The current public health systems of the world are undergoing many transitions. Many factors are coming into play in this regard and the new trend has been the introduction of globalization and the concept of international health. This area is under much debate and scrutiny, but all agree that if cultivated properly, this can lead to much improvement and the heath care systems of the world. The American health care system is perhaps one of the most advanced health care systems of the world, yet it is suffering from lack of coordinated design and infrastructure, improper allocation of funds, and improper use of the resources at hand. More and more Americans are now being affected by these changes, the result of which is that more and more Americans are without health insurance. Unless we understand the major factors and findings of the different health care systems of the world, we cannot implement or develop strategies that can help in creating a good global health care system.
The value of human life although much said upon, is still perhaps the most unvalued. Humans have been given the capacity to live their lives with the help of advanced and most progressive minds that nature has bestowed on any living thing. This mind has been responsible for the astounding development that mankind has been able to achieve in a very short span of its journey on earth. And yet man still has to go further.
With the evolution of the human society came the realization of the importance of good health and sanitary conditions. Thus the first primitive health care systems formed where a village doctor would remedy patients’ illnesses with the help of potions and herbs. As time evolved more and more was learnt about the different drugs, techniques and methods to alleviate pain and disease, and restore health. The first signs of health care system came in to being, which were based on the doctor and patients relationship. The simple health care provider system thus established where the doctor was paid directly for the services he or she rendered.
It was later on that the true foundations of health care system developed. As this area progressed, it organized into many different areas of specialization all united with one cause, to provide better health care to the people. The public health system although has its roots very deep in the past, it was until much later that its full contribution to the health care system fully understood and appreciated.
Public health systems around the world have undergone many rapid and sudden changes over the years. While many changes have been productive, the increased demand on the health care system, coupled with increasing population, increased geriatric patients, increased health care costs, and global trends in health care, all have pushed health care provision to the limit. It is therefore, not surprising to see the current decline in the level of quality health care provision.
The reasons for the decline in the healthcare sector are many and therefore, to identify one problem as the crux of current health care issues is impossible. The different fragments and factors that have evolved during the years, including the most recent climatic changes, are all affecting one way or the other the outcomes in healthcare industry. The modern healthcare industry is not independent from external influences, as it was in the past. Now geological, political, climatic, economical and local factors all are strong determinants of the pattern of healthcare provision in different parts of the world, and together, these different parts form a complex arena of healthcare, unthought-of ever before. These factors may have on the one side given and promoted the health care system, but on the other side, it has increased the complexity of the health care system which was never before. The issues therefore run very deep when it comes to making policies and instituting changes and this complexity is now beginning to affect any steps and effort carried out for health care system’s progression.
The need therefore, of today is to create a global healthcare system, that is applicable any where and everywhere, and which is able to address the needs of a specific location, culture and environment as well. This is a daunting task, for reaching to this utopia mentioned above requires extensive understanding about the different health care systems of the world, and what factors influence them. Identifying the common goals would be a good place to start, but that would be only a scratch in the wall, and will require much more information and understanding to truly inflict change in to the healthcare systems globally.
It is in this respect that the issue of proper definition of the terms global health and international health have also risen from time to time. The details of this debate are given below, however, along side it is a serious debate regarding the potential benefits or losses of globalization in public health. The analysts argue that while there has been much debate about the effects globalization will impart on the health care systems of the world, none so significant have yet been seen. This is because most of the countries and geographical areas have their own set of problems and therefore cannot be simply put into one mould and expected to succeed. This is in many ways true, for the rich and poor country divide seriously dictates the type of health care provision in that region. In this regard, a true health care system for any one region may fail drastically in any other place and the cause may solely be on the ignorance of the needs of the population at hand.
For example, for a country like America or France, where the healthcare systems are one of the most developed in the world, the concerns are about the proper allocation of the resources and creating new ways through which the health care system is able to accommodate more people with minimum loss of time and resources. In a poor country like the countries of Africa, the primary concern is the availability of resources and infrastructure which could then lead to the beginning of a health care system. This is a clear example of the difference of evolution of the two health care systems. While the poor countries may also reach the same position in the years to come, this will not occur unless resources and funding are provided with good policies for such areas.
