Global and Local Interactions in Health Equity

  Credit: elenabs/iStock

Credit: elenabs/iStock

Following my post on global to local learning opportunities from the first issue of the Health Equity Connector, let’s continue on the topic with more definition and clarity on what we mean by “global.” We’ll use this platform to engage in conversations with you about global health equity and intend for it to start conversations and spark new collaborations.

The term “global health” is imbued with grand scale and complexity, weightiness and aspiration. The phrasing is at once invitational and aspirational while also sounding technical and exclusive. Our Alliance for a Healthier World is built on the foundation of global health equity and we consider it our mission to make the concept, and the practical application, available and accessible to all. In other words, we want to explore the many ways you are already engaged in global health and health equity work, whether you use this specific language or other wording. While there are benefits in arriving at a unifying definition of global health, there is also value in the convenings and dialogue on this question that result in new understandings and new learning together, and we are excited to lean into that process.

In an effort to drive toward a shared understanding of global health, the Executive Board of the Consortium of Universities for Global Health (CUGH) published an article in The Lancet in 2009, “Towards a Common Definition of Global Health.” I’ve excerpted one section of the article here (boldface added for emphasis):

What is global? Must a health crisis cross national borders to be deemed a global health issue? We should not restrict global health to health-related issues that literally cross international borders. Rather, in this context, global refers to any health issue that concerns many countries or is affected by transnational determinants, such as climate change or urbanisation, or solutions, such as polio eradication. Epidemic infectious diseases such as dengue, influenza A (H5N1), and HIV infection are clearly global. But global health should also address tobacco control, micronutrient deficiencies, obesity, injury prevention, migrant-worker health, and migration of health workers. The global in global health refers to the scope of problems, not their location. Thus—like public health but unlike international health—global health can focus on domestic health disparities as well as cross-border issues.
- From Towards a Common Definition of Global Health

In many instances, the challenges we address in public health and in global health are not defined by geography, but by social and structural determinants embedded in the fabric of our societies that profoundly shape our lives. It is precisely because global health seeks to establish causal linkages between the social and structural determinants of health and illness, and the resulting risks to entire communities and populations, that we start to see patterns emerge of similar risk profiles in unexpected places. A frequently cited Kaiser Health News article from 2016, with data from the Baltimore City Health Department and World Health Organization (WHO), looked at the metric of life expectancy at birth within different zip codes of Baltimore City and found an 18 year discrepancy between the highest life expectancy zip code (84 years) and the lowest one (66 years). What a staggering difference! As part of this investigation, the group generated this excellent infographic that overlays the name of the country that shares the same life expectancy with each Baltimore City zip code.

  Credit: Screenshot of map by  smusseden

Credit: Screenshot of map by smusseden

At the Johns Hopkins Center for Health Equity (JHCHE), led by Bloomberg Distinguished Professor and AHW Steering Committee member Dr. Lisa Cooper, adverse clinical outcomes experienced by individuals seeking care at the center are also physical manifestations of chronic and persistent poverty and lack of access to socio-economic opportunity. The Alliance has partnered with JHCHE to further understand and design programs to attack underlying social and structural barriers to health. In this partnership, the role of the Alliance is to bridge key findings and lessons from resource poor communities where our faculty work across the globe to the population served by JHCHE and the community leaders who help inform its programming. Stay tuned for upcoming interviews with Dr. Lisa Cooper and her team on this subject.

In rural Kenya and Rwanda where I lived and worked, chronic poverty is a feature of daily life and has been for many decades. Because of this, community members, public and private sector entities, have studied carefully the effects of chronic poverty on health outcomes and successfully experimented with public health, financial inclusion strategies and insurance structures to address the poor health outcomes.

The government of Kenya began an unconditional cash transfer program to the ultra-poor in Kenya in 2002. Unconditional cash transfers simply mean that the government sends recipient families the funds each month with no stipulations or conditions as to how the money is spent. The nongovernmental organization, GiveDirectly, began operations in Kenya in 2011 to augment the cash transfer program of the government and to analyze program results. The economic and psycho-social impacts of this program are well documented and are sufficiently dramatic to spur new thinking about global health and development work models.

In the early 2000’s, the government of Rwanda initiated a centrally planned national health care program to provide universal health access to all citizens. The financing mechanism designed to pay for the system halved the out-of-pocket cost per person, and the healthcare benefits resulted in the steepest decline in child mortality seen in the 20th century. As the U.S. wrangles with questions of new models for healthcare delivery, lessons from Rwanda can provide a case-study for one path forward.

New Series on Global to Local Learning

In future posts, we will dig deeper into specific examples of the global health programs and mechanisms mentioned above and share interviews with the frontline workers and community leaders implementing these health equity initiatives. We will also highlight the perspective of funding entities in the U.S. that are looking at this question of how best to harness lessons from global health across different settings and bring you voices from this sector.

We want to hear from you on this series of discussions about the role Johns Hopkins faculty, staff and students play as leaders, teachers and learners in the field of global health. Please be in touch with us via email: ahealthierworld@jhu.edu.

We look forward to continuing this conversation in upcoming publications. 


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Ben Link is the Executive Manager at the Alliance for a Healthier World (AHW). He brings over 15 years of experience working in both the nonprofit and private sectors on initiatives related to global health and development in diverse settings across southern and eastern Africa, Latin America, the Caribbean and Navajo Nation.