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Global Health Care, Essay Example

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Introduction

Global health care is a challenging phenomenon that supports the development of new perspectives and approaches to solving global health concerns, including nutrition, infectious disease, cancer, and chronic illness. It is important to address global health as a driving force in international healthcare expenditures because it represents an opportunity for clinicians throughout the world to collaborate and to address global health concerns to achieve favorable outcomes. Global healthcare in the modern era includes the utilization of technology to support different population groups and to address different challenges as related to global health problems that impact millions of people in different ways. These challenges demonstrate the importance of large-scale efforts to eradicate disease, to prevent illness, and to manage disease effectively through comprehensive strategies that encourage communication and collaboration across boundaries.

Global health care incorporates a number of critical factors into play so that people throughout the world are given a chance to live and to lead a higher quality of life. The World Health Organization (WHO) is of particular relevance because this organization supports global health initiatives and large-scale impact projects throughout the world (Sundewall et.al, 2009). The WHO recognizes the importance of developing strategies to address global health concerns by pooling resources in order to ensure that many population groups are positively impacted by these initiatives (Sundewall et.al, 2009). The WHO also collaborates with government bodies throughout the world to address specific concerns that are relevant to different population groups, such as infectious diseases, many of which ravage populations in a significant manner (Fineberg and Hunter, 2013). In this context, it is observed that global health has a significant impact on populations and their ability to thrive, given the high mortality rates of some diseases in less developed nations (Fineberg and Hunter, 2013). Therefore, it is expected that there will be additional frameworks in place to accommodate the needs of populations and the resources that are required to achieve favorable outcomes (Fineberg and Hunter, 2013).

In addition to the WHO, there are many other international organizations that support global health and disease in different ways. For example, The United Nations Children’s Fund (UNICEF) supports large-scale global health efforts to support the world’s children (imva.org, 2013). UNICEF works in conjunction with many governments and other sources of funding in order to accomplish its objectives related to child health and wellbeing (imva.org, 2013). UNICEF spends significant funds on many focus areas, including the preservation of child health, nutrition, emergency support, and sanitation in conjunction with local water supplies (imva.org, 2013). In addition, the United States Agency for International Development (USAID) provides support in many areas, including a primary focus on healthcare in developing nations (imva.org, 2013).

Leininger’s Culture Care Theory is essential in satisfying the objectives of global health because it supports an understanding of the issues related to cultural diversity and how they impact healthcare practices throughout the world (Current Nursing, 2012). This theory embodies many of the differences that exist in modern healthcare practices and supports a greater understanding of the issues that are most relevant on a global scale (Current Nursing, 2012). This theory is applicable because it represents a call to action to consider cultural differences when providing care and treatment to different population groups, but not at the expense of the quality of care that is provided (Current Nursing, 2012). In many countries, the provision of care is largely dependent on cultural diversity and customs, which is essential to a thriving healthcare system; however, diversity must also incorporate the concept of providing maximum care for an individual in need of treatment (Current Nursing, 2012).

Professional nursing is highly relevant to global health because nurses address some of the most critical challenges in providing care and expanding access to treatment for millions of people throughout the world. However, it is also important for nurses working with global health initiatives to recognize the importance of these directives and to consider ways to improve quality of care without compromising principles or other factors in the process. These efforts will ensure that nurses maximize their knowledge and understanding of global health and its scope in order to achieve positive outcomes for people in desperate need of healthcare services throughout the world. Nurses must collaborate with small and large-scale organizations regarding global health issues so that population needs are targeted and are specific. These efforts will ensure that patients are treated in areas where healthcare access is severely limited.

Global health represents a significant set of challenges for clinicians throughout the world. It is important to recognize these concerns and to take the steps that are necessary to provide patients with the best possible outcomes to achieve optimal health. The scope of global health concerns is significant; therefore, it is important to address these concerns and to take the steps that are necessary to collaborate and promote initiatives to fight global health problems. When these objectives are achieved using the knowledge and expertise of nurses, it is likely that there will be many opportunities to treat patients and to educate them regarding positive health. With the assistance of large global organizations, nurses play an important role in shaping outcomes for women throughout the world.

Current Nursing (2012). Transcultural nursing. Retrieved from http://currentnursing.com/nursing_theory/transcultural_nursing.html

Fineberg, H.V., and Hunter, D. J. (2013). A global view of health – an unfolding series. T he New England Journal of Medicine, 368(1), 78-79.

Imva.org (2013). Bilateral agencies. Retrieved from http://www.imva.org/Pages/orgfrm.htm

Sundewall, J., Chansa, C., Tomson, G., Forsberg, B.C., and Mudenda, D. (2009). Global health initiatives and country health systems. The Lancet, 374, 1237.

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11 global health issues to watch in 2023, according to IHME experts

Published December 20, 2022

As the year 2022 winds down, what is next on the horizon for global health? We turned to our IHME experts for their takes on the most critical health issues to watch in 2023. Entering our fourth year grappling with COVID-19, most of our experts pointed to issues that were impacted in some way by the pandemic, like long COVID and mental health. They also offered potential interventions to address the threats. 

The faculty members and research scientists who shared their insights are professor Mohsen Naghavi , assistant professor Hwme Kyu , assistant professor Angela Micah , affiliate professor Michael Brauer , affiliate assistant professor Alize Ferrari , lead research scientist Liane Ong , lead research scientist Sarah Wulf Hanson, postdoctoral scholar Christian Razo, postdoctoral scholar Ewerton Cousin, and researcher Emma Nichols. Their comments have been lightly edited for clarity.

1. Long COVID

“Long COVID is absolutely a health issue to watch in 2023. The health impact of long COVID often disrupts a person’s ability to engage with school, work, or relationships for months at a time.   “People with long COVID need diagnostic and proper rehabilitation support from primary care physicians. We desperately need more research to find effective treatments as well as preventive measures to reduce the risk of developing long COVID.” — Sarah Wulf Hanson, lead research scientist of the non-fatal and risk quality enhancement team and lead author of the JAMA paper on long COVID     

2. Mental health

“Mental disorders are a leading cause of disability worldwide, with no evidence of a decrease in this burden since 1990. The impact of the COVID-19 pandemic, war, and violence on mental health remains a priority, specifically understanding how these have impacted the prevalence and burden of mental disorders in 2022 onward and how countries should be adapting their mental health response accordingly. 

“Currently in the GBD study, we investigate childhood sexual abuse, intimate partner violence, and bullying victimization as risk factors for mental disorders. Going forward, we need a better understanding of the other risk factors for mental disorders, how these vary across different populations, and how to offer the best opportunities for prevention at the population level.” — Alize Ferrari, affiliate assistant professor and team lead for estimating the burden of mental disorders     

3. Impact of climate change

“Climate change is already affecting the health of millions of people all over the world, and more importantly, climate change will worsen throughout this century. People are experiencing both the direct effects of extreme heat that we measure in the GBD and a myriad of indirect effects. Flooding can force people from their homes and affect their mental health, droughts and storms can impact food security and water availability, and wildfire smoke episodes can increase air pollution. As we know from the pandemic, preparedness is key, and we are far from prepared for the health impacts of a warmer climate.

“Most of the emphasis to date on climate change – and rightly so – has been on what we call mitigation: reducing the emissions that lead to global warming. Yet to date these efforts have been far too modest. We are now at a point where climate change is clearly with us, and much more attention needs to be put on minimizing the impacts on global health through adaptation or enhancing resilience. 

“One aspect of this is improving overall health and enhancing socioeconomic development because we know that those who are more vulnerable will suffer the most. In addition, there are technological solutions that can support adaptation , such as the use of drought-resistant crops, increasing vegetation in cities to reduce the urban heat island effect, or repurposing land use to adapt to rising sea levels. 

“Air pollution is one of the leading global risk factors that we evaluate in the GBD – currently responsible for about 8% of all global mortality – yet it is a problem with known solutions. Increasing the speed at which we address air pollution will save lives today. Those solutions will move the world closer to the net-zero carbon emissions goals that we need to ultimately address the causes of climate change.” — Michael Brauer, affiliate professor and team lead for estimating the burden of environmental, occupational, and dietary risk factors     

4. Cardiovascular disease

“Cardiovascular diseases such as ischemic heart disease and stroke are the leading causes of death globally, accounting for 28% of total deaths in 2021. Additionally, cardiovascular diseases substantially contribute to health loss and the economic burden on health care systems. Most cardiovascular diseases can be prevented by addressing modifiable cardiovascular risk factors such as high blood pressure, high cholesterol, obesity, dietary risks, smoking, and air pollution.” — Christian Razo, postdoctoral scholar on the team estimating cardiovascular disease burden and lead author of a Burden of Proof study on the effects of elevated systolic blood pressure on ischemic heart disease     

5. Lower respiratory infections

“Lower respiratory infections (LRI), especially respiratory syncytial virus (RSV) and influenza, are health issues to watch in 2023.   “ We saw a general decline in influenza and RSV infections in 2020 due to COVID-19 mitigation measures such as mask use and social distancing. With the relaxation of these measures, many young children who haven’t been exposed to RSV in the past couple of years are being infected, resulting in RSV outbreaks . Countries have also experienced a surge in influenza across all ages.    “ Annual influenza vaccination provides an opportunity to reduce the LRI burden attributable to flu. There is no vaccine yet to prevent RSV, but promising vaccine trials are underway . ” — Hmwe Kyu, assistant professor and team lead for estimating the burden of HIV, TB, and select infectious diseases    “ After experiencing significant disruptions to health care systems worldwide due to the COVID-19 pandemic, the increases in respiratory infections and other communicable diseases have been added to the existing burden of chronic non-communicable diseases, creating a dual burden of disease exacerbated by social inequalities observed globally.” — Christian Razo     

6. Poverty’s role in health

“It seems that poverty is the mother of inequality in health. The unequal distribution of resources has expanded due to climate change and increasing violence. Low- and middle-income countries experience worse health outcomes than high-income countries: the life expectancy is 34 years lower, the under-5 mortality around 100 times higher, deaths due to interpersonal violence and suicide are 30 times higher, and deaths attributable to antimicrobial resistance (AMR) are 12 times higher. We must urgently address the impact of poverty on health, life, and death.” — Mohsen Naghavi, professor and team lead for causes of death, shocks, intermediate causes and estimating the burden of AMR     

7. Health systems strengthening

“Strengthening health systems globally remains a critical aspect of what is needed for resilient health systems. This will be particularly relevant as countries refocus their resources and attention after the acute phase of the COVID-19 pandemic.

“I think what is needed is a longer-term commitment from donors and governments – financial and human resources, governance structures, management, information systems – to ensure that interventions are set up for long-term sustainability and can deliver the outcomes that are aspired to across health systems.” — Angela Micah, assistant professor and co-lead of the development assistance for health resource tracking team

“Given the immense strain of COVID-19 on primary care and hospital systems the past two-and-a-half years, attention should be paid to building back up the health care system and enabling frontline workers to do their jobs effectively. Public health leaders and policymakers need to reflect on lessons learned from the pandemic to prevent health care system collapse in the next crisis and to ensure that people who need care can access quality health care.” — Sarah Wulf Hanson     

8. Diabetes

“Diabetes is the fourth main cause of DALYs in Latin America and the Caribbean, and among the top five causes, it is the only one that shows an increase in the age-standardized rate compared to 1990. The burden of diabetes in the Americas is large, increasing, heterogeneous, and expanding, especially in countries in Central Latin America and the Caribbean. 

“Population-based interventions such as taxes and incentives, more informative food labeling, improving the built environment to facilitate exercise, and greater advocacy to inform people of the risk diabetes poses, combined with expanded health education to combat diabetes risk factors, seem the best options. Policies aimed to help avoid weight gain and improve dietary quality are also paramount. 

“Another important aspect is improving the response of health systems in terms of access and quality care. These should include universal access to low-cost insulin and oral anti-diabetic medication to decrease avoidable deaths from acute complications. Health systems should also strive to furnish feedback from their administrative data systems to providers to help orient diabetes care.” — Ewerton Cousin, postdoctoral scholar on the neglected tropical diseases team and lead author of The Lancet Diabetes & Endocrinology paper on diabetes burden in the Americas     

9. Road injuries

“Road injuries are still an important and preventable injury. For people 15-49 years old, road injuries are the leading cause of death .

“Interventions such as helmets, seatbelts, airbags, speed limits, and laws discouraging alcohol-impaired driving do work. But implementation is not the only thing that determines their success – human behavior must adhere to those policies to make them effective." — Liane Ong, lead research scientist and team lead for estimating the burden of injuries, chronic respiratory diseases, neurological disorders, substance use disorders, diabetes and kidney diseases, sensory organ diseases, musculoskeletal disorders, and impairments (BIRDS)     

10. Dementia

“Anticipated trends in population growth and population aging are expected to lead to large increases in the number of people affected by dementia globally, underscoring the public health importance of dementia. To adequately care for those with dementia, appropriate planning for the necessary supports and services required is needed.

“Interventions targeting modifiable risk factors, such as low education, smoking, and high blood sugar, have the potential to reduce the overall societal burden and should be prioritized.” — Emma Nichols, researcher on the BIRDS team and lead author of The Lancet Public Health paper on dementia forecasting     

11. Population aging

“Adapting health systems to support older populations’ needs should be front of mind in 2023. Globally, the proportion of the population that is above 65 is expected to increase in the coming years. While a lot of attention (and rightfully so) has historically focused on diseases that affect children, it will be prudent to begin thinking through and systematically planning for some of these upcoming changes in demography as well, especially in low- and middle-income countries.” — Angela Micah

The burden of liver cancer in Mongolia from 1990-2019

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• Open access
• Published: 07 April 2020

What is global health? Key concepts and clarification of misperceptions

Report of the 2019 GHRP editorial meeting

• Xinguang Chen 1 , 2 ,
• Hao Li 1 , 3 ,
• Don Eliseo Lucero-Prisno III 4 ,
• Abu S. Abdullah 5 , 6 ,
• Jiayan Huang 7 ,
• Charlotte Laurence 8 ,
• Xiaohui Liang 1 , 3 ,
• Zhenyu Ma 9 ,
• Zongfu Mao 1 , 3 ,
• Ran Ren 10 ,
• Shaolong Wu 11 ,
• Nan Wang 1 , 3 ,
• Peigang Wang 1 , 3 ,
• Tingting Wang 1 , 3 ,
• Hong Yan 3 &
• Yuliang Zou 3  

Global Health Research and Policy volume  5 , Article number:  14 ( 2020 ) Cite this article

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The call for “W orking Together to Build a Community of Shared Future for Mankind” requires us to improve people’s health across the globe, while global health development entails a satisfactory answer to a fundamental question: “What is global health?” To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, in-depth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word “global” in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multi-country and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of “international health” by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of the Belt and Road Initiative proposed by China.

“Promoting Health For All” can be considered as the mission of global health for collective efforts to build “a Community of Shared Future for Mankind” first proposed by President Xi Jinping of China in 2013. The concept of global health continues to evolve along with the rapid development in global health research, education, policymaking, and practice. It has been promoted on various platforms for exchange, including conferences, workshops and academic journals. Within the Editorial Board of Global Health Research and Policy (GHRP), many members expressed their own points of view and often disagreed with each other with regard to the concept of global health. Substantial discrepancies in the definition of global health will not only affect the daily work of the Editorial Board of GHRP, but also impede the development of global health sciences.

To promote a better understanding of the term “ global health” , we convened a special session in the 2019 GHRP Editorial Board Meeting on the 7th of July at Wuhan University, China. The session started with a review of previous work on the concept of global health by researchers from different institutions across the globe, followed by free brainstorms, questions-answers and open discussion. Individual participants raised many questions and generously shared their thoughts and understanding of the term global health. The session was ended with a summary co-led by Dr. Xinguang Chen and Dr. Hao Li. Post-meeting efforts were thus organized to further synthesize the opinions and comments gathered during the meeting and post-meeting development through emails, telephone calls and in-person communications. With all these efforts together, concensus have been met on several key concepts and a number of confusions have been clarified regarding global health. In this editorial, we report the main results and conclusions.

A brief history

Our current understanding of the concept of global health is based on information in the literature in the past seven to eight decades. Global health as a scientific term first appeared in the literature in the 1940s [ 1 ]. It was subsequently used by the World Health Organization (WHO) as guidance and theoretical foundation [ 2 , 3 , 4 ]. Few scholars discussed the concept of global health until the 1990s, and the number of papers on this topic has risen rapidly in the subsequent decade [ 5 ] when global health was promoted under the Global Health Initiative - a global health plan signed by the U.S. President Barack Obama [ 6 ]. As a key part of the national strategy in economic globalization, security and international policies, global health in the United States has promoted collaborations across countries to deal with challenging medical and health issues through federal funding, development aids, capacity building, education, scientific research, policymaking and implementation.

Based on his experience working with Professor Zongfu Mao, the lead Editors-in-Chief, who established the Global Health Institute at Wuhan University in 2011 and launched the GHRP in 2016, Dr. Chen presented his own thoughts surrounding the definition of global health to the 2019 GHRP Editorial Board Meeting. Briefly, Dr. Chen defined global health with a three-dimensional perspective.

First, global health can be considered as a guiding principle, a branch of health sciences, and a specialized discipline within the broader arena of public health and medicine [ 5 ]. As many researchers posit, global health first serves as a guiding principle for people who would like to contribute to the health of all people across the globe [ 5 , 7 , 8 ].

Second, Dr. Chen’s conceptualization of global health is consistent with the opinions of many other scholars. Global health as a branch of sciences focuses primarily on the medical and health issues with global impact or can be effectively addressed through global solutions [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Therefore, the goal of global health science is to understand global medical and health issues and develop global solutions and implications [ 7 , 9 , 15 , 17 , 18 , 19 ].

Third, according to Dr. Chen, to develop global health as a branch of science in the fields of public health and medicine, a specialized discipline must be established, including educational institutions, research entities, and academic societies. Only with such infrastructure, can the professionals and students in the global health field receive academic training, conduct global health research, exchange and disseminate research findings, and promote global health practices [ 5 , 15 , 20 , 21 , 22 , 23 ].

Developmentally and historically, we have learned and will continue to learn global health from the WHO [ 1 , 4 , 24 , 25 ]. WHO’s projects are often ambitious, involving multiple countries, or even global in scope. Through research and action projects, the WHO has established a solid knowledge base, relevant theories, models, methodologies, valuable data, and lots of experiences that can be directly used in developing global health [ 26 , 27 , 28 , 29 ]. Typical examples include WHO’s efforts for global HIV/AIDS control [ 13 , 30 , 31 , 32 ], and the Primary Healthcare Programs to promote Health For All [ 33 , 34 ].

The definition of Global Health

From published studies in the international literature and our experiences in research, training, teaching and practice, our meeting reached a consensus-global health is a newly established branch of health sciences, growing out from medicine, public health and international health, with much input from the WHO. What makes global health different from them is that (1) global health deals with only medical and health issues with global impact [ 35 , 5 , 36 , 10 , 14 , 2 ] the main task of global health is to seek for global solutions to the issues with global health impact [ 7 , 18 , 37 ]; and (3) the ultimate goal is to use the power of academic research and science to promote health for all, and to improve health equity and reduce health disparities [ 7 , 14 , 15 , 18 , 38 ]. Therefore, global health targets populations in all countries and involves all sectors beyond medical and health systems, although global health research and practice can be conducted locally [ 39 ].