The first and foremost issue in this regard is the problem of sustenance of such health systems, which will be discussed in detail below. However, around the world, all agree on seven areas which require attention in order to ensure minimum sustenance of the healthcare systems. The first and foremost is providing equal access to healthcare to all, followed by providing transparency in terms of provision of care and its quality. Promoting competition in the healthcare area will promote a culture of research and development and to finding new ways to improve the healthcare system. Cost of different health enterprises has taken a central role in the decision making in healthcare, and therefore, areas such as cost regulation, tax funding, cost sharing, payer controls and rationing in medical technology are now the main areas of focus in the healthcare industry (The Quality Conundrum, 2006). The concepts of providing cheap methods that help improve quality of health are not out of consideration. It is here that the disparities in the health care provision are acutely seen, for the rich and the poor countries both have been seen to fail in providing complete health care to its publics, save for very few countries. All countries whether rich or poor are currently suffering from people who cannot afford health care facilities, rendering them helpless in acquiring them. The provision of health to all therefore does not get limited to the poorer nations, but also to nations sporting the best health care systems, yet not giving coverage to its full public. The increasing costs of health care in this regard may make provision of health a more difficult issue to those already lacking health care facilities.
The complications in the systems of health are mainly due to the increase in the number of players involved in it. Now, health is not simply a matter of physician and patient. Rather it has become a complex web of insurers, hospitals, claims, pharmaceutical companies and the likes. (The Quality Conundrum, 2006) This makes increased parties with increased demands and needs, which in turn make the simple event of a doctor providing care to the patient a thing of the past. This has led to much affects in the pure nature of the health care provider as well, for he or she is forced to work in accordance with the various rules and regulations of the different players and may not be able to exercise full right over the decision for the patient’s health. Incidents where managed care and insurance companies refuse to in allow physicians to provide care to the patients is one of the sad realities of this system. In other words, people may not be allowed to fall sick unless they can afford it.
It is in light of these changes and challenges that governments and healthcare systems around the world are working towards finding new methods of healthcare delivery. The successful models become the areas of further research and progress, and based on these findings, further examples of new systems are now being formulated. The American healthcare system for example, provides healthcare benefits to its people and work by focusing on improving the wellness programs, disease programs etc. A very opposite approach of family practice pay-for-performance program is fast becoming the best healthcare innovation in the UK. In Australia, disease management projects are working to improve patient access to chronic care (The Quality Conundrum, 2006). Countries who are poor are involving their own public to help them improve the overall health of the areas. Many countries have increased awareness programs to prevent the public from the progression of diseases. Many examples of such innovations exist, and all are able to provide some improvement in healthcare, however, they still have a long way to go. The challenges of the healthcare systems are many, and are complicated by the many factors mentioned above. Without realizing the causes of decline in the healthcare, it will be very difficult to come up with solutions that can ensure proper healthcare delivery in the future. And this decline itself can be manifold.
This research article is an attempt to identify the key factors responsible for the current decline and challenges in the public healthcare sector around the world. For this purpose, the challenges faced by many countries will be highlighted, and will broadly include the United States of America and the OECD countries, China, Australia and other major healthcare systems of the world. The problem faced in Africa and the Indian subcontinent due to the AIDS epidemic also will be briefly discussed. The purpose of this multiple country profiling is to invoke a sense of problems that are affecting the healthcare systems in the world today, what factors are influencing them, and what connects these systems to each other. The connection between these countries and regions will clearly delineate the affect of globalization on the healthcare industry and how it is affecting the policies and outcomes in the public health sector.
Globalization will be the central theme in the paper, with attempts to understand the emerging and increasingly growing role it is playing in the dictation of future healthcare planning. By understanding these roles, it will be easier to understand the different methods that can be employed to correct the healthcare systems. The potential role of different international health institutions such as WHO, their contributions and the challenges that they face will also be discussed. The importance of war and the role it plays on the integrity of the area’s healthcare system will also be brought into focus. The debate over the correct definition and meaning of the terms globalization, international health etc. will also be discussed. The effect of climate change, highly priced drugs and the lack of initiatives and funding from various countries in the areas of health will also be briefly overviewed.
In effect, the article aims to outline the role of globalization in context of the healthcare industry, and how it has affected the outcomes and the current situation, as well as outline the potential role it can play in rectifying the current healthcare crises looming above us. While it may not be able to describe completely the challenges in the health care, it will be able to give a general idea about the forces that are driving it.
The public health sector around the world
The importance of health cannot be stressed more forcefully. Health is one of the major contributors and determinants of a populations overall economic level and the kind of living style that they will achieve. Healthy citizens make a healthy human capital, which is directly related to the human growth potential. Good health in any area is it rich or poor is important to the people as it relates to their overall productivity, which in turn will affect their lifestyle. This realization is the chief reasons why most of the evolved and aware countries try to implement a sound health care system in to their populations (Skolnik, 2008, Chapter 3, Essentials of Global Health).
