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Existential Challenges to Global Health (3.9 MB PDF)
Publisher New York University Center on International Cooperation
Release Date September 23, 2013
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Overview
Regardless of which priorities are adopted as targets for the post-2015 world, the constellation of agencies and initiatives that constitute "Global health" face five existential challenges, any one of which could torpedo the lofty, often extraordinarily successful goals and achievements of the collective endeavors. Two of these challenges boil down to money: The search for sustainable support; and the impact inequitable access to funds has on individual health. A third challenge concerns the increasingly obvious mismatch between the structure of "Global health" and the mission's looming priorities. And the fourth and fifth possibly insurmountable challenges reflect the planetary environment within which global health practitioners are operating. Leaders and institutions that are key to Global health have barely recognized these five existential threats, much less develop policy solutions or adaptations.
Global health is a comparatively new multilateral enterprise, built atop a far less ambitious, poorly funded set of mid-20th Century programs that fell under the rubrics of "tropical medicine" and "international health," largely overseen or guided by the World Health Organization (WHO). Tropical medicine was a colonial field, executed by well-intended wealthy governments, physicians and scientists from the northern hemisphere, working in the colonized outposts of the southern. Tropical medicine aimed its science and public health ventures at ailments not then plaguing temperate northern hemisphere climes: Malaria and other parasitic diseases, pellagra, vaccine-preventable childhood scourges and the like. Over time those involved in international health envisioned a less condescending, post-colonial political world, and recognized that the notion of disease targets as "tropical" was ecologically limiting and medically incorrect. Though it straddled the Cold War, international health conceived of grand targets, such as polio and smallpox eradication, executed from the top (Geneva, Moscow, Washington and London) down to poor countries all over the world.
By the early 1980s the moniker "global health" gained popularity, reflecting a vision of worldwide solidarity in which solutions and actions for health defied the 20th Century obstacles of the Cold War, imperialism, colonialism and traditional North/South divides. As the 1990s supercharged "Davos World" of globalized economics surged forward, the phrase "global health" came to signify movement of technology and resources on a massive scale from wealthy nations to poor, to eliminate a set of diseases, especially HIV/AIDS, malaria and tuberculosis. Those global health ambitions were solidified in 2000 with United Nations endorsement of the Millennium Development Goals, three of which were clear health targets; two more had obvious impact on human health.