As a branch of medical and health sciences, global health has three fundamental tasks: (1) to master the spatio-temporal patterns of a medical and/or health issue across the globe to gain a better understanding of the issue and to assess its global impact [ 40 , 41 , 42 , 43 ]; (2) to investigate the determinants and influential factors associated with medical and health issues that are known to have global impact [ 15 , 40 , 41 , 42 , 43 ]; and (3) to establish evidence-based global solutions, including strategies, frameworks, governances, policies, regulations and laws [ 14 , 15 , 28 , 38 , 44 , 45 , 46 , 47 ].

Like public health, medicine, and other branches of sciences, global health should have three basic functions : The first function is to generate new knowledge and theories about global health issues, influential factors, and develop global solutions. The second function is to distribute the knowledge through education, training, publication and other forms of knowledge sharing. The last function is to apply the global health knowledge, theories, and intervention strategies in practice to solve global health problems.

Understanding the word “global”

Confusion in understanding the term ‘global health’ has largely resulted from our understanding of the word “global”. There are few discrepancies when the word ‘global’ is used in other settings such as in geography. In there, the world global physically pertains to the Earth we live on, including all people and all countries in the world. However, discrepancies appear when the word “global” is combined with the word “health” to form the term “global health”. Following the word “global” literately, an institution, a research project, or an article can be considered as global only if it encompasses all people and all countries in the world. If we follow this understanding, few of the work we are doing now belong to global health; even the work by WHO are for member countries only, not for all people and all countries in the world. But most studies published in various global health journals, including those in our GHRP, are conducted at a local or international level. How could this global health happen?

The argument presented above leads to another conceptualization: Global health means health for a very large group of people in a very large geographic area such as the Western Pacific, Africa, Asia, Europe, and Latin America. Along with this line of understanding, an institution, a research project or an article involving multi-countries and places can be considered as global, including those conducted in countries involved in China’s Belt and Road Initiative (BRI) [ 26 , 48 , 49 , 50 , 51 ]. They are considered as global because they meet our definitions of global health which focus on medical and health issues with global impact or look for global solutions to a medical or health issue [ 5 , 7 , 22 ].

One step further, the word ‘global’ can be considered as a concept of goal-setting in global health. Typical examples of this understanding are the goals established for a global health institution, for faculty specialized in global health, and for students who major or minor in global health. Although few of the global health institutions, scholars and students have conducted or are going to conduct research studies with a global sample or delivered interventions to all people in all countries, all of them share a common goal: Preventing diseases and promoting health for all people in the world. For example, preventing HIV transmission within Wuhan would not necessarily be a global health project; but the same project can be considered as global if it is guided by a global perspective, analyzed with methods with global link such as phylogenetic analysis [ 52 , 53 ], and the goal is to contribute to global implications to end HIV/AIDS epidemic.

The concept of global impact

Global impact is a key concept for global health. Different from other public health and medical disciplines, global health can address any issue that has a global impact on the health of human kind, including health system problems that have already affected or will affect a large number of people or countries across the globe. Three illustrative examples are (1) the SARS epidemic that occurred in several areas in Hong Kong could spread globally in a short period [ 11 ] to cause many medical and public health challenges [ 54 , 55 ]; (2) the global epidemic of HIV/AIDS [ 13 ]; and the novel coronavirus epidemic first broke out in December 2019 in Wuhan and quickly spread to many countries in the world [ 56 ].

Along with rapid and unevenly paced globalization, economic growth, and technological development, more and more medical and health issues with global impact emerge. Typical examples include growing health disparities, migration-related medical and health issues, issues related to internet abuse, the spread of sedentary lifestyles and lack of physical activity, obesity, increasing rates of substance abuse, depression, suicide and many other emerging mental health issues, and so on [ 10 , 23 , 36 , 42 , 57 , 58 , 59 , 60 ]. GHRP is expecting to receive and publish more studies targeting these issues guided by a global health perspective and supports more researchers to look for global solutions to these issues.

The concept of global solution

Another concept parallel to global impact is global solution . What do we mean by global solutions? Different from the conventional understanding in public health and medicine, global health selectively targets issues with global impact. Such issues often can only be effectively solved at the macro level through cross-cultural, international, and/or even global collaboration and cooperation among different entities and stakeholders. Furthermore, as long as the problem is solved, it will benefit a large number of population. We term this type of interventions as a global solution. For example, the 90–90-90 strategy promoted by the WHO is a global solution to end the HIV/AIDS epidemic [ 61 , 62 ]; the measures used to end the SARS epidemic is a global solution [ 11 ]; and the ongoing measures to control influenza [ 63 , 64 ] and malaria [ 45 , 65 ], and the measures taken by China, WHO and many countries in the world to control the new coronaviral epidemic started in China are also great examples of global solutions [ 66 ].

Global solutions are also needed for many emerging health problems, including cardiovascular diseases, sedentary lifestyle, obesity, internet abuse, drug abuse, tobacco smoking, suicide, and other problems [ 29 , 44 ]. As described earlier, global solutions are not often a medical intervention or a procedure for individual patients but frameworks, policies, strategies, laws and regulations. Using social media to deliver interventions represents a promising approach in establishment of global solutions, given its power to penetrate physical barriers and can reach a large body of audience quickly.

Types of Global Health researches

One challenge to GHRP editors (and authors alike) is how to judge whether a research study is global? Based on the new definition of global health we proposed as described above, two types of studies are considered as global and will receive further reviews for publication consideration. Type I includes projects or studies that involve multiple countries with diverse backgrounds or cover a large diverse populations residing in a broad geographical area. Type II includes projects or studies guided by a global perspective, although they may use data from a local population or a local territory. Relative to Type I, we anticipate more Type II project and studies in the field of global health. Type I study is easy to assess, but caution is needed to assess if a project or a study is Type II. Therefore, we propose the following three points for consideration: (1) if the targeted issues are of global health impact, (2) if the research is attempted to understand an issue with a global perspective, and (3) if the research purpose is to seek for a global solution.

An illustrative example of Type I studies is the epidemic and control of SARS in Hong Kong [ 11 , 67 ]. Although started locally, SARS presents a global threat; while controlling the epidemic requires international and global collaboration, including measures to confine the infected and measures to block the transmission paths and measures to protect vulnerable populations, not simply the provisions of vaccines and medicines. HIV/AIDS presents another example of Type I project. The impact of HIV/AIDS is global. Any HIV/AIDS studies regardless of their scope will be global as long as it contributes to the global efforts to end the HIV/AIDS epidemic by 2030 [ 61 , 62 ]. Lastly, an investigation of cardiovascular diseases (CVD) in a country, in Nepal for example, can be considered as global if the study is framed from a global perspective [ 44 ].

The discussion presented above suggests that in addition to scope, the purpose of a project or study can determine if it is global. A pharmaceutical company can target all people in the world to develop a new drug. The research would be considered as global if the purpose is to improve the medical and health conditions of the global population. However, it would not be considered as global if the purpose is purely to pursue profit. A research study on a medical or health problem among rural-to-urban migrants in China [ 57 , 58 , 60 ] can be considered as global if the researchers frame the study with a global perspective and include an objective to inform other countries in the world to deal with the same or similar issues.

Think globally and act locally

The catchphrase “think globally and act locally” presents another guiding principle for global health and can be used to help determine whether a medical or public health research project or a study is global. First, thinking globally and acting locally means to learn from each other in understanding and solving local health problems with the broadest perspective possible. Taking traffic accidents as an example, traffic accidents increase rapidly in many countries undergoing rapid economic growth [ 68 , 69 ]. There are two approaches to the problem: (1) locally focused approach: conducting research studies locally to identify influential factors and to seek for solutions based on local research findings; or (2) a globally focused approach: conducting the same research with a global perspective by learning from other countries with successful solutions to issues related traffic accidents [ 70 ].

Second, thinking globally and acting locally means adopting solutions that haven been proven effective in other comparable settings. It may greatly increase the efficiency to solve many global health issues if we approach these issues with a globally focused perspective. For example, vector-borne diseases are very prevalent among people living in many countries in Africa and Latin America, such as malaria, dengue, and chikungunya [ 45 , 71 , 72 ]. We would be able to control these epidemics by directly adopting the successful strategy of massive use of bed nets that has been proven to be effective and cost-saving [ 73 ]. Unfortunately, this strategy is included only as “simple alternative measures” in the so-called global vector-borne disease control in these countries, while most resources are channeled towards more advanced technologies and vaccinations [ 16 , 19 , 74 ].

Third, thinking globally and acting locally means learning from each other at different levels. At the individual level, people in high income countries can learn from those in low- and mid-income countries (LMICs) to be physically more active, such as playing Taiji, Yoga, etc.; while people in LMICs can learn from those in high income countries to improve their hygiene, life styles, personal health management, etc. At the population level, communities, organizations, governments, and countries can learn from each other in understanding their own medical and health problems and healthcare systems, and to seek solutions for these problems. For example, China can learn from the United States to deal with health issues of rural to urban migrants [ 75 ]; and the United States can learn from China to build three-tier health care systems to deliver primary care and prevention measures to improve health equality.

Lastly, thinking globally and acting locally means opportunities to conduct global health research and to be able to exchange research findings and experiences across the globe; even without traveling to another country. For example, international immigrants and international students present a unique opportunity for global health research in a local city [ 5 , 76 ]. To be global, literature search and review remains the most important approach for us to learn from each other besides conducting collaborative work with the like-minded researchers across countries; rapid development in big data and machine learning provide another powerful approach for global health research. Institutions and programs for global health provides a formal venue for such learning and exchange opportunities.

Reframing a local research study as global

The purpose of this article is to promote global health through research and publication. Anyone who reads this paper up to this point might already be able to have a clear idea on how to reframe his/her own research project or article to be of global nature. There is no doubt that a research project is global if it involves multiple countries with investigators of diverse backgrounds from different countries. However, if a research project targets a local population with investigators from only one or two local institutions, can such project be considered as global?

Our answer to this question is “yes” even if a research study is conducted locally, if the researcher (1) can demonstrate that the issue to be studied or being studied has a global impact, or (2) eventually looks for a global solution although supported with local data. For example, the study of increased traffic accidents in a city in Pakistan can be considered as global if the researchers frame the problem from a global perspective and/or adopt global solutions by learning from other countries. On the other hand, a statistical report of traffic accidents or an epidemiological investigation of factors related to the traffic accidents at the local level will not be considered as global. Studies conducted in a local hospital on drug resistance to antibiotics and associated cost are global if expected findings can inform other countries to prevent abuse of antibiotics [ 77 ]. Lastly, studies supported by international health programs can be packaged as global simply by broadening the vision from international to global.

Is Global Health a new bottle with old wine?

Another challenge question many scholars often ask is: “What new things can global health bring to public health and medicine?” The essence of this question is whether global health is simply a collection of existing medical and health problems packaged with a new title? From our previous discussion, many readers may already have their own answer to this question that this is not true. However, we would like to emphasize a few points. First, global health is not equal to public health, medicine or both, but a newly emerged sub-discipline within the public health-medicine arena. Global health is not for all medical and health problems but for the problems with global impact and with the purpose of seeking global solutions. In other words, global health focuses primarily on mega medical and health problems that transcend geographical, cultural, and national boundaries and seeks broad solutions, including frameworks, partnerships and cooperation, policies, laws and regulations that can be implemented through governments, social media, communities, and other large and broad reaching mechanisms.

Second, global health needs many visions, methods, strategies, approaches, and frameworks that are not conventionally used in public health and medicine [ 5 , 18 , 22 , 34 ]. They will enable global health researchers to locate and investigate those medical and health issues with global impact, gain new knowledge about them, develop new strategies to solve them, and train health workers to deliver the developed strategies. Consequently, geography, history, culture, sociology, governance, and laws that are optional for medicine and public health are essential for global health. Lastly, it is fundamental to have a global perspective for anyone in global health, but this could be optional for other medical and health scientists [ 40 , 41 ].

Global Health, international health, and public health

As previously discussed, global health has been linked to several other related disciplines, particularly public health, international health, and medicine [ 3 , 5 , 7 , 18 , 22 ]. To our understanding, global health can be considered as an application of medical and public health sciences together with other disciplines (1) in tackling those issues with global impact and (2) in the effort to seek global solutions. Thus, global health treats public health sciences and medicine as their foundations, and will selectively use theories, knowledge, techniques, therapeutics and prevention measures from public health, medicine, and other disciplines to understand and solve global health problems.

There are also clear boundaries between global health, public health and medicine with regard to the target population. Medicine targets patient populations, public health targets health populations in general, while global health targets the global population. We have to admit that there are obvious overlaps between global health, public health and medicine, particularly between global health and international health. It is worth noting that global health can be considered as an extension of international health with regard to the scope and purposes. International health focuses on the health of participating countries with intention to affect non-participating countries, while global health directly states that its goal is to promote health and prevent and treat diseases for all people in all countries across the globe. Thus, global health can be considered as developed from, and eventually replace international health.

Challenges and opportunities for China to contribute to Global Health

To pursue A Community with a Shared Future for Mankind , China’s BRI , currently involving more than 150 countries across the globe, creates a great opportunity for Chinese scholars to contribute to global health. China has a lot to learn from other countries in advancing its medical and health technologies and to optimize its own healthcare system, and to reduce health disparities among the 56 ethnic groups of its people. China can also gain knowledge from other countries to construct healthy lifestyles and avoid unhealthy behaviors as Chinese people become more affluent. Adequate materials and money may be able to promote physical health in China; but it will be challenging for Chinese people to avoid mental health problems currently highly prevalent in many rich and developed countries.

To develop global health, we cannot ignore the opportunities along with the BRI for Chinese scholars to share China’s lessons and successful experience with other countries. China has made a lot of achievements in public health and medicine before and after the Open Door Policy [ 49 , 78 ]. Typical examples include the ups and downs of the 3-Tier Healthcare Systems, the Policy of Prevention First, and the Policy of Putting Rural Health as the Priority, the Massive Patriotic Hygiene Movement with emphasis on simple technology and broad community participation, the Free Healthcare System for urban and the Cooperative Healthcare System for rural residents. There are many aspects of these initiatives that other countries can emulate including the implementation of public health programs covering a huge population base unprecedented in many other countries.

There are challenges for Chinese scholars to share China’s experiences with others as encountered in practice. First of all, China is politically very stable while many other countries have to change their national leadership periodically. Changes in leadership may result in changes in the delivery of evidence- based intervention programs/projects, although the changes may not be evidence-based but politically oriented. For example, the 3-Tier Healthcare System that worked in China [ 79 , 80 ] may not work in other countries and places without modifications to suit for the settings where there is a lack of local organizational systems. Culturally, promotion of common values among the public is unique in China, thus interventions that are effective among Chinese population may not work in countries and places where individualism dominates. For example, vaccination program as a global solution against infectious diseases showed great success in China, but not in the United States as indicated by the 2019 measles outbreak [ 81 ].

China can also learn from countries and international agencies such as the United Kingdom, the United States, the World Health Organization, and the United Nations to successfully and effectively provide assistance to LMICs. As China develops, it will increasingly take on the role of a donor country. Therefore, it is important for Chinese scholars to learn from all countries in the world and to work together for a Community of Shared Future for Mankind during the great course to develop global health.

Promotion of global health is an essential part of the Working Together  to Build a Community of Shared Future for Mankind. In this editorial, we summarized our discussions in the 2019 GHRP Editorial Board Meeting regarding the concept of global health. The goal is to enhance consensus among the board members as well as researchers, practitioners, educators and students in the global health community. We welcome comments, suggestions and critiques that may help further our understanding of the concept. We would like to keep the concept of global health open and let it evolve along with our research, teaching, policy and practice in global health.

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The work is funded by the journal development funds of Wuhan University.

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Xinguang Chen, Hao Li, Xiaohui Liang, Zongfu Mao, Nan Wang, Peigang Wang & Tingting Wang

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Chen XG wrote the manuscript. LI H organized the meeting, collecting the comments and editing the manuscript. Lucero-Prisno DE integrated all the comments together. Abdullah AS, Huang JY, Laurence C, Liang XH, Ma ZY, Ren R, Wu SL, Wang N, Wang PG and Wang Tt all participated in the discussion and comments of this manuscript. Laurence C and Liang XH both provided language editing. The author(s) read and approved the final manuscript

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Chen, X., Li, H., Lucero-Prisno, D.E. et al. What is global health? Key concepts and clarification of misperceptions. glob health res policy 5 , 14 (2020). https://doi.org/10.1186/s41256-020-00142-7

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The impact of COVID-19 on global health goals

21 may 2021  |  spotlight, covid-19 responsible for at least 3 million excess deaths in 2020.

As of 31 December 2020, COVID-19 had infected over 82 million people and killed more than 1.8 million worldwide. But preliminary estimates suggest the total number of global “excess deaths” directly and indirectly attributable to COVID-19 in 2020 amount to at least 3 million , 1.2 million higher than the official figures reported by countries to WHO.

With the latest COVID-19 deaths reported to WHO now exceeding 3.4 million, based on the estimates produced for 2020, we are likely facing a significant undercount of total deaths directly and indirectly attributed to COVID-19.

The term “excess deaths” describes deaths beyond what would have been expected under “normal” conditions. It captures not only confirmed deaths, but also COVID-19 deaths that were not correctly diagnosed and reported as well as deaths attributable to the overall crisis conditions. This provides a more comprehensive and accurate measure when compared with confirmed COVID-19 deaths alone.

For example, some countries only report COVID-19 deaths occurring in hospitals or the deaths of people who have tested positive for COVID-19. In addition, many countries cannot accurately measure or report cause of death due to inadequate or under-resourced health information systems.

The pandemic has likely increased deaths from other causes due to disruption to health service delivery and routine immunizations, fewer people seeking care, and shortages of funding for non-COVID-19 services. The second WHO “pulse survey” of 135 countries in March 2021 highlighted persistent disruptions at a considerable scale over one year into the pandemic, with 90% of countries reporting one or more disruptions to essential health services.

Real-time, quality data to track population health is critical for every country to improve health outcomes and eliminate health inequalities.

“Real-time, quality data to track population health is critical for every country to improve health outcomes and eliminate health inequalities", says Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. "WHO is committed to work with countries and partners to strengthen health information systems and support data-driven policies and interventions."

COVID-19 disproportionately impacts vulnerable populations

COVID-19 has exposed persistent inequalities by income, age, race, sex and geographic location. Despite recent global health gains, across the world people continue to face complex, interconnected threats to their health and well-being rooted in social, economic, political and environmental determinants of health.

The pandemic has also revealed significant gaps in country health information systems. While high-resource settings have faced challenges related to overstretched capacity and fragmentation, weaker health systems risk jeopardizing hard-won health and development gains made in recent decades.

Data from the COVID-19 World Symptoms survey shows a decline in preventive behaviours such as physical distancing, mask wearing and hand washing as household overcrowding increases. Among people living in uncrowded households, 79% reported trying to physically distance themselves compared with 71% in moderately overcrowded and 65% in extremely overcrowded households. Similar trends were observed for hand washing and mask-wearing, underscoring vulnerabilities due to socioeconomic status.