The relevance of health to education and economical development can be graphically illustrated by looking at Africa. Africa is one of the hardest hit areas due to HIV, AIDS and Hepatitis C and B. This continent suffers from extreme malnutrition and famine, and therefore, has many illnesses because of malnutrition. The level of education and its quality is low here due to short attendance, sickness, poverty, and malnourishment. It is this picture that defines the role of health and education in the overall economic growth of a country. This relation is not unilateral however. It is a common observation that countries that have good education standards also have good health status. This is because education helps the people grow aware of the different methods one can undertake to increase health, nutrition and quality of life. In other words, a sound educational system is a very important contribution towards the health of the population (Skolnik, 2008, Chapter 3, Essentials of Global Health). Similarly, the education and literacy level of the women in any area is a very strong determinant of the kind of health the public has.
In a country like Africa, it is not affordable for any person to fall sick as this means a further decline in the health and economical status of the person as well as the family. Such families are unable to afford proper health care services, and therefore, have to revert to other cheap but unsuccessful yet dangerous methods to alleviate illness. Usually such alternatives are uneducated, inexperienced people and at times all out hoaxes. The condition therefore deteriorates even further, further increasing the cost of treatment, and further depriving the person of medical attendance (Skolnik, 2008, Chapter 3, Essentials of Global Health).
Public health has evolved tremendously since its origin and is now the leading health care provider in the healthcare sector. This evolution from backseat position to leader in health has been one of many changes and turmoil. Public health has become an institution in itself, and is simultaneously an “activity, a discipline, a profession, an infrastructure, a philosophy and even a movement.” (Raeburn & Macfarlane, 2003) Public health has been around ever since man understood the significance of hygiene and health in the morbidity and mortality of the population. The first public health models therefore, were sanitation and quarantine models that evolved into multitude of programs such as provision of health and prevention of disease, provision of health information and education, and providing care for different populations and age groups according to their needs.
Epidemiology, public health and prevention programs, health insurance and other such disciplines now form a huge part of the once diminutive public healthcare structure. It is no wonder that the health structures of the past enjoyed more autonomy and independence, compared to the current struggles with the insurance companies, claims, governments and health ministries, and global trends such as antimicrobial resistance, epidemics and AIDS, and economical factors. The present health care system therefore, not only requires a dynamic leadership but also a very open and adaptive one, which is able to understand and identify the various aspects in the current healthcare system and plan accordingly for the welfare and the future of the healthcare system (Raeburn and Macfarlane, 2003).
Public sector perhaps enjoyed this autonomy and superiority as it was centered on the customer or the public itself. Although in the recent years with the advent of insurance and Medicare and Medicaid kind of programs, the main concept was lost. The recent trend however, is the revival of the concept that was placed by our forefathers and extracting the essence of the pure human service that formed the center of public health. This is easier said than done, for the players such as the insurance companies etc. now hold a major portion of the health care sector’s resources, and will not be interested in getting excluded out of the rapidly growing industry. This quest for power and dominance if led to progress can lead to intense competition and debate in this regard.
Yet suffice to say that the public, community and the government collaboration has led to many improvements which may not be possible had the health care systems operated alone. The most promising example has been of provision of clean water in many parts of the globe, especially the Indian subcontinent and Africa. Another such example is the promotion of maternal and child care during pregnancy and after delivery, which has reduced both the mother and infant mortality rates world wide. Efforts to increase and improve the health of infants and mothers and increase the literacy rates among them are also underway. Efforts such as these carried out by the WHO and other such related healthcare societies are positive examples of how community and healthcare sectors can work together to improve the general well being and health of the community (Raeburn and Macfarlane, 2003).
Public health has developed with the aid of many factors and contributors. Its evolution led to the development of many systems in healthcare such as socialized insurance etc., but all systems came with their own set of problems. As mentioned above, the influence of various social and economical factors called to attention the many defects in the health systems, which instead to leading to improvement, led to further degradation of such. With mounting problems and now the new role of global effects and factors in the health care industry, the need for newer systems and hybrid models become not a fantasy, but an urgent need. Care however, is still needed, for while such systems and hybrids may improve situations, they may on the other hand lead to further deterioration of the current systems. This is because there is lack of concrete data about the efficacy of the systems. Such systems can in many instances ignore the primary parties involved such as the patients, the health care providers, and may put priority to parties such as insurance etc. without identifying and understanding the relationship between the patient, the professional and the state, any healthcare system can be jeopardized (Coyne et al, 2002).
