nonetheless, scholarly work in the area of global bioethics continues to grow, and there are also various journals and educational programs for bioethics more generally, many of which include articles or research relating to global, or international, health issues.
A number of researchers have advocated the need for expansion of the public discourse of global health bioethics in an increasingly interdependent world. In order to adequately and ethically address global health, they argue that other areas of social life must be addressed as being linked with health, including: “human rights, economic opportunities, good governance, peace and development”[11]. This idea of the interdependency of global health solutions with other social, political and economic issues is echoed in various other recommendations, even if their exclusive concern may not be bioethical consideration [12].
International/global health organizations, like the World Health Organization (WHO)and the United Nations Educational, Scientific and Cultural Organization (UNESCO) have been leaders in promoting discussion and research in global bioethics.
The WHO has been holding a World Congress of Bioethics for the past eight years, and its Global Burden of Disease Project indirectly takes bioethical questions into consideration. The project, which produced a widely-used and well-known report, synthesized data from countless sources in order to produce a comprehensive assessment of the causes of death and disease around the globe. It is perhaps best known for its development of the disability adjusted life year or (DALY), a method which quantifies the burden of disease by adding the years lost in death with the years lost to disability, for a certain health condition. Though the report self-consciously recognizes the subjectivity involved in quantifying disease burden, and consequently, human life, it attempted to create a measure that would be accepted by most cultures but nonetheless be based on egalitarian principles. Thus, they consider, and make practical decisions about the bioethical question of placing numerical value on human life. Currently, the project is working on creating an updated report with new data and developments [13].
UNESCO has both an International Bioethics Committee that meets annually and an Intergovernmental Bioethics Committee that meets at least biennially. At its general meeting in 2005, UNESCO adopted the Universal Declaration on Bioethics and Human Rights. The declaration establishes a set of principles, as approved by UNESCO member states, which it hopes will address medical, scientific, and technological issues as they relate to and respect human life, rights and freedoms.
[edit] Key Resources & Organizations
The observatory is a collection of databases that cover bioethics and other ethics issues as they relate to human life, including the role of science and technology. It is designed to serve as a reference for collaborative, consultative, and comparative ethics activities around the world. It also assists member nations and others parties with the identification of experts, establish committees, design curricula, and create policies in the area of ethics.
This initiative began in 2002 as a launching point for the evaluation of ethics within WHO’s Geneva and regional offices, as well as for the general development of global ethics research and activities.
The Cambridge Quarterly of Healthcare Ethics tackles issues at the challenging intersections of biology, medicine and healthcare, and the people within those fields whom address bioethical issues. As the journal touts itself as an “international forum”, it can be a useful resource for issues of or relating to global health.
This group links those involved in bioethics and related fields, through communication and discussion of cross-cultural issues in bioethics.
This blog is kept by those involved with a collaborative bioethics project entitled 'Strengthening bioethics capacity and justice in health', which promotes bioethics research in Democratic Republic of Congo and Francophone Africa.
This website contains links to academic programs, funding, training courses, higher education, organizations of interest, and various other useful documents and resources, both within the National Institutes of Health (NIH) and beyond
This site contains links to universities and centers offering higher education in bioethics.
[edit] Funding, Research, and Career Opportunities
This department of the NIH offers both pre- and post-doctoral fellowships, which provide opportunities for research, seminars, case conferences, and access to various other NIH supported opportunities.
This program is for graduates and/or professionals who wish to increase their understanding of the WHO’s work in global health. Internships may be in one of four areas: ethics and health; globalization, trade and health; health and human rights; and health law.
The institute sponsors bioethics-related summer internships for UVA’s undergraduate students. Interns will take preparatory courses and complete post-internship narratives, reports, and discussions.
This internship opportunity with the AAAS is unpaid, but offers opportunities to research bioethics issues and provides other support for related activities. Both undergraduates and graduate are encouraged to apply.
The FIC gives funding to domestic and international educational and research institutions so that they may develop or expand educational and training opportunities in international bioethics, especially for professionals in developing countries. Their website lists some of the available programs.
Maintained by bioethics.net, this page updates opportunities for jobs in the bioethics field.
[edit] References
- ^ History of Malaria, http://www.cdc.gov/malaria/history/index.htm#mcwa
- ^ CDC's Origins and Malaria, http://www.cdc.gov/malaria/history/history_cdc.htm
- ^ History of WHO, http://www.who.int/library/historical/access/who/index.en.shtml
- ^ Official Gates bio, http://www.microsoft.com/billgates/bio.asp
- ^ Dianne N. Irving, “What is "Bioethics"?”, http://www.lifeissues.net/writers/irv/irv_36whatisbioethics01.html
- ^ Mark G. Kuczewski “Bioethics: History & Resources”, http://www-hsc.usc.edu/~mbernste/tae.histandref.kuczewski.html
- ^ John D. Arras, “The Nature and Varieties of Bioethics”, http://bioethics.virginia.edu/whatisbioethics.html
- ^ Peter Singer, One World: The Ethics of Globalization, http://www.ecobooks.com/books/oneworld.htm
- ^ Benatar SR, Daar AS, Singer PA, “Global Health Challenges: The Need for an Expanded Discourse on Bioethics”, http://medicine.plosjournals.org/perlserv?request=get-document&doi=10.1371/journal.pmed.0020143
- ^ Rx For Survival, http://www.pbs.org/wgbh/rxforsurvival/
- ^ Benatar SR, Daar AS, Singer PA, “Global Health Challenges: The Need for an Expanded Discourse on Bioethics”, http://medicine.plosjournals.org/perlserv?request=get-document&doi=10.1371/journal.pmed.0020143
- ^ Labonte and Spiegel, “Setting Global Health Research Priorities”, http://bmj.bmjjournals.com/cgi/content/full/326/7392/722?maxtoshow=&HITS=10&%20hits=10&RESULTFORMAT=&fulltext=global+research+priorities&andorexactfulltext%20=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
- ^ The WHO Global Burden of Disease Project, http://www.who.int/healthinfo/bodabout/en/index.html
[edit] External links
- Globalization and Health
- Disease Control Priorities Project (DCPP)
- Global Health Council
- Global Health Reporting (Kaiser Family Foundation)
- Global Health Update (Time.com)
- London School of Hygiene and Tropical Medicine
- Novartis Institute of Tropical Medicine (Singapore)
- Science and Development Network
- World Health News (Harvard)
- World Health Organization
- Center for Global Health at the University of Virginia