Source: WHO calculations using COVID-19 World Symptoms Survey data led by Facebook and the University of Maryland for 35 high-income countries, May 2020 – February 2021.

Irrespective of the pandemic, inequalities and data gaps impede targeted interventions. For example, a recent WHO global assessment of health information systems capacity found that only half of countries include disaggregated data in their published national health statistical reports. Investing in strong health information systems is vital to ensure disaggregated data reaches decision-makers and achieve equitable health outcomes.

With stronger, more equitable health information systems we can more accurately measure progress towards the health-related Sustainable Development Goals and WHO’s Triple Billion targets. “We are now less than nine years away from 2030”, says Dr Samira Asma, Assistant Director-General for the Division of Data, Analytics and Delivery for Impact at WHO. “We know where the gaps are, and we have the solutions to address them. What we need now is commitment and investment to accelerate progress and reach our goals.”

Before COVID-19 the world was making progress towards global health goals - but not fast enough

The World Health Statistics 2021 report presents the most up-to-date data and trends on more than 50 health-related indicators for the Sustainable Development Goal and WHO’s Triple Billion targets.

The data shows that global life expectancy at birth has increased from 66.8 years in 2000 to 73.3 years in 2019, and healthy life expectancy has increased from 58.3 years to 63.7 years. But even before the pandemic struck, progress was too slow and uneven to meet many targets including reduced premature mortality from noncommunicable diseases, tuberculosis and malaria incidence, and new HIV infections.

“Although we are living extended lives and more years in good health, these are no grounds for complacency”, says Dr Bochen Cao, Technical Officer in the Division of Data, Analytics and Delivery for Impact at WHO.  “Many of the underlying health determinants still need critical improvements, and COVID-19 is yet another wake-up call to remind us that our health remains at risk unless urgent actions are taken to close the gaps.”

For instance, while global tobacco use has decreased by 33% since 2000 the prevalence of adult obesity is increasing, and in 2016 up to a quarter of the populations in high-income countries were obese. And although the prevalence of hypertension declined worldwide between 2000 and 2015, it is increasing slightly in low-income countries.

Children and women in low and lower-middle-income countries are also at higher risk of malnutrition including stunting, wasting, and anaemia during pregnancy, while people in upper-middle-income countries are more susceptible to being overweight.

Before COVID-19, many countries were making progress towards universal health coverage. Improvements in the coverage of essential health services were recorded in all income groups and across different types of services, despite persistent inequalities. But financial protection has been deteriorating. As of the latest figures, the proportion of the population spending more than 10% of their household budget on healthcare rose from 9% to 13% between 2000 and 2015, and almost 3% were spending more than 25% of their budget on health care.   

Health emergencies protection also requires urgent reform. Despite an increased focus on global health security, COVID-19 has revealed a critical need for a well-coordinated, multisectoral health emergency surge capacity and preparedness at all levels and within all countries. Continuing efforts are needed to improve and maintain early warning systems to mitigate and manage public health risks within the national context and to consider the worldwide pandemic contexts for national health emergency and operational preparedness planning.

World Health Data Hub to improve access to data

In addition to underscoring inequalities and data gaps, COVID-19 has highlighted the need for universal access to global health data. WHO’s new World Health Data Hub will provide an interactive digital platform and trusted source for all global health data, fulfilling WHO’s commitment to provide health data as a public good.

The Hub will provide easy access to powerful visualization tools that reveal trends, patterns and connections and draw insights. It will also allow Member States to upload and review their data in a secure environment, will be scalable to allow different varieties, volumes and velocities of data and will provide access to the latest predictive analytics technologies.

The Hub brings together all of WHO’s data assets including the Global Health Observatory , the GPW 13 Triple Billion dashboard , the health equity monitor , and the WHO Mortality Database .

Leveraging partnerships to get back on track

The World Health Data Hub is made possible through partnerships that combine digital technology and innovative solutions with the global convening capabilities of an organization like WHO. As key technology partners, Microsoft and Avanade are supporting WHO to deliver this ambitious end-to-end solution with a shared commitment to promote health data as a public good.

“This partnership was started to address a common goal not only to respond to the pandemic but to ensure that every person, every citizen and every country has a chance for a healthier life”, says Dr Samira Asma. “We have to be accountable for results, but that accountability can’t come if we don’t have underlying data systems and robust partnerships.”

Public-private partnerships like this one maximize the combined leadership, expertise, resources and reach of each organization to rapidly scale solutions and deliver measurable impact.

“It is our greatest ambition with the World Health Data Hub that we are more effective as a global community in making a difference in people’s lives because we have come together, building on our respective expertise, to bring to life that unified view that we've never had before,” says Justin Spelhaug, Vice President of Tech for Social Impact at Microsoft.

“At Avanade, our purpose is to make a genuine human impact,” adds Pam Maynard, CEO at Avanade. “The work our Tech for Social Good teams are doing to create scalable, repeatable and affordable solutions for the social sector is one way we bring that purpose to life every day.”

COVID-19 has underscored the need for efficient, multilateral cooperation that is responsive to country needs and reflects their unique priorities. WHO is committed to collaborating with all partners to support countries and get back on track towards the SDGs and Triple Billion targets. “There's no one organization, one nation or one group that's going to solve COVID-19”, says Spelhaug. “It requires full mobilization of the public and private sector at new levels of scale to empower countries, policymakers, and responders.”

“It’s been incredibly rewarding to see how the power of data and analytics can transform organizations, like the WHO, to accelerate from insights to action, allowing them to spend more time focusing on what matters most: improving the lives of people and communities around the world,” says Maynard.

With less than nine years to 2030, we have no time to lose.

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• Review Article
• Published: 13 October 2021

Infectious disease in an era of global change

• Rachel E. Baker   ORCID: orcid.org/0000-0002-2661-8103 1 , 2 ,
• Ayesha S. Mahmud 3 ,
• Ian F. Miller   ORCID: orcid.org/0000-0002-2673-9618 1 , 4 ,
• Malavika Rajeev 1 ,
• Fidisoa Rasambainarivo 1 , 2 , 5 ,
• Benjamin L. Rice 1 , 6 ,
• Saki Takahashi 7 ,
• Andrew J. Tatem 8 ,
• Caroline E. Wagner 9 ,
• Lin-Fa Wang   ORCID: orcid.org/0000-0003-2752-0535 10 , 11 ,
• Amy Wesolowski 12 &
• C. Jessica E. Metcalf 1 , 13  

Nature Reviews Microbiology volume  20 ,  pages 193–205 ( 2022 ) Cite this article

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• Infectious diseases
• Policy and public health in microbiology

The twenty-first century has witnessed a wave of severe infectious disease outbreaks, not least the COVID-19 pandemic, which has had a devastating impact on lives and livelihoods around the globe. The 2003 severe acute respiratory syndrome coronavirus outbreak, the 2009 swine flu pandemic, the 2012 Middle East respiratory syndrome coronavirus outbreak, the 2013–2016 Ebola virus disease epidemic in West Africa and the 2015 Zika virus disease epidemic all resulted in substantial morbidity and mortality while spreading across borders to infect people in multiple countries. At the same time, the past few decades have ushered in an unprecedented era of technological, demographic and climatic change: airline flights have doubled since 2000, since 2007 more people live in urban areas than rural areas, population numbers continue to climb and climate change presents an escalating threat to society. In this Review, we consider the extent to which these recent global changes have increased the risk of infectious disease outbreaks, even as improved sanitation and access to health care have resulted in considerable progress worldwide.

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Introduction.

In premodern times, colonization, slavery and war led to the global spread of infectious diseases, with devastating consequences (Fig.  1a ). Human diseases such as tuberculosis, polio, smallpox and diphtheria circulated widely, and before the advent of vaccines, these diseases caused substantial morbidity and mortality. At the same time, animal diseases such as rinderpest spread along trade routes and with travelling armies, with devastating impacts on livestock and dependent human populations 1 . However, in the past two decades, medical advances, access to health care and improved sanitation have reduced the overall mortality and morbidity linked to infectious diseases, particularly for lower respiratory tract infections and diarrhoeal disease (Fig.  1d ). The swift development of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine speaks to the efficacy of modern science in rapidly countering threats from emerging pathogens. Nevertheless, infectious disease burden remains substantial in countries with low and lower-middle incomes, while mortality and morbidity associated with neglected tropical diseases, HIV infection, tuberculosis and malaria remain high. Moreover, deaths from emerging and re-emerging infections, in comparison with seasonal and endemic infections, have persisted throughout the twenty-first century (Fig.  1c ). This points to a possible new era of infectious disease, defined by outbreaks of emerging, re-emerging and endemic pathogens that spread quickly, aided by global connectivity and shifted ranges owing to climate change (Fig.  1d ).

a | Examples of epidemic periods associated with different eras of human transportation (land, maritime and air travel) are shown. Overland trade networks and war campaigns are thought to have contributed to multiple epidemics in the Mediterranean in late classical antiquity (green), beginning with the Antonine plague, which reportedly claimed the life of the Roman emperor Lucius Verus 125 , 126 , 127 , 128 . Maritime transportation (red and grey) leading to European contact with the Americas and the subsequent Atlantic slave trade resulted in the importation of Plasmodium falciparum malaria and novel viral pathogens 129 . In modern times, air travel (purple) resulted in the importation of severe acute respiratory syndrome (SARS) coronavirus to 27 countries before transmission was halted 130 . b | In recent years, increases in air travel, trade and urbanization at global (left) and regional (right) scales have accelerated, indicating ever more frequent transport of people and goods between growing urban areas (source World Bank ). c | Log deaths from major epidemics in the twenty-first century (source World Health Organization ). d | Disability-adjusted life years lost from infectious diseases (source Our World in Data ). MERS, Middle East respiratory syndrome; NTD, neglected tropical disease.

Here, we review how recent anthropogenic climatic, demographic and technological changes have altered the landscape of infectious disease risk in the past two decades. In terms of climate change, we consider both the influence of recent warming and projected future changes. For demographic change, we include trends such as urbanization (Fig.  1b ), population growth, land-use change, migration, ageing and changing birth rates. For technological changes, we primarily consider advances that enable cheaper, faster global travel and trade (Fig.  1b ), as well as improved health care. We do not explicitly address economic change; however, economic changes, including economic development, are crucial drivers of these three factors: climate, demography and technology. We also do not explicitly discuss natural drivers of pathogen evolution or biological processes unless they interact with human-driven global change.

New infections chart a pathway beginning with emergence, followed by local-scale transmission, movement beyond borders and possible global-scale spread. Global changes may differentially affect the risk of emergence, the dynamics of disease within a local population and the global spread of diseases between populations. We provide an overview of each step, first considering features of recent global change that have altered the risks of spillover of viral, fungal, bacterial and apicomplexan (malaria) infections into human populations, then detailing how spread within human populations, driven by the seasonal dynamics of transmission, may be impacted by global change, of relevance to both emergent and established pathogens. Finally, we consider changes to the drivers of global spread, focusing in particular on travel, migration and animal and plant trade.

Pathogen emergence into human populations

Recent decades have seen repeated pathogen emergence from wild or domestic animal reservoirs into human populations, from HIV-1 and HIV-2, to the 1918 influenza virus, to Middle East respiratory syndrome coronavirus, to SARS-CoV-2 (refs 2 , 3 , 4 ). For a novel pathogen to become a threat to human populations, first, contact between humans and the animal reservoir must occur; the pathogen must either have or evolve (Box  1 ) the capacity for human-to-human transmission 5 ; and finally, this human-to-human transmission must enable expansion of the pathogen’s geographical range beyond the zone of spillover. Recent global changes have affected each of these steps.

Patterns of contact between human and wildlife reservoirs have increased as human populations move into previously unoccupied regions. Population growth and agricultural expansion, coupled with increasing wealth and larger property sizes, are driving factors for these interactions and the resulting habitat destruction. This may occur alongside behaviours that increase the potential for spillover, such as consumption of wild meat 6 , or intensifying contact between wild and domestic animal hosts. For example, Nipah virus has been identified in several bat populations, particularly flying foxes, but in 1999 caused a severe disease outbreak in Malaysia, primarily among pig farmers 7 . It is hypothesized that the spillover of Nipah virus from bats to pigs was driven by three factors related to global change: pig farms expanding into the bat habitat; intensification of pig farming, leading to a high density of hosts; and international trade, leading to the spread of the infection among other pig populations in Malaysia and Singapore 8 . Expanding agriculture and its intensification may create conditions that favour pathogen circulation within domestic animal (or plant) reservoirs via high-density farming practices 9 . Beyond creating opportunities for emergence of problematic livestock pathogens, this could also increase opportunities for evolution of novel variants of risk to humans in domestic animal reservoirs. This may occur alongside increasing risk to workers interacting with animal populations 10 as a result of work practices. Global increase in the demand for and resulting intensification of meat production will importantly drive these processes, and associated use of antibiotics in domestic animals has the potential to select for resistant strains of bacteria with potential to affect human health 11 .

The nature of human populations that are exposed to potential spillover is also changing. For example, the elimination of smallpox led to the cessation of smallpox vaccination, which may have enabled the expansion of monkeypox 12 . More generally, globally ageing populations may provide an immune landscape that is more at risk of spillover, as ageing immune landscapes are less capable of containing infectious agents 13 . The intersection between declining function of immunity at later ages 14 and globally ageing populations may increase the probability of pathogen emergence, but this remains conjectural and an important area for research. The changing global context may allow existing human pathogens to both evolve novel characteristics and expand in scope. Selection for drug resistance now occurs worldwide, and antibiotic resistance has and will evolve repeatedly 15 . As with antibiotic resistance, rapid global spread is commonplace for antimalarial resistance following evolution 16 .

Climate change may play a role in the risk from pathogen spillover. Changing environmental conditions can alter species range and density, leading to novel interactions between species, and increase the risk of zoonotic emergence 17 . A series of compounded environmental factors, including a long period of drought followed by extreme precipitation, is hypothesized to have driven an upsurge in rodent populations causing the emergence of pulmonary hantavirus in 1993 (ref. 18 ). Similarly, evidence suggests that populations of the black flying fox in Australia, a key reservoir of Hendra virus, have moved 100 km southward in the past 100 years owing to climatic changes. This shifting range likely caused Hendra virus to spill over into southern horse populations, and these horses subsequently infected humans 19 , 20 . Patterns of change are likely occurring in other bat populations globally but remain understudied — a clear cause for concern given the crucial role bat populations play as a reservoir host for several high-fatality pathogens 21 .

Rapid rates of urbanization in low-income and middle-income countries, and the increase in populations residing in crowded, low-quality dwellings, have created new opportunities for the emergence of infectious diseases (Fig.  2 ). Urbanization has promoted the emergence and spread of arboviral diseases such as dengue, Zika virus disease and chikungunya, which are transmitted by Aedes aegypti and Aedes albopictus mosquitoes that are well adapted to urban areas 22 , 23 , 24 . Population density appears correlated with the preference of Ae. aegypti for human odour, and hence the evolution of human-biting — the transmission pathway for arboviral disease 24 . However the role of urbanization in vector-borne disease spread is complex: the preference of the Anopheles spp. vector for rural environments may have led to a decline in the prevalence of malaria in urbanizing regions 25 . Nevertheless, dense and highly connected urban areas are potential hot spots for the rapid spread of diseases such as COVID-19 and SARS, and cities can serve as a catalyst for rapid local and global transmission.

Interactions between urbanization and infectious disease are complex, with increased urbanization driving both positive and negative changes to global disease burden.

Box 1 Global change and evolution of hosts and pathogens

Mutations constantly arise in the genomes of all species, from viruses to elephants. Some genetic changes may have no observable effects on fitness (and thus will be selectively neutral), but can be used to track pathogen spread; for example, to trace the impacts of global connectivity on an outbreak 70 . Some genetic changes will affect disease phenotypes, potentially increasing the transmissibility, virulence or immune escape of a pathogen lineage 133 . The degree to which such mutations increase in frequency or spread geographically will depend on the degree to which they increase fitness, as well as pathogen population dynamics, which may be modulated by the global change context. Increases in the density and geographical distribution of susceptible hosts (whether they be people, crops or livestock) may provide greater opportunity for novel variants to emerge 9 simply by amplifying pathogen populations and thus circulating mutations. While understanding the nuance of cross-scale selection (that is, how the selective context of the individual host translates into the selective context at the scale of populations) remains a challenging frontier 134 , it is likely that ageing populations or the presence of immunosuppressive pathogens might further modulate selection pressures. Indeed, it has been suggested that the emergence of more transmissible or less immune-vulnerable variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was enabled in part by selection processes occurring during chronic infections in immunosuppressed individuals 135 . Greater global connectivity leads to more frequent exchange of this genetic material between populations of the same or different species, potentially leading to the erosion of evolved or engineered host resistance and increased rates of pathogen evolution 136 . Associated spillover followed by spillback can create scenarios that facilitate amplification and potentially selection of problematic pathogen variants 137 , an issue highlighted by recent documentation of human to mink to human transmission of SARS-CoV-2 (ref. 138 ). Likewise, increased rates of pathogen importation provide increased opportunities for pathogen populations to evolve the ability to utilize novel vectors (as has been observed in the Americas for malaria 129 ). Increased population connectivity can also enable pathogens and their vectors to shift to novel host species, from infected mosquitoes travelling on boats or in planes to agricultural pathogens being inadvertently relocated. Hosts that have not previously been exposed to such pathogens, and thus have no co-evolved defences, yet are phylogenetically and/or genetically similar to the original host are often most at risk 139 , 140 , a fact that makes homogenization of crops 141 or livestock a concern. Novel pathogen introductions can have large-scale population and ecosystem impacts, of which one famous example is the extirpation of the American chestnut tree by chestnut blight 142 . Changes in selection pressure resulting from changes in health-care strategies (for example, introduction of vaccination) may have the potential to select for different pathogen characteristics, and could potentially drive the evolution of virulence in pathogens 143 , 144 .

Local-scale disease dynamics

Emerging, re-emerging and endemic pathogens in human populations may exhibit distinct dynamic patterns of spread at the local scale. These patterns will be governed by demographic factors, including the effects of human behaviour on transmission (for example, school terms drive transmission of many childhood infections 26 and sex-specific travel patterns may result in higher burdens of chikungunya in women in Bangladesh 27 ) and immunity (which, for immunizing infections such as measles and rotavirus infection, is, in turn, shaped by replenishment of susceptible individuals via births 28 , 29 and depletion by vaccination where vaccines are available 30 ). Transmission may also be affected by climatic variables acting spatially or over the course of the year in line with seasonal fluctuations 31 , 32 . Recent global changes have affected each of these drivers of local-scale dynamics (Fig.  3 ).

The table summarizes select recent global changes (rows) and their impacts on disease emergence, local-scale dynamics and global spread (columns). An example susceptible ( S ), infected ( I ), recovered ( R ) model is shown, where β represents the transmission rate and γ is the recovery rate.