On the other hand, ignoring such new concepts and sticking to the old models may not help the matters either. This is especially the case seen with the NHS in the UK, which is struggling to provide proper number of professionals, adequate level of competency and timely provision of health care to its patients. For the UK health care system to improve and progress, it must include the private parties within itself and be more open to changes and directions of the global health care. Not only is there a need to replace but there is a need to reform the old systems that are popular within health care. Also needed is the introduction of the private sector health into the main stream.
Still despite the many negative aspects that plague public health, there are many who have much hope for public health. This can be attributed to the efforts of many individuals who have brought to light the socioeconomic impact that health has in the global scenario. Prior to this, the role of global public health was not even considered in the making of economy. The advent of new and global challenges have however, highlighted this matter effectively (Chan, 2007). The growing interest in addressing the issues pertaining to health, and the initiative taken therefore, are increasing positive efforts and outcomes. Globalization, although considered as a negative trend by many, can be turned around to become a positive factor for health industry. One of the biggest steps that have led to this positive trend is the identification of the problems that health care sector is facing and that current methods to rectify these faults are inadequate. A clear perspective about the current global trends, the transitions and their impact on the health care are the beginning factors to consider reaching long term goals.
The challenges for who; A failed institution?
The role of WHO has been of a leader in the provision of global health. And for a long time, it did give us guidance. However, today, WHO faces much criticism about the increased numbers of failures it has seen during its reign. WHO which was at one time, the center of activity for global health care planning and organization has become a backseat spectator in the event of its many failed policies. This loss of faith among donors and investors triggered the switch towards other health care agencies, which further exacerbated WHO’s condition. The result is that WHO now fights for reclaiming its lost position in the global health care sector (Brookings Institution, 2002).
WHO is perhaps one of the earliest organizations that cared to realize the trends and shifts between terminologies and concepts of globalization and international public health. Therefore, it is perhaps the best resource to begin with in order to understand the progression of public health in the current decades. Although WHO later on came to suffer from crisis within itself, it is still one of the active organizations in pursuit of provision of good health and public health services. It is not difficult to say even that the terminology and concept of global and international were first coined by WHO, which since the late eighties had begun on the terms global eradication and funding etc. however, it was later that the actual meaning and implications of the term globalization itself were realized. It is still in the explorative phase, yet all seem to agree the dominant role of WHO in the emergence of global health concepts. There are many campaigns and initiatives in the WHO records of achievements that vouch for their mastery in the area of health. However, it is only in the recent years has the WHO become a sideline participant in global health scenario. While it was the late eighties when WHO began to define the international and global health, it was much later that the true contribution of WHO was fully appreciated.
To make the global health sector strong, it is important to realize the role of the condition of the country where efforts are to be implemented. Countries facing economic decline, or any crises, be it natural, civil, political, geological, or due to disease prevalence, all will influence the outcome of the health care setup in the area. These problems are very acute in areas such as the Middle East, Africa, and Asian continent etc. where the lack of provision of the basic needs includes complete lack of access to health care. This is in addition to the different geopolitical instabilities that the countries are facing through war, sanctions and civil issues. This means that most of such countries are able to give health services to its city populations, leaving other areas almost completely unattended. There is a constant decline in the human development index in many countries within a decade, which shows that the health quality continues in such regions is failing to keep up with its standards. Inequalities in health continue to grow, and mirror the economic divide that is increasing in every country that is developing it. Countries with high disease prevalence are caught in a viscous cycle of constant degrading economy and depletion of already scarce resources. Access to clean water remains a dream to many in almost the entire globe. The lack of structure, organization, peace and economical and social stability make any country vulnerable and weak, which reinforces the point that in order to improve public health in such regions, one must improve the country’s overall condition. Health will improve as a consequence to improvement in the country, for with better revenues, more investments will take place in health. Similarly, an improvement in the educational system will help people to address issues that are solvable by themselves.
Women and children health, and reproductive health issues
The evolutions of the current healthcare systems and global trends have been in the making for two centuries, and therefore, their roots, role and influence becomes extremely strong. The past two centuries saw changes in the overall health and mortality rates, with increased life expectancies etc. Globalization also saw the events of modern slavery, with more division between gender equality and rich and poor countries. These influences have affected the current life a style too, among which is the effect on the reproductive health of women, fertility and morbidity and mortality rates. However, women’s rights remain still an issue that needs extensive efforts especially in the Asian and the African continents.
