Definition of Global Health

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INVITED EDITORIAL æ

What is global health?

‘G

lobal health’ is coming of age, at least as measured by the increasing number of academic centres, especially in North America, which use this title to describe their interests (1). Most global health centres are in high-income countries although several have strong links with low- and middleincome countries. A task force is establishing a mechanism to coordinate European Academic Global Health initiatives through ASPER. Two recent papers raise important issues about the meaning and scope of global health (2, 3) and highlight, yet again, the need for a common definition of global health which is short, sharp and widely accepted, including by the public (4). Koplan et al. from the Consortium of Universities for Global Health Executive Board point out that without an accepted definition of global health, it will be difficult to agree on what global health is trying to achieve and how progress will be made and monitored (2). This is particularly important given the recent global crises Á climate change, economic, food and energy crises Á that make global health efforts even more challenging (5). Koplan and colleagues propose a definition of global health which they hope will receive wide acceptance and thus encourage global health efforts. They distinguish between global health, international health and public health; tropical medicine has close connections with international health (1). However, there is widespread confusion and overlap among the three terms. International health, in Koplan’s view, focuses on the health issues, especially infectious diseases, and maternal and child health in low-income countries. However, elsewhere international health is also used as a synonym for global health. For example, Merson et al. view international health as ‘the application of the principles of public health to problems and challenges that affect low and middle-income countries and to the complex array of global and local forces that influence them’ (6). The term ‘international health’ has also been used to refer to ‘the involvement of countries in the work of international organizations such as WHO, usually through small departments of international health in the Ministries of Health and as development aid and humanitarian assistance’ (7). Public health is usually viewed as having a focus on the health of the population of a specific country or community, a perspective shared by Koplan et al. (2). Fried et al. dispute any distinction between public health and global health and suggest that ‘public health is global health for the public good’ (3). Their strong arguments are based on the need for both global and public health to address the underlying social, economic, environmental and political

determinants of health, irrespective of whether the primary focus is national or global health.

Current definitions of global health
Koplan et al. define global health as: ‘an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide’. This is a useful definition with a broad focus on health improvement and health equity. However, it is wordy and uninspiring. Kickbush defines global health as: ‘those health issues that transcend national boundaries and governments and call for actions on the global forces that determine the health of people’ (7). This definition also has a broad focus but has no clear goal, is passive in its call for action, and omits the need for collaboration and research. Elsewhere, the European Foundation Centre calls for a European approach which makes global health a policy priority across all sectors based on a global public goods foundation (8). In an important policy document, the UK Government refers to global health as ‘health issues where the determinants circumvent, undermine or are oblivious to the territorial boundaries of states, and are thus beyond the capacity of...
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