As school attendance not only modulates transmission of childhood infections 26 but also shapes human mobility 33 , dramatic increases in rates of school attendance globally thus have the potential to substantially alter the dynamics of many infections. That this has yet to be documented is perhaps in part because this change has happened alongside expansion of access to vaccines that protect children against many of the relevant infections, as well as global declines in birth rates, which also facilitate control efforts by diminishing the size of the susceptible pool 34 . If the burden of disease is age specific, the intersection between immunity and shifting demography may be particularly marked: declining birth rates translate into a smaller pool of susceptible individuals and thus infected individuals, reducing the overall rate at which susceptible individuals become infected, and thus increasing the average age of infection or disease, as reported for dengue in Thailand 35 and rubella in Costa Rica 36 as these countries went through the demographic transition. Conversely, ageing populations may increase transmission; for example, longer shedding has been suggested with increasing age for SARS-CoV-2 (ref. 37 ).

Demographic changes to population size and density via urbanization may also affect dynamics. Influenza, for example, tends to exhibit more persistent outbreaks in more populous, denser urban regions 38 (Fig.  2 ). A similar pattern was reported in the early COVID-19 pandemic 39 . If demographic change has importantly altered the context of infectious diseases in recent years, arguably an even larger effect is caused by changes in the occurrence of immunomodulatory infections, which, in turn, may affect other infections. For example, the emergence of HIV has amplified the burden of tuberculosis 40 . Mass drug administration efforts have reduced helminth prevalence, which will have knock-on effects on the burden of other infections, such as malaria, which may be increased in individuals experiencing a heavy worm burden 41 ; both will also intersect with the efficacy of vaccination programmes 42 .

The climate plays a key role in driving the local-scale seasonal dynamics of many infectious diseases, which may thus be altered by global change in climatic conditions 43 , 44 . Considering these impacts requires recognizing that interactions with climate differ by pathogen type. For directly transmitted infections, the role of climate is revealed by marked latitudinal gradients in epidemic timing 32 , 45 . Several respiratory pathogens, including influenza virus, are more highly seasonal in temperate climates and exhibit greater year-round persistence in tropical locations 32 , 46 . Climate change is expected to lead to an expansion of these tropical patterns, with possible implications for pathogen evolution 43 , 47 . At the individual level, susceptibility to respiratory viral infections may be impacted by exposure to local air pollution, which is a concern for rapidly urbanizing locations, where urban air pollution may disproportionately affect low-income communities and communities of colour 48 , 49 . For example, non-Hispanic Black and Hispanic populations in the USA were found to have higher exposure to certain PM 2.5 components than non-Hispanic white populations 49 . At the same time, globally, a move to an urban location may bring benefits in terms of increased access to health care (Fig.  2 ).

For some bacterial and fungal diseases, climatic changes may affect the pathogen’s environmental reservoir. Incidence of coccidioidomycosis (valley fever), caused by inhalation of fungal spores of Coccidioides spp., is expected to increase with climate change as the region with optimal conditions for fungal spore production expands 50 . Climate change may also have played a role in the emergence of the drug-resistant fungal pathogen Candida auris . C. auris emerged in several continents at the same time and has been shown to have increased thermotolerance compared with other closely related fungal species, which perhaps evolved in response to global warming 51 , 52 . This increased thermotolerance may have enabled the pathogen to jump from its environmental habitat into an intermediary avian host, given the higher body temperatures of avian fauna, before infecting humans 52 .

Demographic change and technological changes may alter a host’s interaction with the environmental reservoir. Cholera, caused by the bacterial pathogen Vibrio cholerae , persists in the environment, particularly in aquatic settings. Changes to environmental conditions, including elevated sea temperatures, lead to increased reproduction of the pathogen and local epidemics 53 , with clear links to longer-term climate phenomena such as El Niño 54 . However, improved sanitation lowers the risk of exposure to V. cholerae and has led to a decline of the disease in many locations 53 .

For vector-transmitted diseases, biological traits of both the vector and the pathogen may be sensitive to climate. Many transmission-related life cycle traits of the mosquito (biting rate, adult lifespan, population size and distribution) and the pathogen (extrinsic incubation rate) are temperature sensitive, and oviposition patterns depend on water availability 55 . Consequently, the geographical range for dengue, malaria and other vector-borne diseases 56 , 57 , 58 is affected by the local climate, and there is substantial effort to understand how these ranges may change with climate change 59 , 60 , 61 . For certain vector-borne diseases such as Zika virus disease, climate change may lead to an expanded range 62 . However, for other diseases, such as malaria, climate change may shift the spatial range of the infection to higher latitudes 63 . As ever, the footprint of human interventions may loom larger than these changes in local conditions 25 .

At the local scale, one of the strongest footprints detectable on the dynamics of many endemic infections in recent years is declines in incidence associated with access to vaccinations 64 . However, the introduction of a vaccine does not imply immediate elimination. As vaccination coverage increases, measles outbreaks, for instance, follow a pathway towards elimination defined by declines in mean incidence but high variability in outbreak size 34 . Imperfect vaccine coverage may allow population susceptibility to increase such that substantial outbreaks can occur if the disease is reintroduced; for example, the 2018 measles outbreak in Madagascar, which led to more than 100,000 cases 65 . Improved surveillance of the landscape of population immunity, via serological surveys, could help determine gaps in vaccination coverage 66 .

Global spread

As local conditions alter demographically, or as a result of climate change potentially expanding the range of locations suitable to a particular pathogen or vector, increased global connectivity will enable pathogens to reach these new environments more rapidly (Figs  3 , 4 ). Here, we review the impact of global change on three forms of global connectivity — international travel, human migration and local-scale mobility, and the international trade of animals, animal products and plants — while considering the impact on infectious disease risk. Technological change over the past two decades has dramatically lowered the cost of international travel, while demographic change has led to heightened demand for inexpensive flights (Fig.  1b ). Demographic and climatic drivers have altered patterns of local mobility and regional migration, while rising demand and technological change have increased the trade of plants and animals. At the same time, an increasingly urban population is better connected than ever before to global travel networks (Fig.  4 ). These changes to global connectivity will present unique risk factors for infectious disease spread, enabling pathogens to travel further and faster than ever before.

a | The global international air travel network expanded substantially from 1933 to 2020 (data from WorldPop and ref. 131 ). b | Average monthly maximum temperature in 1970–2000) and difference between 2070–2100 and 1970–2000 averages (data from WorldClim , Shared Socioeconomic Pathway 3 (SSP3)). c | Population projections under SSP3 in 2010 and relative population change projected until 2100 (source NASA Socioeconomic Data and Applications Center (ref. 132 )). Part a adapted with permission from ref. 131 , OUP.

International travel

The late twentieth century and the early twenty-first century have been marked by technological developments enabling ever swifter movement of people and pathogens over large distances — from trains to planes, and an expanding international airline network (Fig.  4 ). The total number of airline passengers doubled from just below two billion in 2000 to more than four billion in 2019 (Fig.  1b ). This rampant increase in global connectivity brings with it new risks from emerging pathogens (Box  2 ). However, many endemic pathogens also circulate via transit routes: seasonal influenza circulation in the USA can be predicted by flight patterns 67 , 68 , with evidence that flight bans following the events of 9/11 caused a delayed outbreak, and a prolonged influenza season within the USA as measured by a 60% increase in the time to transnational spread 68 . Similarly, rapid global air travel is expected to have played a key role in the global spread of SARS-CoV-2. Genetic analyses demonstrate multiple introductions of SARS-CoV-2, driven by air travel, in the Middle East 69 , northern California 70 and Brazil 71 .

International travel can lead to the global spread of vector-borne diseases via the introduction of new vectors into regions with suitable environmental conditions or the introduction of new pathogens into native and invasive vector populations. Historically, vectors have been introduced via trade routes: ships are thought to have been key to the global dispersal of Ae. aegypti and Ae. albopictus , which then became established in locations with appropriate environmental conditions 72 , 73 . Anopheles gambiae , the primary vector of malaria in Africa, was introduced into Brazil in the 1930s and became established in a region with a climate similar to that of its native Kenya 74 . Although malaria was already endemic in Brazil at the time, An. gambiae proved a much more effective vector, leading to a severe outbreak and a costly (but successful) eradication campaign 73 . There has been relatively little documented evidence of the introduction of new vectors via air travel. This is likely due to the low probability of vectors surviving the flight, and disembarking in a suitable region, in sufficient numbers to establish and drive an epidemic 75 . However, cases of ‘airport malaria’, that is, malaria transmitted within international airports, even outside endemic regions, are rare but becoming more common 76 .

A more feasible scenario is that air travel can bring an infected human host into contact with a native or invasive vector population that then establishes local transmission. Climate change has driven a shift in the range of several key vectors, which may make this introduction more likely. The range of the biting midge Culicoides imicola , a vector of bluetongue virus, which causes disease in ruminants, has expanded over the past few decades from sub-Saharan Africa and the Middle East into Europe, bringing a wave of bluetongue epidemics 77 . Following this expansion, bluetongue virus then spread outside the range of C. imicola into native populations of Culicoides spp. in more northerly regions of Europe. In terms of air travel, the 2015 Zika virus disease epidemic in the Americas may provide a recent example of a pathogen spreading into a susceptible vector population, likely facilitated by high connectivity 78 . Zika virus is thought to have been introduced to Brazil from French Polynesia and vectored by Aedes spp., although the volume of air travel during this period makes it almost impossible to conclusively determine the origin 78 . Similarly, it is hard to pinpoint the pathway via which West Nile virus was introduced into the USA in the 1990s; however, transport by either shipping (transporting vectors) or aircraft (transporting a human host) is likely 79 . After introduction, West Nile virus spread in the native Culex spp. mosquito population. More broadly, climate change complicates the picture in terms of possible future introductions. As the range of locations with environmental suitability for certain vector species changes, successful introductions of pathogens into these vector populations may become more likely 80 . At the same time, changes to population structure (for example, via urbanization) may alter the suitability of an environment for vector reproduction (Fig.  2 ).

Box 2 Will there be another pandemic like COVID-19?

COVID-19 has had an unprecedented impact on both human lives and our society, and we will likely be dealing with the consequences for decades to come. As we reckon with these consequences, one concern is that a suite of global changes has increased the risk from emerging pathogens, such that pandemics similar to COVID-19 could be a more frequent occurrence. However, there are biological features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that have made the pathogen distinctly difficult to control, primarily the virus’s ability to spread asymptomatically and presymptomatically. Many pathogens do not exhibit these features, which may be a cause for cautious optimism going forward.

The expansion of regional and global air travel, along with the increasing development of high-speed railway networks, has resulted in a substantial degree of connectivity between human populations 73 . At the same time, land-use change and climate change may have increased the risk of pathogen emergence. In combination, these drivers imply an era where pathogens are more likely to emerge, and more likely to spread globally on emergence. However, while the last century bore witness to several pandemics (Fig.  1 ), SARS-CoV-2 is unrivalled in its rapid, global reach. A key question is why SARS-CoV-2 was so successful at spreading globally and whether this was due to recent increases in global connectivity as opposed to epidemiological and biological characteristics of the virus itself 145 .

A clear distinction between SARS-CoV-2 and other recently emerged pathogens (for example, SARS-CoV and Ebola virus) is that an individual infected with SARS-CoV-2 may become infectious before developing symptoms 146 . This presents a unique challenge from a disease control perspective. A standard approach for limiting the onward spread of a new outbreak is to isolate infected individuals when they show symptoms. Case isolation proved successful in mitigating earlier SARS 147 and Ebola virus disease 148 outbreaks. However, symptoms for SARS-CoV-2 infection likely occur after an individual is already infectious 146 . This possible presymptomatic spread limits the efficacy of case isolation interventions as by the time the infected individual is isolated, the person may have already spread the pathogen to others 149 . In the figure, we plot the time to infectiousness (latent period) against the time to symptom onset (incubation period) for four pathogens that have caused severe outbreaks in recent decades. When the latent period equals the incubation period (dashed line in the figure), symptoms occur at a similar time to infectiousness (for example, influenza). The shaded region to the right of this line in the figure indicates possible presymptomatic spread, which may be uniquely difficult to control.

The 2–3-day delay between infectiousness and symptom onset provides ample time for long-distance spread of the disease, given current transport networks (see the figure). Control policies, such as testing before travel, provide a more effective option in this context, yet developing and distributing a test takes time, during which time the disease may spread rapidly. The good news is that this presymptomatic spread appears somewhat unique to SARS-CoV-2, at least compared with other acute infections such as influenza, SARS and Ebola virus disease (Fig.  4 ). In comparison, asymptomatic spread explains some of the difficulty in controlling acquired immunodeficiency syndrome before antiretroviral measures were available.

Migration and local mobility

Human migration is an intrinsic component of population dynamics driven by socio-economic, political and environmental factors, and one that has undergone considerable upheaval in the modern era. It is estimated that globally the number of international migrants, those who intentionally relocate to a country other than their birth country, is almost 272 million, representing 3.5% of the world’s population. By contrast, temporary migration, often considered ‘seasonal migration’, is driven largely by economic patterns, including agricultural seasons that require short periods of intense labour. The rate of migration continues to increase owing to both social, economic, political and environmental drivers in origin countries and economic opportunities, physical safety and security in destination countries. Projections for migration are unclear, with the UN projecting stable rates after 2050 (ref. 81 ). However, climate change will likely provide an escalating push factor, with sea level rise and extreme weather events leading to forced migration from exposed regions 82 .

Given the movement of people between countries, there remain risks of introduction of infectious diseases, including those common and uncommon in the country of migration 83 . It is possible for a infectious disease common in the source country, such as latent tuberculosis, malaria, viral hepatitis and infection with intestinal parasites, to be imported via this mechanism 84 , 85 , 86 . For example, in many destination countries, a large proportion of cases of tuberculosis are observed in the foreign-born population. However, the ultimate impact of these introduction events will depend largely on the population-level susceptibility and environmental suitability for sustained transmission in the destination country. More importantly, migrant groups often have more limited access to health care, treatment and resources, particularly those displaced, who are often provided with limited options to safely seek care and treatment 87 . Minimizing the impact of these possible disease threats depends on providing appropriate health care to these high-risk groups that takes into account the multifaceted social, political and economic components 88 .

Within-country population mobility can also play a key role in disease spread; however, it is typically difficult to track these movements. Aggregated mobile phone data are a valuable tool for tracing patterns of local mobility and predicting future outbreaks 89 . In recent work, mobility data have been shown to be predictive of inequities in COVID-19 burden in the USA 90 . Similarly, population mobility was found to predict the spread of the 2011 dengue epidemic in Pakistan 91 , while local travel following the Eid holidays was found to predict the spread of the chikungunya outbreak in 2017 in Bangladesh 92 . As the trend of urbanization continues, mobility to and from dense urban centres (that is, megacities) will likely play a future role in local spread of infections 92 . Better tracking of within-country population mobility, using novel data streams, may present an opportunity for forecasting future outbreaks 93 .

Intensification of animal and plant trade

International trade has expanded rapidly in the modern era and has been matched by a global proliferation of infectious diseases affecting not only humans but also animals and plants 94 , 95 . Trade drives this pattern by facilitating the translocation of hosts and pathogens across the geographical and ecological boundaries that constrain their spread. The economic and environmental threats posed by trade-driven infectious diseases of plants and animals are increasingly being recognized, and calls for more stringent containment measures have intensified in recent years 96 , 97 .

Plant trade

Deliberate transport of plant products has existed since the emergence of trade. Increases in the speed of transport during modern times have allowed more live plant tissue, and as a result more viable pathogen propagules , to be transported over long distances. Combined with the intensification of trade at the global scale, this pattern has driven a rise in long-distance transmission and disease emergence 98 , 99 . Trade drives the emergence of novel plant diseases by creating novel interactions between hosts and pathogens 100 . One pathway through which this can occur is the introduction of novel pathogens to native plants. For example, Xylella fastidiosa , a generalist bacterium vectored by xylem-feeding insects, was introduced into Europe in 2013 from the USA, likely as a result of trade. In Italy, X. fastidiosa is causing an ongoing epidemic of ‘olive quick decline syndrome’, resulting in severe losses of an economically and culturally important crop 101 , 102 . Trade can also drive the emergence of plant disease by introducing novel hosts to native pathogens. Eucalyptus rust, a disease caused by the fungal pathogen Austropuccinia psidii , emerged when the pathogen transferred from its native South American hosts in the myrtle family (Myrtaceae) to non-native Eucalyptus trees (which also belong to the myrtle family) being grown on plantations 103 . The disease now threatens to ‘spill back’ into naive endemic Eucalyptus populations in Australia.

Animal and animal-product trade

Animal trade has contributed to multiple outbreaks and emergence events globally, which have had major consequences for the agricultural sector as a whole and pose substantial risk for animal and public health. Large numbers of livestock are traded annually between countries and may facilitate the spread of pathogens. Rift Valley fever, for example, is a zoonotic vector-borne viral disease causing abortion and high neonatal mortality in domestic ruminants. The disease is widespread on the African continent and has recently been detected in Saudi Arabia and Yemen. Live cattle movement between East Africa and the Arabian peninsula or from the Union of Comoros to Madagascar is thought to have contributed to the introduction of Rift Valley fever virus and caused outbreaks in these locations in 2000 (Arabian Peninsula) and 2008 (Madagascar) 104 , 105 .

Additionally, the trade of animal-derived products such as meat may enable the movement of pathogens over large distances and between continents. For instance, African swine fever is a highly contagious viral disease affecting several members of the family Suidae, including domestic pigs and wild boars. Infection by African swine fever virus may result in up to 100% morbidity and mortality in affected pig herds and substantial economic losses for producers. In 2007, the accidental introduction of African swine fever virus to Georgia led to the first outbreak of African swine fever in Europe since the early 1990s 106 . The virus, which used to occur primarily in sub-Saharan Africa, was allegedly introduced to the Caucasian peninsula through meat products contaminated with viruses closely related to the ones found in Madagascar, Mozambique or Zambia 107 . Despite efforts to contain the virus, the disease has spread to more than 20 countries in Europe and Asia 108 , 109 .

Similarly, in recent decades there has been an expansion in infections of Vibrio parahaemolyticus — a bacterial pathogen found in shellfish and the leading cause of seafood-related illness globally. The pathogen is endemic to regions of the US Pacific Northwest but has recently spread to other parts of the USA, Europe and South America 110 , 111 . The concerning increase in V. parahaemolyticus infection is expected to have several drivers connected to global change. Declines in sea ice have increased ship traffic through the Bering Strait, with cargo ships possibly transporting V. parahaemolyticus in ballast water. At the same time, increasing sea temperatures may have increased the global environmental suitability for V. parahaemolyticus in the marine environment 110 . Finally, dispersal of the pathogen may have occurred via increasing global trade in shellfish, with evidence suggesting possible dispersal via Manila clams introduced into Spain from Canada 111 . This combination of possible drivers speaks to the complexity of understanding infectious disease risk in an era of global change, and the necessity of exploring concurrent changes.