The increase in the quality healthcare provision than before has ensured protection of lives of women and children. Also is an increase in the life expectancy of adults. The big picture therefore, is a world with more population which is expected to increase many fold in the years to come. The trends in reproduction are also variable in different areas of the globe, but may be of more concern in areas where poverty, unemployment, corruption, illiteracy, lack of basic life resources and facilities are lacking. However it is not limited to poor countries and areas. Even in countries that are well developed, the mother and infant mortality rates are high, although still lower than the poor countries. This creates a difficult situation where people of the richer and more developed countries will continue to gain better quality of life, where as the reverse will happen in economically challenges countries. Coupled to these problems is the prevalence of disease and death in such areas such as AIDS in Africa, which is fast becoming an increasing concern in Asian regions as well. The poor infrastructure is leading to chaos, and with time the deterioration of the system will increase the problems manifold.
However, contrary to the belief, the modern and industrialized nations still have not found an ideal equilibrium or utopia in the areas of quality of life. European and American nations have at least been able to control the issue of fertility by increasing awareness programs and methods to avoid pregnancy. Such interventions are also showing promise in underdeveloped nations as well, but the full impact is yet to come. Reproductive health is perhaps the most ignored health care area where the mortality rate during pregnancy and childbirth remain very high especially in the poorer nations. Most of this problem lies with the societal norms and taboos, the lack of knowledge about the reproductive health, and lack of proper healthcare structures that provide quality care to women and children’s health (Raleigh, 1999).
This situation in the recent years has become even more complicated with the advent of HIV, AIDS, hepatitis, and other such sexually transmitted diseases, which affect the mother and child both. In the poor nations, contracting such disease is virtually a death sentence, for there is a complete lack of resources, methods and personal affordability to address and treat the disease. The lack of proper education and awareness structures has made such patients a taboo for the society, and such people are shunned or avoided. Therefore, it becomes especially difficult for a woman to seek medical help or counseling and treating her condition. The result is the increase in the rates of sexually transmissible diseases, which doom the life of a child even before it is born. Again, perhaps the biggest culprit in all this is the social taboos of certain societies and lack of understanding about the nature of the diseases.
Yet the problems of health care are not limited to women and reproductive health. With industrialization and global trends, there is a reported increase in the non-communicable diseases such as cancer, hypertension and heart conditions etc. that are costing huge expenditures of health. These conditions remain with the person until death, and therefore, the costs of healthcare and medicines, as well as screening programs continue to increase as the demand increases exponentially. Communicable diseases on the rise include sexually transmissible diseases as mentioned above, tuberculosis, malaria, diarrhea and dysentery and such poverty induced illnesses. The overall death toll due to these diseases runs into millions, with the biggest death loss found in children, majority of whom die before their fifth birthdays. The effects on the structure and the economy of the countries are hard to calculate in terms of costs of healthcare and provision, loss of manpower, and loss of resources (Raleigh, 1999).
The biggest problem in addressing the issue of healthcare lies in the incorrect way to approaching it. Many of the industries and players of the healthcare system view it as a business strategy, which is the main reason why it remains unsuccessful. This is seen readily by the number of people who are without health insurance around the world. The adherence to the typical business strategies and the reluctance to adopt new models and new approaches makes the situation stationary (Baldwin, 2000). It is erroneous to assume that healthcare systems will improve. Without proper planning decision making, there is very little hope that the current problems can be eliminated. Health includes many moral demands in it, which distinguishes it from other businesses. Contrary to this, the insurance companies and medical provision claim that health care service should be provided on fee basis. The more you pay the better options in health you get. This moral pitfall is the crux of the problem, for where emphasis is on giving basic health, there are no clear guidelines about what constitutes basic health, and no government rights for people to claim health as their right. The health system therefore, becomes an entirely different breed of social service cut off from marketing and business and education sectors. This lack of understanding remains to cause confusion and problems in the healthcare system. Simple provision of high cost services is not enough if a majority of the people are unable to access it. Health care therefore, becomes a very complex issue indeed (Baldwin, 2000). Due attention is needed to give public health an identity that is separate from other institutions. And understanding the trends that shape it becomes the first priority.
Almost all countries’ health care services run on some parallel trends and methodologies. It is for this reason it is easy to assess where a particular health care system is heading towards, based on the studies of the previous such systems. Some thoughts in this matter are clear however. For example, the amount of money spent on health care will be directly proportional to the amount of income of the country. (Skolnik, 2008, Chapter 3, Essentials of Global Health) For an average country, this can range from 9 to 12 percent of the national income and 3 to 6 percent for a developing or a poor country (Skolnik, 2008, Chapter 3, Essentials of Global Health). This however, is not a rule of thumb, and there are exceptions to such trends as well, like America, Cuba and Cambodia, where expenditure on health is comparatively large based on the above averages and calculations. The relationship between health expenditure and life expectancy is linear; therefore, countries with established health care enjoy greater life expectancies. Introduction of interventions in such areas regarding health have shown positive results in terms of reducing costs on health care, and improving health outcomes (Skolnik, 2008, Chapter 3, Essentials of Global Health).
There are many examples of interventions taken to show the effect of health on the overall outcomes in different areas, and all have shown positive results due to proper education and health as mentioned above. Therefore, studying the parallel roles of health and education can help increase the effect of the interventions done in the health care sector.
Impact of globalization in modern thinking and health
The effect of globalization has been twofold. At one side it has helped in the propagation of the world at a faster pace. On the other hand however, the rich and poor divide could not have been greater. This trend is clearly visible in the countries of South Asia and Africa, where the progression towards globalization is leading to regression in the quality of living among the public.
The globalization standards are simple. “Privatization and liberalization, subsidisation, regulation and protection are all part of the globalization process” (Smith, 1999). While in an economical perspective such implementations may no doubt be very effective, same could not be said for the health system. This is because the health system is unlike any business venture and is composed of many moral, ethical, legal, and financial factors. Without identifying the individual composition of this system, it is impossible to come to a global health care system. The role of globalization is yet to be fully understood with in health care, as pundits say that not much has changed in the health care sector with the advent of globalization.
It is crucial to identify and understand the critical role of globalization in the current world scenario, as it is shaping almost every structure of the human life. Many influences have come in between the world of the past and of the present. The industrial revolution and economy boosts there within have led to opening of new vistas in world trade, finance and organizational politics. Issues of poverty and increased/ stable gap between the rich and the poor have led to further debates about the way the future will look like. Where as in the past the countries’ health care systems were able to operate independently, the same cannot be said for today. With newer terminologies and players in the line such as external liberalization and domestic deregulation, there is increased debate about the effect of economical and global changes on the healthcare systems around the world. Literature has shown mixed impacts of global health systems forcing analysts to look into what can make globalization positive for the current health scenario. Up till now, globalization was taken only as a trend and not as an entity that will change the global outlook of the future. Now however, as we reach to that point, there is an urgency to come to terms with solutions that can help globalization become a positive building force for every country (Feacum and Sachs, 2002).
One of the most visible examples of globalization and its effect in health care is the spread of infections from countries to countries. Spread of resistant strains of tuberculosis, SARS, AIDS, hemorrhagic fevers etc. all are now claiming attention due to the heavy potential loss of life accompanying such infections. Cross border dissemination of diseases has led to introduction of new disease in an otherwise unknown area. Migration and mass movement is another reason how infections are able to traverse boundaries. This negative effect however, has led to some improvement in the health care sector. For now the global health systems and countries are intervening and cooperating to come up with ways to prevent spread of such infections. These are either locally or cross border applied strategies and include elimination and eradication programs for the diseases, global surveillance for the disease and containment of antimicrobial resistance. Along side is cooperation for finding out about the natures of the diseases and how these can be tackled in a foreign environment. It is seen that pharmaceutical companies in a region aim to work towards drugs that eliminate disease within their own regions. Therefore, they are superior in having knowledge about certain diseases, and likewise not in others. Cross transfer of this knowledge can lead to improvement in the diseases where they have been introduced for the first time. The initiation for programs that provide health products to different areas of the world is another method which needs active participation, which at the current moment is slow (Feachum and Sachs, 2002).
The effect of globalization on health is not hard to fathom now. Globalization directly determines the investments and efforts that are placed in any health care sector of a country. In the health care sector are there are many programs that are directly funded by and are under influence of the government. Such programs include neonatal and obstetric health, AIDS and such awareness programs, anti smoking programs etc. and these are badly affected should the funding be slow (Smith, 1999). the increased costs and the advent of privatization of the health care sector have further secluded the access of health towards the poor. This poor organization and ignorance towards the poor has led to problems in the provision of medicines as well, increasing the morbidity and mortality rates even further. Globalization is like a two ended sword, which is both positively and negatively affecting the health care sector (Smith, 1999).