Transboundary spread of diseases through legal and illegal trade of live animals may also have important consequences for biodiversity on a global scale. For example, the amphibian trade contributed to the expansion of novel strains of the fungal pathogen genus Batrachochytrium into naive hosts, devastating wild amphibian populations globally 112 . Conversely, infectious diseases also hamper trade, resulting in indirect economic losses in affected populations. Foot and mouth disease virus is a major reason for trade restrictions on livestock. While endemic in certain countries in Asia and Africa, foot and mouth disease virus causes outbreaks in naive populations, resulting in large economic losses 113 . While trade is a major driver of pathogen spread, food animal production has transformed in recent history into large-scale intensified systems with high-density, genetically homogenous populations, ideal for pathogen emergence and maintenance 114 . Critically, animal production systems often serve as the interface between wild and human populations, and multiple viral spillover events have occurred at this nexus. Nipah virus spilled over from fruit bats to the domestic pig population multiple times before subsequently infecting humans 115 . Pandemic variants of human influenza A virus are often the result of reassortment between human and avian viruses, with both domestic poultry and wild birds posited to play a role 116 , 117 , 118 . A non-viral example is the spillover of antimicrobial-resistant pathogens from livestock into humans: intensive antibiotic use in industrialized and smallholder livestock production systems to promote growth and prevent infections has been linked to the emergence of antibiotic resistance in humans 119 . Tackling emergence and disease spread in animal systems will require rethinking both food animal production and global trade of animals.

A new era of infectious disease

In recent decades, declines in mortality and morbidity, particularly childhood mortality, have been one of the great triumphs of public health. Greater access to care, such as therapeutics (including antibiotics), improved sanitation and the development of vaccines 120 have been core drivers of this progress. Even as medical advances in the twenty-first century have spurred advances in population health, inequalities in access to these advances remain widespread between and within countries 121 . Reducing inequities in access to health care and improving surveillance and monitoring for infectious diseases in low-income and middle-income countries, and in underserved populations within countries, should be a priority in tackling pathogen emergence and spread.

While life expectancy continues to increase, and life years lost to infectious diseases decline, the new threat of infectious disease will likely come from emerging and re-emerging infections. Climate change, rapid urbanization and changing land-use patterns will increase the risk of disease emergence in the coming decades. Climate change, in particular, may alter the range of global pathogens, allowing infections, particularly vector-borne infections, to expand into new locations. A continued uptick in global travel, trade and mobility will transport pathogens rapidly, following emergence. However, there are counterpoints to this trend: the rapid growth of connectivity observed in the early twenty-first century may stabilize, and structural changes wrought during the COVID-19 pandemic may persist 122 . Increased investment in outbreak response, such as the recent formation of the WHO Hub for Pandemic and Epidemic Intelligence, could help mitigate the threat from future emerging infections. In addition, efforts to develop universal vaccines (that is, vaccines that engender immunity against all strains of influenza viruses or coronaviruses, for example) could provide a monumental leap forward in tackling present and future infections 123 .

A changing world requires changing science to evaluate future risks from infectious disease. Future work needs to explicitly address concurrent changes: how shifting patterns of demographic, climatic and technological factors may collectively affect the risk of pathogen emergence, alterations to dynamics and global spread. More forward-looking research, to contend with possible future outcomes, is required in addition to the retroactive analyses that typically dominate the literature. Increasing attention needs to be paid to pathogens currently circulating in both wild and domestic animal populations, especially in cases where agriculture is expanding into native species’ habitats and, conversely, invasive species are moving into populous regions due to climate change. As the battle against certain long-term endemic infections is won, institutional structures built to address these old enemies can be co-opted and adapted for emerging threats. At the same time, new technologies, including advances in data collection and surveillance, need to be harnessed (Box  3 ). There is much recent innovation around surveillance, from reinterpreting information available from classic tools such as PCR 124 to leveraging multiplex serology approaches to identify anomalies that might suggest pathogen emergence, and there is increasing interest in integrating multiple surveillance platforms (from genomic to case data) to better understand pathogen spread. Finally, future research needs to align with a global view of disease risk. In an increasingly connected world, the risk from infectious disease is globally shared. The COVID-19 pandemic, including the rapid global circulation of evolved strains, highlights the need for a collaborative, worldwide framework for infectious disease research and control.

Box 3 Big data for disease

Recent technological advances in collecting, sharing and processing large datasets, from satellite images to genomes, represent a new opportunity to answer critical questions in global health. However, challenges remain, including the uneven geographical distribution of available data as well as biases in representative sampling. We highlight three areas of future growth.

Serological surveys

Serological surveys detect the presence of antibodies in blood — recent advances in testing now enable the detection of exposure to multiple pathogens with use of a small sample of blood 150 . Serological surveys have attracted attention during the COVID-19 pandemic as a means to track population exposure given under-reporting, although test performance characteristics differ widely between epidemiological contexts as well as the choice of assay used 151 . Historically, serological surveys have been financially and logistically expensive to run, but declining costs are leading to increased availability of serological data.

Genomic surveillance systems

Genomic surveillance systems are able to characterize and track the emergence of novel variants (for example, during the COVID-19 pandemic). Undoubtedly these data have enabled the rapid development of diagnostics and vaccines and, when combined with epidemiological information, are able to provide a more detailed picture of ongoing transmission dynamics. Efforts to develop national and international genomic surveillance networks are varied but with clear success stories 152 , 153 even in low-resources settings 154 . However, resource limitations, including sequencing platforms, bioinformatic pipelines and the regular collection of samples for processing, continue to limit the global expansion of sequencing.

Artificial intelligence and machine learning

These techniques are frequently proposed as tools for answering key public health questions, yet specific use cases remain elusive 155 . Using these tools to predict viral emergence, for example, may prove difficult due to microbiological complexities and the cost of data collection 156 , yet could prove valuable for targeting sampling efforts 157 . In terms of uncovering population-level drivers of disease transmission, statistical approaches, including machine learning, can be used to leverage novel, and high-volume, data streams. However, more classical, mechanistic models may provide a more robust framework for projecting future outcomes for the disease system under demographic, technological and climatic change. Future work should aim to improve the integration of machine learning approaches within the traditional mechanistic modelling frameworks to rapidly and accurately assess prospective challenges.

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Acknowledgements

R.E.B. is supported by the Cooperative Institute for Modelling Earth Systems. R.E.B., C.J.E.M. and F.R. are supported by the High Meadows Environmental Institute at Princeton University. A.W. is supported by the US National Institutes of Health through the National Library of Medicine (DP2LM013102) and the National Institute of Allergy and Infectious Diseases (1R01A1160780-01) and a Career Award at the Scientific Interface from the Burroughs Wellcome Fund. Research in the L.-F.W. group is supported by grants from the Singapore National Research Foundation (NRF2012NRF-CRP001-056 and NRF2016NRF-NSFC002-013), the National Medical Research Council of Singapore (MOH-OFIRG19MAY-0011, COVID19RF-003 and NMRC/BNIG/2040/2015) and the Ministry of Education, Singapore (MOE2019-T2-2-130). A.J.T. is supported by the Bill & Melinda Gates Foundation (INV-024911). S.T. is supported by the Schmidt Science Fellows programme, in partnership with the Rhodes Trust.

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A correlated series of climate events associated with the warm phase of the El Niño Southern Oscillation cycle.

Pathogen units responsible for infection, such as a fungal spore or viral particle.

The mixing of genetic material of different pathogens within an infected cell.

The measurement of antibody responses to multiple pathogens simultaneously.

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Baker, R.E., Mahmud, A.S., Miller, I.F. et al. Infectious disease in an era of global change. Nat Rev Microbiol 20 , 193–205 (2022). https://doi.org/10.1038/s41579-021-00639-z

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The Global Health Policy Issues Essay

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Vague, time-delayed estimates

Distrusts, myths and a lack of coordination among agencies, recruitment of qualified personnel, volunteers and poor health infrastructures, countries’ global health policies.

After observing the Ebola outbreak crises in West Africa, Michaud and Kates have concluded that the global health policymaking is in a fog (Michaud & Kates, 2014). Policymaking is a major challenge in the global health today. In most cases, severe outbreaks of epidemics around the world indicate gaps in the global health policy.

Policymaking relies on timely and robust data for effective decision-making. In most cases, however, such timely, robust data are not available. As a result, policymakers tend to use time-delayed estimates for decision-making, which often do not yield expected outcomes.

For instance, the recent observed case of Ebola crisis has shown that delivering personnel, supplies and services where they are most needed have become much more difficult due to availability of “only vague and time-delayed estimates for some of the core epidemiological aspects of the current outbreak” (Michaud & Kates, 2014).

It has been difficult to determine the exact number of infected and affected people, areas worst hit by epidemic outbreaks, specific locations with increasing or declining cases of new infections, the rate of transmission and potential number of people who remain at risk of contracting new infections.

Michaud and Kates (2014) have attributed these issues partly to a lack of critical data and poor surveillance capabilities in many countries that experience health crises. In addition, there are also observed rapid changes and chaotic prevailing situations on the ground.

The US CDC and the WHO have done their best to provide the global community with some authoritative data, situational updates and projections.

However, some governments have not appreciated such efforts. For instance, the Liberian President has insisted that the US and UN Ebola forecasts are wrong and asserted that the epidemic is stabilizing (Lewis, 2014). The WHO tends to account for all unreported, uncounted and undetected cases in their estimates.

Clearly, there is a lack of coordination among various agencies involved in the global health crises. A lack of coordination has affected service delivery in the worst hit areas.

The global health community requires coordination among “governmental Ministries of Health, non-governmental organizations, multilateral institutions and aid agencies in rural and urban areas that are spread out across multiple countries” (Michaud & Kates, 2014).

The distrust that exists between governments and global health agencies is responsible for poor global health policy formulation and responses.

Knowledge about certain viruses and epidemics remain low. While several global agencies have enhanced their efforts to understand various epidemics, their causes and mechanisms of transmission, findings remain poorly understood on the ground. For instance, there are anecdotal reports, which show that armed people have attacked quarantined locations in West Africa and freed Ebola infected people.

A lack of sufficient knowledge could negatively hinder any progresses on combating serious cases of epidemics. Therefore, controlling such outbreaks require individuals in high-risk locations to understand how epidemics spread and how they might contract them. In addition, they should be able to recognize various symptoms and reduce chances of new infections.

Equally relevant is the need to enhance awareness campaigns and reduce cases of myths and misinformation about epidemics. In most cases, lack of sufficient information escalates fear and causes irrational behaviors among people in affected locations.

The global health policies have failed to address the lack of health infrastructures, particularly in poor countries. In most situations, the global health community is desperate for help when epidemics spread fast and death tolls surge.

The responses to global health crises have been reactive rather than proactive. For instance, the WHO and West African presidents launched a campaign to raise funds as a part of an “intensified international, regional and national campaign to bring the outbreak under control” (Gharib, 2014). In response to such initiatives, various countries responded with aid in various forms.

The UK Government pledged to construct a 700-bed hospital in Sierra Leone (Phillip, 2014). The US and other countries have sent military personnel, doctors and other experts to construct healthcare facilities and coordinate logistics by delivering help to agencies on the ground.

While some of these efforts could have immediate impacts, others outcomes of these efforts could take several months or years to be felt. Meanwhile, such epidemics continue to spread rapidly with severe consequences to humanity.

It is difficult to recruit qualified personnel and volunteers to combat global health crises as demonstrated by the Ebola case in West Africa (Phillip, 2014). The situation creates the frightening view of the current global health policy.

The world has recognized its failure in developing effective health policies. Consequently, various stakeholders, including governments, policymakers, media, business leaders, and other institutions have increasingly shown their support during global health crises. Specifically, substantial funding, donor support, new institutions and community-led initiatives have grown to address such crises in poor and emerging economies.

The US has remained the most active and largest fund provider and implementer of global health programs worldwide. It is involved at different stages, for instance, there are government departments and agencies, Congressional committees, initiatives and funding streams to support global health.

In addition, the US is engaged in “multi-pronged, multi-billion dollar investments that focus on a myriad of global health challenges, countries, and stakeholders”. Hence, it has a complex global health response plan.

While the US has such a clear policy in addressing the global health crises, perhaps other developed and emerging economies lack similar policies. The failure by countries to develop effective global health support policies has affected responses to worst health crises in the world. Governments, therefore, require such policies in place to mitigate global health challenges.

The current global health policy has created a complex task in any situation, which has been made even more challenging as emerging health crises spread so far so quickly. Hence, it is a major challenge and a wake-up call for the global health community to review its current policies.

There is a need to gather data. Health agencies and states need to collect reliable data on a timely basis and eliminate the use of crude estimates and trajectories. Currently, the global health community has to rely on such data for decision-making.

While data show expected outcomes, poor coordination and a lack of trust among various agencies have affected rapid responses and service delivery in affected countries. Data should create incentive for all stakeholders to respond effectively in order to contain such global health crises.

Countries need to develop their global health policy programs. Such programs should be creative and multifaceted to account for several elements of global health concerns.

Gharib, M. (2014). How the global health community is responding to Ebola . Web.

Kaiser Family Foundation. (2013). The U.S. Government Engagement in Global Health: A Primer. Menlo Park, CA: Kaiser Family Foundation.

Lewis, D. (2014). Ebola stabilizing in Liberia, doomsday forecasts wrong – president . Reuters. Web.

Michaud, J., & Kates, J. (2014). Measuring the Impact of Ebola: Will it Reach 1.4 Million? Web.

Phillip, A. (2014). Aid organizations are ‘desperate’ for help with Ebola as death toll surges past 3,300 . The Washington Post . Web.

• Implementation of Effective Training in Health Care Facilities
• Global Health Policy and Healthcare Financing
• Healthcare: the Ways to Address the Ebola Menace
• The Ebola Threat: Culture, Medicine, Authority and Risk
• Ebola Control in Conflict Zones: Sierra Leone & Uganda
• The Global Definition of Health
• Quality Management in Healthcare
• Policies and Regulations for the Twenty-First Century Healthcare Organizations
• The Future of ICD-10 in America’s Healthcare System
• Quality Indicators of Patient Safety
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Essay on Global Health Issues And Concerns

Students are often asked to write an essay on Global Health Issues And Concerns in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Global Health Issues And Concerns

What is global health.

Global health is about keeping people all over the world safe from sickness. It means doctors and leaders work together to fight diseases that can spread from country to country. It’s not just about one place; it’s about everyone, everywhere.

Common Diseases

Many countries face illnesses like malaria, HIV, and tuberculosis. These diseases make lots of people very sick and can spread easily. Doctors try to stop these diseases by giving out medicine and teaching people how to stay healthy.

Health Care for All

Some places don’t have enough doctors or hospitals. People in these areas can’t always get the help they need when they are sick. It’s important for richer countries to help poorer ones so everyone can see a doctor.

Eating and Drinking Right

Getting the right food and clean water is a big problem in some places. Without these, people can get very sick. Healthy food and water help kids grow strong and stay healthy.

Working Together

250 words essay on global health issues and concerns, what are global health issues.

Global health issues are health problems that affect many people across the world. These issues do not stop at country borders. They spread from one country to another and can affect anyone, no matter where they live.

Common Health Problems

One big health problem is infectious diseases. These are illnesses like the flu, HIV, and coronavirus. They can spread quickly and make lots of people sick. Another problem is not having enough food, which makes people weak and more likely to get sick.

Why Do These Problems Happen?

Many things cause global health issues. Poor countries might not have enough doctors or hospitals. Some places have dirty water, which can make people sick. Also, in crowded cities, diseases can spread faster because people are close together.

What Can We Do?

To fix these problems, countries need to work together. Doctors and medicines should be available for everyone. Clean water and good food are important too. Also, we need to teach people how to stay healthy and stop diseases from spreading.

By sharing knowledge and helping each other, we can fight global health issues. It’s important for all countries to join hands and make sure everyone can live a healthy life. When we all help, we can make the world a better place for everyone.

500 Words Essay on Global Health Issues And Concerns

What are global health issues, common diseases around the world.

One big problem is diseases that spread quickly, like the flu or COVID-19. These can make a lot of people sick at the same time. There are also diseases like malaria, which is spread by mosquitoes, and it’s very common in some parts of the world. Many people, especially kids, can get very sick or even die if they catch these diseases.

Getting Medicine and Doctors to Everyone

In some places, it’s hard for people to get to a doctor or a hospital. They might live too far away, or there might not be enough doctors where they live. Also, some medicines are too expensive for people to buy. This means that even if there is a cure for a sickness, not everyone can get it. It’s like when you need a pencil for class, but the store is too far away, or the pencil is too costly.

Eating Healthy and Staying Clean

Helping each other out.

Countries and organizations around the world are working together to solve these problems. They send doctors and nurses to places where there aren’t enough, and they help make medicines more affordable. They also teach people how to stay healthy, like washing their hands and eating the right foods. It’s like when your class works together on a project, and everyone helps out.

Even if we’re just kids, there’s a lot we can do to help. Learning about these issues is the first step. We can also help raise money or donate to organizations that are working to make things better. And we can be thankful for what we have, like clean water and good schools, and think about how we can share with others who don’t have as much.

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How has the COVID-19 Pandemic Impacted Global Health?

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Introduction

The emergence of the coronavirus disease 2019 (COVID-19), which is caused by infection from the previously unknown severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has devastated economies and caused unprecedented challenges to healthcare and food systems around the world. Globally, billions of people have been ordered to stay at home as a result of lockdowns, while almost three million people have died (as of the end of March 2021).

The Global Health Security (GHS) Index

At the end of the Ebola outbreak that occurred in 2014, the GHS Index was developed to determine the ability of a total of 195 countries to cope with a future infectious disease outbreak. In order to make this prediction, the GHS Index considers the biological risks of each country, which includes an analysis of the nation’s current geopolitics, health system and capacity to control infectious disease outbreaks.

To evaluate a given country’s GHS Index, they are rated on prevention, detection and reporting, rapid response, health system, compliance with international norms and risk environment.

Since the outbreak of COVID-19, public health officials have investigated whether the GHS Index could be used to assess the performance of countries during the current pandemic. In a research study looking to do just this, the GHS Index was found to have a positive correlation with COVID-19 associated morbidity and mortality rates in 178 different countries.

Despite this observation, these researchers actually found that this positive association had a limited value in determining a country’s ability to deal with a global pandemic.

The effect of COVID-19 on other health problems

The COVID-19 pandemic has overwhelmed healthcare systems around the world, having a knock-on effect on the diagnosis and treatment of other diseases.

Social distancing and lockdowns have reduced diagnosis rates of infectious diseases such as seasonal influenza, as would be expected with reduced social contact.

However, individuals have avoided seeking help for other health problems due to lockdowns and avoidance of medical settings, leading to reduced diagnosis and treatment despite the problem still being there. Meanwhile, even in diagnosed cases, treatment for diseases and conditions such as cancer had to be postponed in many cases due to the immediate threat of COVID-19 consuming health systems and their resources.

Scientific research around the world has also focused on COVID-19, potentially delaying research and breakthroughs on other diseases.

Furthermore, other infectious diseases such as malaria, HIV and tuberculosis were put on the sidelines, despite still being very real problems, particularly in more vulnerable populations. An assessment by the Bill & Melinda Gates foundations in September 2020 assessed data on vaccine coverage from the first portion of the pandemic and came to a conclusion that vaccine coverage in health systems had been pushed back around 25 years in 25 weeks.

Before the pandemic, around half of the world's population did not have access to essential healthcare, and this number has been increased by the pandemic. Healthcare systems across the globe need to become more accessible and need to be prepared for future pandemic-like events in a way that will reduce the impact on the management of other diseases.

Global mental health impact

The most common characteristics associated with the novel infectious COVID-19 include respiratory symptoms including cough, fever, respiratory problems, and, in certain cases, atypical pneumonia. Outside of the respiratory system, SARS-CoV-2 also appears to affect the cardiovascular, gastrointestinal, and urinary systems.

Psychological effects of COVID-19

In addition to these symptoms, various neurological manifestations have been observed following infection by SARS-CoV-2. Some examples of these manifestations include hyposmia, dysgeusia, encephalitis, meningitis, and acute cerebrovascular disease. It has been suggested that these neurological effects are due to direct infection of the brain, a virus-induced hyperinflammatory response, hypercoagulation, and post-infectious immune-mediated processes. As a result, these neurological effects can lead to a wide range of psychological issues ranging from depression, anxiety, fatigue, and post-traumatic stress disorder (PTSD).

Healthcare workers

In addition to having a direct impact on COVID-19 patients, the mental health of both health care providers and non-infected members of the general population has also been dramatically changed during the pandemic.

Health care providers, for example, are at a high risk of infection to the virus, as well as COVID-19 related traumatic events. Furthermore, healthcare workers who must quarantine have been shown to be at a greater risk of avoidance behaviors and more severe symptoms of PTSD as compared to the general public.  

General population

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Many will agree that the physical and social distancing measures that have been introduced throughout many parts of the world have significantly affected how the general population connects to and interacts with others. This loss of connection has been further impaired by the inability to meet with others at central areas of social interaction and support such as restaurants, libraries, sports facilities and both cultural and community centers.  

The closures of both schools and businesses have also increased the sense of isolation as unemployment numbers have risen and affected individuals experience significant financial distress. Taken together, these dramatic social changes have increased the mental health burden and subsequently worsened mental health outcomes. Furthermore, fear-related behaviors such as extreme avoidance of social contact have also risen, further exacerbating the risk of poor mental health issues.

Lessons learned

Overall, it is generally believed that no country was fully prepared to handle a pandemic, particularly one at the magnitude of the COVID-19 pandemic. SARS-CoV-2 has a unique ability to spread from asymptomatic people prior to the onset of symptoms which, combined with its long incubation time, makes it difficult for countries to prevent the spread of this disease.

Additional barriers to control the spread of COVID-19 include community resistance to outbreak mitigation efforts including travel restrictions, use of face masks in public, and social distancing, hospital transmission rates and a general lack of crucial funding and resources.

One of the most significant lessons that can be learned from the COVID-19 pandemic is the importance of political will in its role in protecting people from epidemics. The COVID-19 outbreak also awakened much of the global population to the broken and overextended health systems in many parts of the world.

In order to ensure that the world is better prepared for the next new infectious agent, public health systems must remain committed to developing adequate surveillance programs, prompt diagnostic techniques, and robust research initiatives that can detect and understand the basic biology and treatment, if necessary, of new organisms.

• Bill & Melinda Gates Foundation. COVID-19 A Global Perspective. Available from: https://www.gatesfoundation.org/goalkeepers/report/2020-report/#GlobalPerspective
• Hou, L., Mehta, S. D., Christian, E., et al. (2020). Impact of the COVID-19 pandemic on global health research training and education. Journal of Global Health 2 . doi:10.7189.jogh.10.020366.
• Impact of COVID-19 on people’s livelihoods, their health and our food systems [Online]. Available from: https://www.who.int/news/item/13-10-2020-impact-of-covid-19-on-people%27s-livelihoods-their-health-and-our-food-systems .
• Ji, Y., Shao, J., Tao, B., et al,. (2021). Are we ready to deal with a global COVID-19 pandemic? Rethinking countries’ capacity based on the Global Health Security Index. International Journal of Infectious Diseases. doi:10.1016/j.ijid.2021.03.089.
• Lange, K. W. (2021). Coronavirus disease 2019 (COVID-19) and global mental health. Global Health Journal. doi:10.1016/j.glohj.2021.02.004.

Further Reading

• All Coronavirus Disease COVID-19 Content
• The COVID-19 Pandemic: What have the experts learned?
• What Mutations of SARS-CoV-2 are Causing Concern?
• What Role has Social Media Played in COVID-19?
• Unlocking our clinical understanding of SARS-CoV-2 infection, Post-Acute COVID Syndrome (PACS), and systemic recovery

Last Updated: Jul 5, 2022

Benedette Cuffari

After completing her Bachelor of Science in Toxicology with two minors in Spanish and Chemistry in 2016, Benedette continued her studies to complete her Master of Science in Toxicology in May of 2018. During graduate school, Benedette investigated the dermatotoxicity of mechlorethamine and bendamustine; two nitrogen mustard alkylating agents that are used in anticancer therapy.

Please use one of the following formats to cite this article in your essay, paper or report:

Cuffari, Benedette. (2022, July 05). How has the COVID-19 Pandemic Impacted Global Health?. News-Medical. Retrieved on August 30, 2024 from https://www.news-medical.net/health/How-has-the-COVID-19-Pandemic-Impacted-Global-Health.aspx.

Cuffari, Benedette. "How has the COVID-19 Pandemic Impacted Global Health?". News-Medical . 30 August 2024. <https://www.news-medical.net/health/How-has-the-COVID-19-Pandemic-Impacted-Global-Health.aspx>.

Cuffari, Benedette. "How has the COVID-19 Pandemic Impacted Global Health?". News-Medical. https://www.news-medical.net/health/How-has-the-COVID-19-Pandemic-Impacted-Global-Health.aspx. (accessed August 30, 2024).

Cuffari, Benedette. 2022. How has the COVID-19 Pandemic Impacted Global Health? . News-Medical, viewed 30 August 2024, https://www.news-medical.net/health/How-has-the-COVID-19-Pandemic-Impacted-Global-Health.aspx.

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The climate crisis is a health crisis – here’s why

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• Human health is deeply interconnected with our planet’s climate and the health of the biosphere.
• Climate change impacts human health through more frequent and intense severe weather, extreme heat, air pollution, intensified disease outbreaks and pandemics, increased malnutrition rates from food insecurity, and mental distress.
• As the impacts of climate change escalate, they can perpetuate or even aggravate cycles of inequality, deepening health and social inequities within and between countries.
• Countries must work to integrate climate and health policies and build climate-informed, green and resilient health systems.

What is the connection between climate change and public health?

Human health is deeply interconnected with our planet’s climate and the health of the biosphere. When temperatures and sea levels rise, when storms rage and wildfire smoke pollutes the air, when habitat destruction and droughts affect water and food security, humans cannot escape the consequences–especially in countries and communities already struggling to manage existing health challenges. 

As the impacts of climate change escalate, they can perpetuate or even aggravate cycles of inequality, deepening health and social inequities within and between countries. Marginalized communities, who are least equipped to cope with the effects, often bear the brunt of these impacts. 

What are some specific and common ways that climate change impacts our health?

• Severe weather:  Extreme weather events such as storms, floods and landslides have caused over two million deaths between 1970 and 2021, with over 90 percent occurring in low- and middle-income countries. These events are becoming more frequent and severe due to climate change, inflicting immense physical and psychological harm. As a result, they increase demand for health services while simultaneously threatening the health sector’s ability to provide quality services and care by interrupting power lines, damaging or destroying facilities, and hindering access to care, especially in remote areas where infrastructure is already fragile.  
• Extreme heat:  Climate change is driving more frequent and intense heatwaves. For example, it is estimated that nearly 50,000 lives were lost in Europe in 2023 due to extreme heat. Under our current trajectory, about 2 billion people will be exposed to severe heat by 2100, with South and Southeast Asia being particularly vulnerable to wet-bulb temperatures . Many people are also increasingly at risk of wildfires, with longer fire seasons and the frequency and magnitude of extreme wildfires doubling over the past 20 years .  
• Infectious diseases:  Climate change is ushering in an era of new and intensified disease outbreaks and pandemics. Vectors, including disease-carrying mosquitoes, are already spreading to regions where they had never been present before. Extreme flooding aggravates the spread of waterborne diseases like cholera and rising temperatures are projected to cause a 20 percent increase in cases of dengue, Zika and chikungunya. By 2040, the spread of malaria alone could put 5 billion people at risk . And with ecosystems being reshaped by deforestation, urbanization and rising global temperatures, animals and humans are forced into closer contact, raising the risk for pandemics caused by zoonotic diseases like COVID-19.  
• Malnutrition:  The direct effects of climate change on health are compounded by indirect climate change impacts like loss of food supply–linked to droughts, floods, shifting seasons–which can create and exacerbate nutritional issues. A new analysis of 103 countries shows that days of extreme heat, increasing in frequency and intensity of drought due to climate change, accounted for an estimated 98 million more people reporting moderate to severe food insecurity in 2020 than the average in the period between 1981–2010.

Wildfires pose an extreme risk to human health. In 2023 alone, an area twice the size of Mexico was consumed by flames. Photo: UNDP Costa Rica / SINAC

By 2040, because of climate change, 5 billion people might be at risk of malaria. Community health points are crucial for early diagnosis and treatment. Photo: Miguel Samper / UNDP Bolivia

• Air pollution:  The burning of fossil fuels is the primary cause of climate change, but it is also responsible for air pollution. 99 percent of the world is breathing at levels deemed unsafe by the World Health Organization (WHO). Air pollution is associated with an increase in several chronic diseases like cancers and heart and respiratory diseases and can seriously aggravate existing conditions. The WHO estimates that air pollution is responsible for about 6.7 million deaths annually, and is linked to negative pre- and postnatal outcomes and neurological conditions such as dementia. Low- and middle-income countries pay the heaviest price, with 90 percent of premature deaths caused by air pollution occurring in these countries.  
• The mental toll:  Whether it’s trauma, mental illness and distress in response to floods, storms and wildfires, or the chronic mental health impacts of water and food shortages, conflict and migration, and more frequent and severe pandemics, climate change has widespread and alarming implications for mental health . The awareness of these threats leads to its own psychological impacts, with ‘climate anxiety’ and ‘eco stress’ impacting many, particularly young people who must cope with the prospect of a highly uncertain and unstable future.

What can countries do to limit the health impacts of climate change?

Countries must incorporate health at every step of the way in their climate change mitigation, preparedness and adaptation measures. This includes deeply interrogating the systems we've built–reliant on fossil fuels, unsustainable land use and agricultural practices, deforestation and urban sprawl–which not only drive climate change but also intensify the health consequences, particularly for vulnerable groups.

Integrate climate and health policies

An increasing number of actors, including the Intergovernmental Panel on Climate Change (IPCC), are calling for coordinated action across sectors to alleviate the health impacts of climate change. At COP28 in 2023, 148 country governments endorsed the groundbreaking COP28 Declaration on Climate and Health . In this declaration, countries committed to pursuing better integration of health considerations into their climate policy processes and of climate considerations into their health policy agendas.

This entails, for example, taking health into account in designing the next round of Nationally Determined Contributions (NDCs) due in 2025. Currently, only 32 percent of these national climate pledges specifically mention the health sector and note climate-related health outcomes or adaptation measures.

A switch to LED lightbulbs is saving energy and improving conditions for health workers in Jamaica. Photo: UNDP Jamaica

The eVIN smart vaccine supply chain management system has revolutionized vaccine storage and stock monitoring in India. Photo: UNDP India

Build climate-informed and resilient health systems

Low-emission, resilient health systems are critical for keeping communities healthy as they grapple with the impacts of climate change. But what does a “resilient health system” actually look like in practice? 

It might look like integrating climate and weather information in health surveillance systems that are monitoring climate-sensitive diseases. This helps ensure continuous data collection and analysis, efficient forecasting and early warning for health risks. It also involves enhancing climate-informed disease control and prevention programmes, including digitizing information and surveillance systems, improving medical laboratories for case detection, and training health personnel on climate change and health. It is also quite literal: climate-proofing healthcare facilities, infrastructure and operations, so that extreme weather events don’t severely disrupt or impact healthcare services. 

And perhaps most importantly, it is about people. To ensure health service delivery and preparedness at every step of the way, countries must invest in and train local health workforces, strengthen community-led interventions and promote local climate action, all of which will enhance equitable access to and delivery of health services to meet people where they are.  

Green the health sector and leverage health expertise

In 2020, the healthcare sector was responsible for 4.6 percent of global greenhouse gas emissions and one in three healthcare facilities lacked the resources to manage their waste. By transferring to renewable energy, greening the health sector supply chain and improving energy efficiency and waste management in the health sector, countries can advance their climate change mitigation efforts while improving health outcomes. The benefits are many: reduced emissions and air pollution, cost savings, improved access to quality healthcare, and enhanced resilience to future climate change impacts.

At COP26 in 2021, countries committed to lowering the emissions of their health systems , with 14 countries setting clear mitigation targets to reach net-zero carbon emissions from their health systems by 2050. As a result, the Alliance for Transformative Action on Climate and Health (ATACH) was created by the World Health Organization to help countries implement these commitments by revising their NDCs and other climate policies and programmes, with UNDP as a supporting member. 

How can we ensure no one is left behind in climate and health efforts?

The impacts of climate change on human health and well-being are exacerbated by a vicious cycle of inequalities, disproportionately affecting society’s most vulnerable and marginalized people, including women, children (especially girls), the elderly, people with disabilities, Indigenous Peoples, outdoor and informal workers, and people living in poverty or in remote locations.

These groups often have less access to healthcare, safe housing and resources like air conditioning, making them more susceptible to diseases and the health impacts of extreme climate events. For example, people with disabilities are up to four times more likely to die in disasters. Climate change also poses an immense threat to pregnant women, newborns and children, not least of which is due to disease, poor nutrition and extreme heat, which can lead to adverse maternal and perinatal outcomes . People living with HIV or other chronic illnesses are also at risk if access to health services is disrupted by climate-related hazards or pandemics.

Disaster preparedness drills are crucial to protecting vulnerable groups, such as children, from climate hazards. Photo: Manuth Buth / UNDP Cambodia

Water scarcity affects vulnerable groups the most, particularly women and girls, who often bear the burden of ensuring water access for their households. Photo: UNDP Zimbabwe

In addition, climate change is expected to push up to 132 million people (more than half of whom live in Sub-Saharan Africa and South Asia) into extreme poverty by 2030, with 44 million of these driven by health impacts. Threats to incomes, livelihoods and well-being will be made all the more salient as climate change continues to force people to move within and out of their countries, further straining health systems, threatening human rights, increasing the risk of conflict and worsening poverty. In 2023, there were already at least 7.7 million people in 82 countries and territories living in internal displacement as a result of weather-related hazards. And by 2050, that number could increase to 216 million people due to slow-onset climate change impacts.

In light of this, countries must make a commitment to consider how power and discrimination shape health inequities and address the social determinants of health such as income, employment, education, food insecurity, housing and social protection, discrimination, displacement and more. Bold action at the global and national levels to reduce these inequalities is critical, including by considering how health can feature in ongoing discussions around loss and damage .

How does UNDP support action to limit the health impacts of climate change?

In 2023, UNDP worked with 59 countries on the nexus of health, environment and climate change, work that is guided by the UNDP HIV and Health Strategy 2022-2025 and UNDP Strategic Plan 2022-2025 .

Through its climate change mitigation work, UNDP aims to reduce the emissions footprint of the healthcare sector and improve health outcomes. This work includes supporting sustainable procurement initiatives to ensure health products have the lowest possible climate impact; helping governments adopt environmentally and socially sound practices to manage healthcare waste in Southwest Asia ; and training women to become clean energy entrepreneurs to reduce indoor air pollution from cooking in Peru . Under Solar for Health , UNDP has helped enable climate-resilient, low-emission and reliable health services across 15 countries by providing access to renewable energy.

Under Solar for Health, UNDP has helped provide access to renewable energy for health facilities in 15 countries. Photo: UNDP Zimbabwe

At the same time, UNDP’s support to 100 countries worldwide to adapt to climate change helps protect communities from the health impacts of growing water and food insecurity and more extreme weather events. Examples of this work include supporting the integration of health considerations into national adaptation policy and planning in countries from Bhutan to Papua New Guinea ; fostering resilience for food security and climate resilient agriculture in countries from Kiribati to El Salvador ; improving water resource management and access to water in countries from the Maldives to Somalia ; strengthening access to climate information and early warning systems in countries from Pakistan to Malawi ; and strengthening climate-resilient health systems in Least Developed Countries in Asia and the Pacific Islands in partnership with WHO and with funding from the Global Environment Facility (GEF).

With funding from the European Union, UNDP has supported Ethiopia, India and Mongolia to develop air pollution investment cases , revealing the economic, health and environmental burden of air pollution and calculating the return on investment for priority solutions.

Furthermore, in Bangladesh, Bhutan and Maldives, UNDP supports the safe sorting, sterilizing and disposing of healthcare waste to help prevent the negative impacts of healthcare waste on human and environmental health, with funding from Japan.

Continued, new and strengthened partnerships are key for this work to be effective and sustainable. In 2023, at COP28, the Green Climate Fund (GCF), UNDP and WHO launched a new initiative that is ramping up financial support for developing countries to mitigate and respond to the impacts of climate change on health in 15 countries across Africa, Asia and Southeastern Europe.

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• v.6(6); 2021

Defining global health: findings from a systematic review and thematic analysis of the literature

Melissa salm.

1 Anthropology, University of California Davis, Davis, California, USA

2 University of California Davis, Davis, California, USA

Mairead Minihane

Patricia conrad.

3 VM:PMI, University of California Davis, Davis, California, USA

Associated Data

No data are available. All data relevant to the study are included in the article or uploaded as supplementary information. n/a.

Introduction

Debate around a common definition of global health has seen extensive scholarly interest within the last two decades; however, consensus around a precise definition remains elusive. The objective of this study was to systematically review definitions of global health in the literature and offer grounded theoretical insights into what might be seen as relevant for establishing a common definition of global health.

A systematic review was conducted with qualitative synthesis of findings using peer-reviewed literature from key databases. Publications were identified by the keywords of ‘global health’ and ‘define’ or ‘definition’ or ‘defining’. Coding methods were used for qualitative analysis to identify recurring themes in definitions of global health published between 2009 and 2019.

The search resulted in 1363 publications, of which 78 were included. Qualitative analysis of the data generated four theoretical categories and associated subthemes delineating key aspects of global health. These included: (1) global health is a multiplex approach to worldwide health improvement taught and pursued at research institutions; (2) global health is an ethically oriented initiative that is guided by justice principles; (3) global health is a mode of governance that yields influence through problem identification, political decision-making, as well as the allocation and exchange of resources across borders and (4) global health is a vague yet versatile concept with multiple meanings, historical antecedents and an emergent future.

Extant definitions of global health can be categorised thematically to designate areas of importance for stakeholders and to organise future debates on its definition. Future contributions to this debate may consider shifting from questioning the abstract ‘what’ of global health towards more pragmatic and reflexive questions about ‘who’ defines global health and towards what ends.

Key questions

What is already known.

• Debate around a common definition of global health has seen extensive scholarly interest within the last two decades; despite the abundance of literature, ambiguity still persists around its precise definition.
• No systematic reviews with thematic analysis have been conducted to explore extant definitions of global health nor to contribute to a comprehensive definition of global health.

What are the new findings?

• We compile and thematically analyse extant definitions of global health and propose grounded theoretical insights into what might be seen as relevant for establishing a common definition of global health moving forward.
• The need for a clear and concise definition of global health has the highest stakes in the domain of global health policy governance.

What do the new findings imply?

• Stakeholders tend to define the ‘what’ of global health: its spaces, objects and practices. Our findings suggest that the debate around definition should shift to more pragmatic and reflexive questions regarding ‘who’ defines global health and towards what ends.