The twentieth century saw the advent of many changes in the global front with increased development economically. The development and urbanization is perhaps the most central theme related to the 20th century. This development led to creation of many problems and trends that were never seen before. The introduction of the urban society was perhaps seen the most in the form of automobile multiplicity, where by there became an increased reliance on the cars to carry out even the most simple of the tasks. The direct consequence of increased traffic is the air pollution. This has led to many problems in the health of the people, both physical and mental. The physical illness is evident by the increase in the respiratory and cardiogenic illnesses, where as the mental illnesses included stress, anxiety, anger, road rage etc. This trend continues to increase as more cars and vehicles come out in the roads, along with the increase in the air pollutants due to factory emissions, and depletion of ozone layer. Where such incidences and happenings were considered a minor concern in health, the increasing occurrence is now showing itself more aggressively (Frumkin, 2002). Of course air pollution is among the few environmental factors that are coming into play in the current health care scenario. Environmental pollution of seas and oceans, nuclear emissions, depletion of ozone layer, the use of increasingly toxic pesticides and the decline in the quality of healthy products are some of the other factors that will affect the health of the future.
Current health statistics of the world
Health in the world is still a commodity afforded by few. Despite the different efforts and successes in the reduction of morbidity and mortality in many diseases, the prevalence of death from preventable diseases remains high. The exit of old diseases led to the entrance and emergence of new diseases such as HIV and AIDS, Hepatitis etc. along side is the reemergence of old diseases such as malaria and tuberculosis. The death rates remain very high despite the much advancement as high number of people is unable to access medical facilities.
Many disturbing trends still persist despite the extensive efforts of pubic health sectors, demonstrating the inadequacies of this system in the current times. Although there has been a decrease in the previously high incidents of tuberculosis along with contagious skin diseases; there has been a concurrent increase in XDR tuberculosis, non-communicable diseases, mental disorders, suicide rates and alcoholism (Population Health, 2006). While HIV and AIDS still remain the largest epidemics, recent surveys are showing stabilization and regression in the reported cases and incidents respectively. Vaccine preventable diseases however, have risen, the most prominent being viral hepatitis, Lyme disease, yersiniosis, syphilis and gonorrhea. Acute intestinal infections are on the rise and are claiming many lives. Surveys have shown more improvements in areas where efforts were placed in increasing awareness and motivation among the communities. AIDS and HIV rates reduction is perhaps one of the biggest achievements over time, and simultaneous reduction in tuberculosis incidents also must be considered a very huge step towards global health, although XDR tuberculosis remains an issue of concern (Population Health, 2006).
All in all, almost all of the health care sectors around the world fall behind in many respects. Whether it is the United States or the UK, or Australia or Canada or China, almost all have shown lack of initiative and reform that is so crucial to the success of the health system. There seems to be a constant hesitation on the government and the investment sector to implement new strategies, or to address the issues with new perspectives. The long time dependency on the age old methods has suddenly become inadequate in the current global healthcare climate, and therefore, in order to succeed, more efforts are necessary (Blendon et al, 2003). With it has been a lack of research in this area to discover alternate ways of improving health of the populations. There is less interest of the governments in applying and investing more in to the health sector. The influence of the policy makers and the various players in the health care system make the problem increasingly complex.
One of the biggest indicators of the adequacy of the health system in an area is the level of satisfaction among the citizens. Surveys of the major countries of the world have given mixed responses about the satisfaction level towards the health systems. None of the countries have more than 25% of the population satisfied with the health system. The dissatisfaction is especially high in New Zealand, where two out of every five individuals have reported the same, 38% dissatisfaction in the UK, and 44% in the United States. The dissatisfaction resides primarily, as stated before, on the many factors surrounding health care. High costs are the biggest concern in the US only, while in countries such as Canada, Australia, UK and New Zealand, this is only a minor concern. Dissatisfaction to inadequate coverage of services is highest in the USA, which is about 25%. However, America’s public is not entirely dissatisfied with shortage of the hospital staff, waiting times or lack of government funding, the three factors of dissatisfaction that rate high in other countries. Shortage of staff leads to 54% dissatisfaction among Canadians, with UK next in line with 33%. Almost all country residents agree that the governments need to increase spending to improve the quality of health care and to increase the number of staff as per needed. None however, are completely satisfied with the system, and claim more is needed to be done to do so (Blendon et al, 2003).