Debate around a common definition of global health (GH) has seen extensive scholarly interest within the last two decades. In 2009, a widely circulated paper by Koplan and colleagues aimed to establish ‘a common definition of global health’ as distinct from its derivations in public health (PH) and international health (IH). 1 They rooted the definition of PH in the mid-19th century social reform movements of Europe and the USA, the growth of biological and medical knowledge, and the discipline’s emphasis on population-level health management. Similarly, they traced the evolution of IH back to its colonial roots in hygiene and tropical medicine (TM) through to the mid-20th century with its geographic focus on developing countries. GH, they argued, would require a distinctive definition of its own to be ‘more than a rephrasing of a common definition of PH or a politically correct updating of international health’. Their intervention built on prior research noting confusion and overlap among the three terms and thus a need to carefully articulate the important differences between them. 2–5 Additional stakeholders have since elaborated varied definitions of GH, yet consensus around its precise definition remains elusive.

To determine how GH is presently defined and to identify whether a common conceptualisation has been established, we conducted a qualitative systematic literature review (SLR) of the GH literature between 2009 and 2019. SLRs are a methodology used ‘to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question’. 6 Unlike unsystematic narrative reviews, SLRs use formal, repeatable and transparent, procedures for identifying, evaluating and interpreting available research, thus ensuring robust coverage of the current literature while reducing the biased presentation of available evidence. 7–9 Medical researchers and policy-makers have long relied on SLRs because they integrate and critically evaluate current knowledge to support decisions about important issues. 10 However, very few SLRs exploring aspects of GH have yet been published, 11–13 and no SLRs focusing on extant definitions of GH have been conducted. This paper fills that gap by exploring the thematic components of extant definitions and thereby contributes towards a comprehensive definition of GH.

Aims and objectives

The aim of this review is: (a) to examine how GH has been defined in the literature between 2009 and 2019, (b) to systematically analyse the core thematic categories undergirding extant definitions of GH and (c) to offer grounded theoretical insights into what might be seen as relevant for establishing a common definition of GH.

Aiming to capture definitions of GH in literature between 2009 and 2019, our team conducted a systematic review of the peer-reviewed literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines ( figure 1 ). 14 The sequential steps of our review process included the following.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of citation analysis and systematic literature review. 14

Search strategy: identify papers and relevant databases

Search technique.

The terms ‘global health’ AND ‘define’ OR ‘definition’ OR ‘defining’ were queried when they appeared in the title, abstract or keyword of studies. Published studies were identified through comprehensive searches of electronic databases accessible through the authors’ university library system (Web of Science, Scopus, Embase, PubMed, EBSCO). Citation tracking through Google Scholar was also completed.

Study selection criteria

Articles published in international peer-reviewed journals, including conference papers, book chapters and editorial material, were reviewed. The studies included were written in English and published between 2009 and 2019. The year 2009 was chosen as a starting point because this is the year in which Koplan et al published ‘Towards a Common Definition of Global Health’. For this review, the team excluded news articles, theses, book reviews and published papers that were not written in English.

Assessment strategy: appraise which papers to include in review

The protocol-driven search strategy required that articles included in the review must: (a) contain the keywords ‘global health’ and ‘definition’ and/or ‘define’; (b) be in the English language and (c) be published between 2009 and 2019. The number of articles containing these keywords was recorded, and all the titles uncovered in the search were imported into Mendeley, a software for managing citations. Duplicates were identified and removed, after which abstracts were screened to assess eligibility against the inclusion criteria. Full-text articles were retrieved for those that met the inclusion criteria and three team members read a designated number of the articles selected for full review. To be included in the data extraction sheet, each article needed to: (a) focus on and explicitly name GH, (b) offer an original definition or description of GH and/or (c) cite an already-existing definition of GH. Articles that mentioned the query terms without any relation to these requirements (eg, did not provide a definition of GH or descriptive data to support interpretations of a GH definition) were excluded. Assessment for relevance and content was conducted by two investigators who reviewed all identified articles independently. Disagreements were resolved by consensus with a third investigator.

Synthesis strategy: extract the data

Based on the research goals, the team designed an initial coding template in Google Sheets as a method of documentation, with the following coding variables: author, title, typology, definition(s), conclusions and conceptual dimensions. To achieve a high level of reliability, the review team open-coded the same five articles, compared their coding experiences, and reconciled differences before adopting a final coding template and evenly dividing the remaining articles to be analysed. Extracted data included the type of study or research paradigm of each publication, the location and disciplinary affiliation of each study based on the contact information of the corresponding author, definitions and descriptions of GH and specialised dimensions of GH. Whenever articles contained more than one definition or description of GH, those items were organised line-by-line under the author on the data extraction sheet.

Analysis strategy: analyse the data

The team conducted thematic analysis of the data to understand how GH has been defined since 2009. Our approach to thematic analysis was based on the guidelines described by Thomas and Harden 15 and further informed by principles in grounded theory. 16 Our strategy consisted of three main stages: Initial Coding—remaining open to all possible emergent themes indicated by readings of the data; 16 17 Focused Coding—categorising the data inductively based on thematic similarity at the level of description 17 and finally, Theoretical Coding—integrating thematic categories into core theoretical constructs at a higher level of analysis. 18

In the first cycle, open descriptive codes were generated (eg, differences between PH and IH, GH education requirements, social justice values) directly from the definitions and descriptions of GH found in the articles. Individual sentences defining or describing GH were treated as unique line items on the data extraction sheet and coded accordingly in order to generate a range of ideas and information on which to build.

In the second cycle, a focused thematic analysis was carried out to identify general relationships and patterns among definitions in the literature and to confirm significant links between the openly coded data. Thematic phrases (eg, GH is multidisciplinary, GH promotes equity) were developed and reapplied to coded definitions on the data extraction sheet. Team members wrote and attached analytic memos to each coded datum—reflecting on emergent patterns and further ‘codeweaving’, 18 which is a term for charting possible relationships among the coded data. At this stage, additional coding techniques were utilised. Attribute coding was applied as a management technique for logging information about the characteristics of each publication. 19 Data segments coded in this manner were extracted from the main data extraction form and reassembled together in a separate Google Sheet for further analysis. The team also coded extracted definitions of GH by type: (a) original definition, (b) cited definition, (c) original description to track possible relationships between citational practices and developments in the conceptualisation and definition of GH.

In the third cycle, thematic phrases were ordered according to frequency then commonality and abstracted for overriding significance into theoretical categories. At this stage, the conceptual level of analysis was raised from description to a more abstract, theoretical level leading to a grounded theory. This resulted in the construction of four thematic categories, which are presented below with their supporting subthemes.

Patient and public involvement

Patients and public were not directly involved in this review; we used publicly available data for the analysis.

The search strategy retrieved bibliographic records for 1363 papers. The assessment strategy resulted in the elimination of 1237 papers after the removal of duplicates. Consequently, 78 papers were subjected to our strategies of synthesis (data extraction) and analysis.

Characteristics of study

A variety of studies were included in this review. The majority (27) were commentaries, viewpoints or debates. 1 20–48 Twenty-four were grouped as review/overview articles. 45–68 There were 25 original research articles, of which 13 used qualitative methods, 69–81 11 used mixed-methods 82–92 and one 93 used quantitative data from a survey to proffer definitions of GH. Two studies included in the review were book chapters. 94 95

The typologic, geographic and disciplinary distribution of the studies in this review are shown in table 1 . Most studies were authored in North America (40), 1 20–31 39–41 43 46 47 50 54–58 61 63 66 68 70 73 74 76–80 83 84 86 87 89–91 94 followed by European countries (29), 22 26 28 32 34–38 42 44 45 48 51 52 59 62 64 65 67 71 75 82 85 88 92 93 95 96 countries in Asia (2), 33 72 Latin America and the Caribbean (2), 60 81 and New Zealand (1). 20 Disciplinary fields represented in our sample included health (56), 20 22–27 30–32 34–40 42 43 45–51 54–56 58–61 63–69 72 74 75 77–79 82–84 86 88–91 93 95 law, social and cultural professions (19), 1 20 28 29 33 41 44 52 53 57 62 70 71 73 76 80 81 87 92 94 and education (2). 20 31

Summary of characteristics of retrieved publications

Attributes of definitions

All 78 studies under review defined, described and/or cited extant definitions of GH. The 34 papers shown in table 2 included descriptive definitions of GH that were formulated distinctly by its authors, that is, they were presented as original and without direct reference to other definitions.

How global health has been defined by academics since 2009

Several scholars engaged directly with the Koplan et al definition of GH 1 to stipulate definitions of their own. For example, some authors proposed amendments to Koplan et al that would place greater emphasis on inequity reduction and the need for collaboration, 20 particularly with institutional partners from developing countries. 73 Others were more critical of the broad yet weak conceptual idealism 86 of Koplan et al and recommended detaching normative objectives from its definition, 26 such as the value-laden concept of equity, which could compromise the definition’s technical neutrality by rendering it ideological. 91 Other authors sought to analytically clarify the meaning of ‘the global’ 26 in the definition provided by Koplan et al , distinguish it more clearly from IH 78 or dispute their distinction between GH and PH. 27 Indeed, the impact of the definition of GH proposed by Koplan et al has been substantial. It was variously adopted by the Consortium of Universities for Global Health, 47 the Canadian government, 23 Global Health for Family Medicine, 89 the German Academy of Sciences 75 and the Chinese Consortium of Universities for Global Health. 77

In general, GH was defined as a term, 37 51 95 and in particular, an umbrella term 49 75 or a concept; 69 and more broadly as a zone 76 or field 32 48 91 94 or area of research and practice, 1 56 as an achievable goal, 50 an approach, 48 82 a set of principles, 45 83 an organising framework for thinking and action 96 or a collection of problems. 35 94 GH was frequently contrasted to IH 32 35 68 69 94 95 and PH, 20 21 31 32 35 or else seen as indistinguishably from PH and IH. 27 Additionally, several papers explicitly specified and subsequently defined certain dimensions of GH, such as ‘global health governance’ (GHG), 32 33 35 38 42 51 52 58 69 80 81 87 ‘global health diplomacy’ (GHD), 24 28 95 ‘global health education’, 36 39 46–49 59 70 74 75 77 78 82 89 93 ‘global health security’, 26 41 76 88 92 97 98 ‘global health network’, 41 81 ‘global health actor’, 52 ‘global health ethics’, 69 ‘global health academics’ 64 67 and ‘global health social justice’ 61 (see table 3 ).

Frequently defined facets of ‘Global Health’ with exemplary definitions

Grounded theory approach based on thematic analysis

Definitions and descriptions of GH were aggregated into nine thematic codes reflecting the contents and scope of GH definitions, the functionality of those definitions and/or perceptions about defining GH. Codes were: (1) GH is a domain of research, healthcare and education, (2) GH is multifaceted (disciplinary, sectoral, cultural, national), (3) GH is rooted in a commitment to equity, (4) GH is a political field comprising power relations, (5) GH is problem-oriented, (6) GH transcends national borders, (7) GH is determined by globalisation and international interdependence, (8) conceptually, GH is either similar or dissimilar to PH, IH and TM and (9) GH is perceived as definitionally vague.

These codes were grouped selectively into higher analytical categories or theoretical statements as grounded in the literature: (1) GH is a multiplex approach to worldwide health improvement and form of expertise taught and researched through academic institutions, (2) GH is an ethos (ethical orientation and appeal) that is guided by justice principles, (3) GH is a mode of governance that yields degrees of national, international, transnational and supranational influence through political decision-making, problem identification, the allocation and exchange of resources across borders, (4) GH is a polysemous concept with many meanings and historical antecedents, and which has an emergent future ( table 4 ).

Defining global health with grounded theory analysis—table of themes, code categories and quotes from text

IH, international health; PH, public health; TM, tropical medicine.

Theme: global health is a multiplex approach to worldwide health improvement taught and pursued through research institutions

Subtheme: gh is a domain of research, healthcare, education.

GH was repeatedly defined as an active field of knowledge production that is composed of the following key elements: research, education, training and practice related to health improvement. 1 20 21 23 32 33 35 38 40 44–49 52 55–58 61 63–69 72 74 75 77 78 80 82 90–92 94 Few authors defined GH as a new, independent discipline within the broader domain of medical knowledge, 17 33 38 46 63 74 80 82 90 and some outlined discipline-specific competencies that were considered integral to the definition of GH, at least in curriculum development; for example: clinical literacy, 80 medical humanities, 82 cross-cultural sensitivity, 33 38 46 59 63 80 90 experiential learning 47 and critical thinking skills. 72 82 Several authors defined GH as a diffuse arena of scholarship that spans an array of academic disciplines, including anthropology, engineering, law, agriculture and healthcare administration. 44 56 59 63–65 78 91 94 Others defined GH explicitly as a ‘transdiscipline’ that seeks to transcend the restricted gaze of any single discipline and consequently integrate knowledge from a variety of sources. 67 94 Several authors explicitly defined GH as a necessarily collaborative field. 1 20 22 24 36 43 45 47 57 61 63 68 77 78 80 91

Subtheme: GH is multifaceted (disciplinary, sectoral, cultural, national)

The prefix ‘multi-’ was consistently applied in definitions of GH to describe a perspective that focuses on the multitude of interrelated factors, dimensions, values and features that underpin health as well as efforts to improve and study it. There was broad agreement that multidisciplinarity is a defining characteristic of GH. 1 23 25 32–34 36 38 40 45–47 49 52 55–57 59 60 64–69 72 75 77 78 80 82 91 However, there was some debate whether multiple disciplines are always needed and beneficial—and therefore essential—to the definition of GH. 23 One author argued that the multidisciplinary nature of GH is precisely what differentiates it from PH and IH. 68 Although some claimed that GH, with its focus on social and economic determinants, is inherently ‘predisposed to include aspects of the liberal arts and social sciences’, 75 others critically observed that most GH educational opportunities still cater predominantly to medical students, 32 35 48 72 which suggests that greater efforts will be required to achieve multidisciplinarity in the field moving forward.

There was a correspondence between GH definitions citing multidisciplinarity and cultural competency. 32 33 38 48 49 56 78 82 90 Curiously, multisectorality was less frequently mentioned than multidisciplinarity in definitions of GH, though it was referenced in some papers. 20 22 43 52 66 83 86 95

Theme: global health is an ethical initiative that is guided by justice principles

Subtheme: gh is rooted in values of equity and social justice.

Equity and social justice were the two most commonly and explicitly referenced values undergirding GH definitions and goals. Equity was repeatedly framed as a ‘main objective’ 60 and core component of GH research and practice. 23 25 43 46 48 53 66 67 77 78 84 However, it remains unclear whether the authors in our sample share the same meaning of equity. Velji and Bryant defined equity broadly as ‘ensuring equal opportunities and resources to enable all people to achieve their fullest health potential’. 66 Meanwhile, others rooted their conceptualisation of equity more specifically in the principles of social justice 30 61 69 88 89 or the human rights concept of equality, 54 62 67 83 86 which asserts that ‘all people are equal in regard to dignity and rights, regardless of their origin and all biological, social or other specific differences’. 59 This postwar sensibility echoes the 1978 Alma Ata Declaration of ‘health for all’, 20 24 as well as a traditional humanitarian ideal, even if now associated with principles grounded in national and global security. 24 54 88

Occasionally, the terms ‘equity’ and ‘equality’ were used interchangeably, suggesting they possess a commonly shared valence and reciprocal relationship despite slight differences in signification. Whereas equity refers to the provision of resources and opportunity based on specific needs, equality connotes providing the same level of resources and opportunities for all. 86 Nevertheless, other scholars questioned whether equity or equality should be included in official definitions of GH, at all, 27 48 75 insofar as what counts as ‘equitable’ for one country may be different for another. 26 32 48

Theme: global health is a form of governance that yields national, international, transnational and supranational influence through political decision-making, problem identification, the allocation and exchange of resources across borders

Subtheme: gh is a political field comprising power relations at multiple scales.

Numerous papers defined GH as embedded within a political field comprising power relations at multiple scales. 20 22–24 26 28 29 31–33 35 41 42 45 48 51–54 56 58 60 63 66 70 72 76 79 87 95 ‘Political field’ refers here to a sphere of influence and jurisdiction wherein institutions determine governing modalities (eg, laws, policies, instruments) to assure a range of activities, such as determining priorities, coordinating stakeholders, regulating funding mechanisms, establishing accountability, allocating resources and providing access to health services for the general public. ‘Power relations’ refers to the capacity of institutions, individuals, instruments and ideas to affect the actions of others; and ‘at multiple scales’ refers to levels of analysis (ie, worldwide, regional, national, local, etc.).

Within the literature on GHG and GH security, authors argued the need for a universal definition of GH to shape policy frameworks that ensure compliance with IH law. 32 45 51 88 95 Here, it is important to note that the ability to shape GH policy is, itself, an exercise in power: some GH actors, defined as ‘individuals or organizations that operate transnationally with a primary intent to improve health’, 56 are more capacitated than others to impact the formulation of policies and amount of attention and resources that certain GH issues receive. 32 41 45 52 95 For example, several papers discussed how ‘GH actors’ like the World Bank and the WHO shaped discussions around the response to Ebola, leading to refined definitions of GHG 35 87 88 and GH security. 41 Similarly, definitions of GH in line with the 2015 United Nations Millennium Development Goals, were also commonly referenced, 25 35 45 51 reflecting the influence of certain GH actors on the conceptualisation of GH.

Subtheme: GH is determined by globalisation and international interdependence

Numerous authors linked interdependence and accelerating globalisation (the process of integrating governments and markets, and of connecting people worldwide) with the need for a cohesive definition of GH, particularly to address issues of governance. 24 32 35 45 68 88 GHG and GHD were outlined as two influential subdomains in which the interconnections between globalisation, foreign policy and international relations were viewed as indispensable to definitions of GH. Two articles quoted David P Fidler’s definition of GHG as ‘the use of formal and informal institutions, rules, and processes by states, intergovernmental organizations, and nonstate actors to deal with challenges to health that require cross-border collective action to address effectively’. 35 58 Elsewhere, GHD was described as ‘bringing together the disciplines of public health, international affairs, management, law and economics and focuses on negotiations that shape and manage the global policy environment for health’. 95

Subtheme: GH issues transcend national borders

Across several papers, we observed a common refrain that GH ‘crosses borders’ and ‘transcends national boundaries’. 1 20 23 42 45 52 60 67 68 74 Authors frequently described GH concerns as those exceeding the jurisdictional reaches of any individual nation-state alone. 34 42 45 51 52 54 77 95 One paper claimed that GH is ‘transnational by definition’, 74 and others characterised GH problems as those experienced transnationally. 20 32 48 50 68

Studies focusing on GH research and training frequently referenced specific diseases and health risks that ‘transcend national borders’ alongside parallel recommendations to include an international component in the development of GH curricula. 16 48 49 63 74 93 While crossing national borders to research and promote health for all is widely perceived as an historical condition for GH 24 that has led to GH’s emergence as an academic discipline, 63 several scholars argued that GH should also focus on domestic health disparities 1 27 38 46 and for local issues to be simultaneously understood as universal or worldwide 48 74 75 to the extent they may occur anywhere 22 and are almost always impacted by global phenomena. 56

Subtheme: GH is problem-oriented

Medical anthropologists, Arthur Kleinman and Paul Farmer, described GH as a collection of problems rather than a distinct discipline. 35 94 Several authors in our review delineated GH problems through identification of specific diseases, such as HIV/AIDS, malaria, TB, Zika and Ebola. 24 29 30 35 45 83 Lee and Brumme noted that it has become common for experts to define GH problems by identifying their objects, namely diseases, population groups and locations. 58 Indeed, some authors outlined GH problems as the set of challenges ‘among those most neglected in developing countries’, 86 among them: emerging infectious diseases and maternal and child health; 43 65 diabetes, cardiovascular disease and other noncommunicable diseases in ‘local’ communities 25 63 and even neurological disorders among refugees arriving in Europe. 93 How these types of object-based definitions of GH problems come to shape GH agendum is important to note.

Clark made a compelling argument against the definition of GH problems in terms of specific diseases, writing that such ‘medicalisation’ may ‘prove detrimental for how the world responds and resources actions designed to alleviate poor health and poverty, redress inequities, and save lives’. 72 Brada also argued against defining GH problems geographically and instead urged experts to consider how the processes by which GH and its quintessential spaces, namely ‘resource-limited’ and ‘resource-poor settings’, are actively constituted, reinforced and contested. 70 Several authors similarly suggested that focusing on the social, political, economic and cultural forces contributing to health inequity and diseases of poverty better captured the scope of GH problems than naming any particular set of diseases or places in the world. 33 43 56 58 69 72 73 86 92

Lack of consensus regarding what counts as a ‘true’ GH problem was linked to the lack of a clear and concise definition of GH. Indeed, several scholars argued that the current inability to define GH made it difficult for stakeholders to define precisely what the ‘problem’ is. 44 45 48 86 Furthermore, the diagnosis of GH problems determined what types of GH ‘solutions’ were proposed in response. For example, when GH problems were defined as universally shared and transnational, then cross-border solutions were developed; when GH issues were framed epidemiologically in terms of distributed risk, then actions targeting specific determinants and burdens were proposed. 1 20 23 67 68 92 When GH problems were framed as threats to inter/national security, strategies were formulated to protect borders, economies, health systems and to improve surveillance mechanisms. 41 45 54 76 80 88 When the problem of inequality drove definitions of GH, recommendations to alleviate poverty, food insecurity, poor sanitation, etc. were proposed. 32 53 60 72

Although Kuhlmann suggested that GH tends to over-prioritise problem-identification to the detriment of critical solution-oriented work, 31 our analysis suggests that the type, scope and quality of solutions proposed are contingent on the elaboration of problems. Similarly, Campbell wrote, ‘Unlike a science or an art, the field of global health is very much about providing solutions to current problems. As such, it would be short-sighted not to consider the causes of global health problems in order to better formulate the solutions. The causes ought to be included in a comprehensive and complete definition of the field’. 23

Theme: global health is a polysemous concept with historical antecedents and an emergent future

Subtheme: gh is conceptually dis/similar to ph, ih and tm.

GH was consistently traced back to and compared with PH, IH and TM. 1 20 27 32–34 43 57 69 71 75 84 86 88 Disagreement or confusion regarding the degrees of similarity and difference between these domains seemed to stem from a shared understanding that GH, in fact, evolved to a varying degree from each of these fields and does not, therefore, denote a clear-cut break with nor full-blown departure from any of them. 84 94

Several authors argued that the scope and scale of GH is distinct from PH. 1 20 32 69 71 Some argued that ‘public health is equated primarily with population-wide interventions; global health is concerned with all strategies for health improvement,’ including clinical care; 20 and that ‘public health acknowledges the state as a dominant actor, (while) global health recognizes the rise of other actors like international institutions’. 35 GH was also seen as placing a greater emphasis on multidisciplinarity and promoting a more expansive conceptualisation of ‘health’, itself, compared with PH. 69 Beyond the prevention of and response to biomedicalised health risks at the population level, Rowson defined GH as oriented towards the ‘underlying determinants of those problems, which are social, political and economic in nature.’ 32 It is questionable, however, to assume similar notions of health have not also been pursued in PH. Meanwhile, opposing views found GH and PH conceptually indistinguishable, 27 43 86 either as terms that could be used interchangeably, 95 or else as coconstitutive of one another, such that PH could be understood as a descriptive component of GH. 33 86

Differences between GH and IH echoed those drawn between GH and PH. For example, GH was characterised as more attentive to multidisciplinarity, while IH was said to implement a more limited biomedical approach to healthcare and health research. 1 69 95 Undergirding a major point of distinction between GH and IH was the belief that IH focuses on health problems in developing countries 1 22 32 43 45 48 54 83 86 93 and relies on ‘the flow of resources and knowledge from the developed to the developing world’, 32 whereas GH either is, or should be, more bidirectional. 1 45 84 In other cases, GH was described as comparable to IH, for example, when countries link GH efforts with development aid. 86 This is because the emphasis on delivering aid to poor countries reinforces an image of the world’s poor as needy subjects and, therefore, marks a continuation of IH and its sentiments under the guise of GH. 35

Finally, the field of TM was referenced to describe the evolutionary track of GH, particularly that GH is a modern-day product of the former. 20 25 57 69 75 84 A few authors critically pointed out that although GH has generally replaced TM and IH as terms embedded in histories of colonial power relations, many of the contemporary structures for governing and/or facilitating GH between countries today have remained largely the same, 25 48 54 62 suggesting that distinguishability between these terms too often occurs at the level of semantics.

Subtheme: GH is still vaguely defined

While GH was often described as a popular and well-established term, another key attribute repeated across the literature was its enduring vagueness. 23 25 26 31 33 43 45 48 52 62 74–77 81 86 Indeed, most papers commented on the term’s defiance of easy definition, its ambiguity and the lack of clarity regarding how people and organisations engaged in GH are using (or not using) the term to describe their interests. For example, Beaglehole and Bonita pointed out that research centres in low-income and middle-income countries are often engaged in GH issues but under other labels. 20 Some authors viewed the present lack of a clear and common definition as an obstacle endangering the coherence and maturation of the field. 33 35 45 For others, this indistinctness was thought to be precisely what gives GH such wide applicability, a certain degree of currency and political expediency. 45 76 81 86

A major concern cited was the lack of guidance for defining the term ‘global’ in GH. 26 34 43 48 75 As Bozorgmehr has outlined, the term is often used interchangeably within the GH community to mean ‘worldwide’, ‘everywhere’, ‘holistic’ and/or ‘issues that transcend national boundaries’. 48 This trend was noticeable within our review, as well. Engebretsen emphasised that GH ‘does not only allude to supranational dependency within the health field, but refers to a norm or vision for health with global ambitions’. 26 This view suggests that because the planet is populated by a multiplicity of positionings, perspectives and diverse world views, there can never be a truly a universal definition of ‘the global’ nor a global consensus around the definition of GH.

Finally, among studies that conducted original research into the definition of GH, several reported that study participants could not reach consensus on a definition. 52 74 75 77 Many thought it would be difficult if not impossible to arrive at a single, unified theoretical definition of GH, yet considered it important to formulate an operational definition of GH for guiding emerging activities related to GH. 23 45 77

This is the first study to systematically synthesise the literature defining GH and analyse the definitions found therein. All of the articles included in this study were published in peer-reviewed journals since 2009 indicating recent and steadfast interest in the topic of GH’s definition. This review examined GH definitions in the literature, and our thematic analysis focused on identifying recurrent themes across different definitions of GH.

Of the 78 articles included in this study, approximately one-third utilised empirical research methodologies to posit definitions of GH or else directly contribute towards the establishment of a common definition. Another one-third of papers summarised and discussed previously published definitions of GH (eg, reviews/overviews), while the remaining one-third suggested definitions of GH that were less grounded in analysis of empirical data than in the perspectives of its authors (eg, editorials, viewpoints). This systematic analysis indicated that the question of GH’s precise definition marks a point of controversy across fields of expertise. The variety of GH definitions posited by diverse experts in search of a common definition indicate that GH is multifaceted and polysemous.

In its broadest sense, GH can be defined as an area of research and practice committed to the application of overtly multidisciplinary, multisectoral and culturally sensitive approaches for reducing health disparities that transcend national borders. Indeed, it was most commonly defined across the literature in such general terms.

More specific definitions of GH were, of course, proposed by and considered valuable for many stakeholders in our review. Our analysis indicates that the precise definitions proposed by different experts were devised to serve particular functions. For example, narrow and concise definitions of GH were most frequently sought in the domains of governance and education, primarily for steering the development of policy frameworks and curricula, respectively. The imperative for an exact definition of GH in these subfields may be linked to bureaucratic demands for demarcating a technical term under which to classify specific activities, standardise certain functions, administer funds and direct workflow accordingly. It is also in this domain that authors most vociferously decried the absence of a unified and concise definition of GH, arguing this lack has led to ineffective initiatives, elusive methods for establishing accountability and instances of resource allocation based on ad hoc criteria—attractiveness to donors, public opinion, development agendum, foreign, economic or security policy priorities and so on—rather than via transparent mechanisms for adjudicating health need. 28 54 58 65 83 In contexts where health needs and upstream challenges were articulated, the lack of an agreed-upon definition oft impeded the policy process because stakeholders could not discern which GH issues among the multitude of different problems labelled as important were, in fact, the most pressing. 24 45 52 Because political indecision ramifies disproportionately for publics in countries where reliance on GH aid is a matter of life and death, establishing a clear definition of GH seems most crucial for the domain of governance.

We also found that detailed descriptions of GH’s specific conceptual and functional dimensions tended to reflect the specialisations or discipline-specific priorities of their authors. For example, definitions of GH stipulating the primacy of ‘cultural competency’ and ‘multidisciplinarity’ were more commonly proposed by interdisciplinary professionals in the literature on GH education than in journals of health policy, where definitions of GH were oriented more toward ‘security’ and ‘governance’ concerns. This suggests a correspondence between the subjective, experiential positions of the definers and the vocabulary they used to define or frame the need to define GH.

Unsurprisingly, we found that health professionals proposed the majority of definitions of GH in the literature. Additionally, the majority of publications and their authors were from higher income countries. Several authors in our review critically observed that GH has become institutionalised at a faster rate in higher income countries compared with lower and middle-income countries. 20 48 63 72 77 82 Their observations combined with our findings suggest that extant definitions of GH published in the literature or otherwise circulating in academic and professionalised spaces may unevenly reflect the interests and priorities of stakeholders from higher income countries. This suggests a need for greater diversity and inclusion in the debate on GH’s definition, as well as further reflexivity regarding who is defining GH, their means and motivations for doing so, and what these definitions put into action.

Interestingly, several articles published since 2019 have extended the debate on this topic of GH’s definition by directly engaging questions of geography and positionality: a recent commentary by King and Kolski defining GH ‘as public health somewhere else’ was met with pushback by those who argue that spatial definitions of GH are limited and limiting. 99–102

Limitations

To determine how GH is defined by experts in the literature, we ensured that the selection criteria developed for this study were broad enough to include a wide range of perspectives. Therefore, we included articles with varying degrees of evidentiary support, such as viewpoints, commentaries and editorials. Consequently, the results may be influenced by some of the primary researchers’ assumptions, projections, and biases. Backward citation tracking was used to add relevant articles to the review that had not been initially identified through database searching. This ensured that the review was exhaustive, however it also means that some conclusions drawn in the thematic analysis may have been influenced by this manual search strategy. By applying qualitative methods, this review provided a robust analysis of the thematic categories undergirding extant definitions of GH. A major limitation of this form of analysis is the extensive time required to develop and establish a code book and standardise the three coders’ use of the code book. However, this was deemed necessary to ensure consistency of judgement and intercoder reliability at each stage in the analysis. Another limitation of this study is that only articles written in English were included. To enhance the generalisability of results, future reviews should include data from non-English articles, especially if an inclusive, common definition of GH is to be achieved. Finally, this review was finalised prior to the emergence of the novel coronavirus. As such, future research should take into account new definitions of GH that emerge in light of the pandemic and lessons learnt.

Between 2009 and 2019, GH was most commonly defined in the literature in broad and general terms: as an area of research and practice committed to the application of multidisciplinary, multisectoral and culturally sensitive approaches for reducing health disparities that transcend national borders. More precise definitions exist to serve particular functions and tend to reflect the priorities of its definers. The four key themes that emerged from the present analysis are that GH is: (1) a multiplex approach to worldwide health improvement taught and researched through academic institutions; (2) an ethos that is guided by justice principles; (3) a mode of governance that yields influence through political decision-making, problem identification, the allocation and exchange of resources across borders and (4) a polysemous concept with historical antecedents and an emergent future. Findings from this thematic analysis have the potential to organise future conversations about which definition of GH is most common and/or most useful. Future discussions on the topic might shift from questioning the abstract ‘what’ of GH to more pragmatic and reflexive questions about ‘who’ defines GH and towards what ends.

Acknowledgments

Helpful comments by anonymous reviewers are acknowledged with thanks.

Handling editor: Seye Abimbola

Contributors: MS initiated and designed the project. MS, MA and MM contributed to the implementation of the research, to the collection of data, analysis of the results and to the writing of the manuscript. PC supervised the project and provided feedback on the manuscript.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement

• Global Health Law: International Law and Public Health Policy Words: 1199
• Global Health Policy Issue: Africa Words: 1260
• Global Health Issues: On the Border Line Words: 899
• Why Is Public Health Important Words: 1221
• Health Systems and Working Together for Global Health Words: 656
• Health Problems of Aboriginal Communities in Canada Words: 601
• Global Health History and Evolution Words: 804
• Nursing Migration and Global Health Words: 724
• The Mental Health Problem in New York City Words: 2038
• Aspects of Global Health Issues Words: 1379
• Social Determinants of Health Words: 624

Global Health Problems and Their Impact

The global community faces problems every day. Some problems are related to the economical situation in the world whereas others are aimed at developing methods of treatment of global health problems. In this respect, there are different approaches to the same problems and, in this case, the global community should make an effort to overcome the problems in a unified way using coordinating mutual attempts in the way of reaching a common goal.

However, I decided to choose the disease that was confined to the third world and developing countries, and now the rest of the world including developed countries is affected. This disease is called dengue fever; it became more ‘international’ after the development of tourism, different international programs on assistance and cooperation, and missions aimed at the establishment of economic and political relations between countries. But I think that tourism now remains one of the main reasons for the spread of this disease.

The nursing practice area should be prepared in accordance with the increasing number of cases when people fall ill and do not know the symptoms and possible algorithm of actions in similar situations. In this respect, people that come from exotic countries that are most frequently are those of the third world should bear in mind the possibility of falling ill. A complex approach should be used to overcome difficulties relevant to global health problems and international methods of treating those. As some countries can fail to take preventive measures in the treatment of dengue fever, nurses should not exclude the possibility of their patients being a carrier of various viruses. For instance, dengue fever should be treated correspondingly to its nature and prevented in numerous cases, whenever possible.

Dengue fever can be considered one of the global health problems that should be treated by a complex approach appropriate for the international community members. Besides, not only nurses but doctors, “sanitarians, law enforcement, media, lawyers”, and representatives of other related areas should take part in the treatment and preventive measures, as reported by Benjamin (n.d.). In this respect, nurses can gain experience while collaborating with members of the complex approach team including the acquisition of skills necessary for the treatment of global health problems and anticipation in international programs.

Thus, regarding the current situation in the global health sector, the US government should take measures appropriate for the public health community sector such as “Put more resources into achieving [goals]; focus on activities for achieving them; hold certain people accountable if goals are not met” (Benjamin, n.d.).

Dengue fever is a serious disease “[w]ith more than one-third of the world’s population living in areas at risk for transmission, dengue infection is a leading cause of illness and death in the tropics and subtropics” (Center for Disease Control and Prevention, CDC, 2010). As you can see, this problem requires resources that are taken in accordance with the situation contrasted to those when people use resources at hand.

Thus, the study by Maurer & Smith (2005) emphasizes the importance of specific preparation for nurses to deal with global health problems adequately (p.3). In other words, all possible algorithms should be taken into account and a special solution must be found for each problem. This means that every person, every member of the team should take a global approach while visualizing the situation and weighing up all pros and cons of various decisions.

As suggested by Benjamin (n.d.), more emphasis should be given to the role of the public in solving global health problems. So, it is necessary to inform the population about different diseases and encourage them to react immediately to the symptoms and take appropriate measures for preventing some diseases. Knowledge can be the most effective as the most destructive weapons while dealing with global health problems. In other words, there is a vague difference between informing people about some diseases and effects produced by certain vaccines and making people panic. In this respect, a nurse is a member of the global community and a professional that solves global health problems adequately.

Benjamin, G. (Executive director). (n.d.) Scope of community/public health . The practice of population-based care week 1. Web.

Center for Disease Control and Prevention (CDC). (2010). Dengue. Web.

Maurer, F. A., & Smith, C. M. (2005). Community/public health nursing practice: health for families and populations . 3 rd ed. Philadelphia: Elsevier Health Sciences.

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Suffering without remedy: the medically unexplained symptoms of fibromyalgia syndrome and long covid.

1. Introduction

Situating fibromyalgia syndrome & long covid, 2. diagnostic categories and illness experiences, 2.1. fibromyalgia syndrome as diagnosis, 2.2. fms as illness experience, 2.3. long covid as diagnosis.

• Post-COVID-19 Condition, The World Health Organization: Post-COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. (Source: https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition Accessed on 1 August 2024)
• Post-COVID-19 Syndrome, The United Kingdom National Institute for Health and Care Excellence (NICE): Signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis. (Source: https://www.nice.org.uk/guidance/ng188/chapter/1-Identification#case-definition Accessed on 1 August 2024)
• Post-COVID Conditions, The United States Centers for Disease Control: An infection-associated chronic condition that can occur after SARS-CoV-2 infection, the virus that causes COVID-19, and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ system. (Source: https://www.cdc.gov/covid/long-term-effects/?CDC_AAref_Val = https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/ Accessed on 1 August 2024)
• Post-Acute Sequelae of SARS-CoV-2 Infections, United States National Institutes of Health: Long-term effects of COVID may be different for everyone and they can affect many different parts of the body, such as the brain, heart, and lungs. And people who have PASC, including Long COVID, can have different kinds of effects. These effects may come and go, and they may last for a few weeks, a few months, or longer. (Source: https://recovercovid.org/long-covid Accessed on 1 August 2024)

2.4. Long COVID as Illness Experience

3. feminization-medicalization and suffering without remedy, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Share and Cite

Moretti, C.; Barker, K.K. Suffering without Remedy: The Medically Unexplained Symptoms of Fibromyalgia Syndrome and Long COVID. Soc. Sci. 2024 , 13 , 450. https://doi.org/10.3390/socsci13090450

Moretti C, Barker KK. Suffering without Remedy: The Medically Unexplained Symptoms of Fibromyalgia Syndrome and Long COVID. Social Sciences . 2024; 13(9):450. https://doi.org/10.3390/socsci13090450

Moretti, Chiara, and Kristin Kay Barker. 2024. "Suffering without Remedy: The Medically Unexplained Symptoms of Fibromyalgia Syndrome and Long COVID" Social Sciences 13, no. 9: 450. https://doi.org/10.3390/socsci13090450

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