The situation of health in poorer countries also is declining and on the verge of collapse. Such countries have been unable to provide for the needs of the public and formulate plans or strategies that will help improve future healthcare sectors. The lack of a road map for health productivity and evolution is leading towards a rapid decline, which according to many international health organizations, requires immediate effect and changes. The target helpers in creating a better healthcare system would involve not only all the countries to more or less extent, but also global and local healthcare organizations to create a framework for the systems. The biggest issue facing the poorer countries is the lack of sustained and adequate funding to rebuild healthcare structure. This is the responsibility of the governments to provide the resources, but unfortunately, the countries themselves lack them. Another factor causing chaos in the health systems in the world is the different types of systems present in different countries, which makes synchronization impossible. Such health institutions are under intense influence of the insurance and investment companies, which largely dictate the outcomes of the health care decisions. Currently many of the government employees are opting for positions in the non-government setups which are increasing problems within such systems as the dependency on external staff is increasing. Such changes in turn lead to disintegration of the systems themselves, which are dependant upon the employees, provision of resources and funding. The consequent booms in the adjustment programs have increased problems further, as such programs are generally of short term and cause downsizing of the employees. Increase in the healthcare fee and expenditures have led to increased chasm for the poor to access health care. Privatization in such countries have led to increased gap between the rich and the poor, as both segments are virtually cut off from understanding the other party’s dilemmas and problems. This causes loss of initiative to provide or contribute to the health of the poor. Overly commercialized private health care has started to monopolize the public sector by claiming it as an inadequate system, where the level of care is poor. This is driving the investor companies to put their efforts in to the private sector, causing further degradation of the health system (Global Health Watch, 2006).
Such countries are facing another health care issue regarding the health personnel. The “brain drain” or the foreign recruitment of the skilled personnel from such poor countries is leading to acute shortages of nursing, paramedical and medical staff from the parent countries already short of resources, which is increasing the complications in the health care systems. This is in light of the increasing poverty and diseased conditions such as tuberculosis, AIDS, and hepatitis epidemics. The richer countries even though recruiting qualified professionals from around the world, are still not able to provide quality health to the consumers. Similarly, the poor countries are getting depleted of their resources through improper planning and execution, loss of medical supplies and resources and loss of trained professionals that could help rebuild the health care infrastructure of the countries (Global Health Watch, 2006).
The current statistics reveal many findings that are common to many countries, displaying the fact that many countries are following more or less the same trends in their health care policies and decision making processes. In many ways this similar trend is making the same advancements with in the different health care sectors along with the same mistakes. When compared to America, countries like the UK, Canada, Australia and New Zealand show increased satisfaction towards their respective health care sectors. All these countries however, have their own burdons to bear. While Australia is the later entry in the efforts to improve the health care sector, countries with good records like Canada, are facing setbacks due to financial constraints in health. On the same note, UK is developing itself to become one of the most organized health care sectors of the world, yet the time has still not come to claim dominance in this regard. All these findings are a very brief outline of the various trends and the shifts in the various health sectors, and what affects them.
Health care sectors of today are also under influence of the outside influences just like any other industry. This may be a hard concept to comprehend, but there are some findings that have supported this theory. The first and perhaps the foremost is the fact that the current health care system is affected by the politics of the region. The lack of recognizing the cultural norms and practices is perhaps another reason what affects public planning. Such programs are short lived as it takes it a long time to become approved by the public. Finally the lack of bottom up support is also affecting the outcomes of health (Brown and Fee, 2004).
Current challenges of global health
The health care industries of the globe are now more linked with one another than ever before. This is the reason why the concept of global health care systems is followed with interest. Identifying the fact that all health care sectors are going through more or less the same changes and challenges at small or large levels are the main indication why global health becomes necessary. These common issues include the recurrence of certain resistant infections the misuse of drugs in healthcare, the changes in the climate and the spreading of disease from one geographical area to another. The biggest challenge is the lack of initiative in understanding the local processes and reasons for the development of a certain disease in an area, and how to implement local as well as global changes to enable responding to the threat. In other words, with out the knowledge of the factors and the environment which led to the advent of the disease, no effort will be successful. This reinforces the theory of improving the individual healthcare systems of the world in order to improve overall global health condition.
The emphasis of local response to challenges can help in creating solutions which can then be shared with the remaining world, and thereby prepare other health systems to respond to the problem should the need arise (Janes, 2003).
The benefit is mutual globally, as most of the problems health systems face is experienced by all in more or less extents. Microbial resistance to pharmaceutical drugs has become the main area of concern globally. Many factors have led to the current situation. These include the bacterial ability to respond to and develop resistance to the offending agent in order to increase its survival. If this was the only process involved, then the situation of microbial resistance may had been delayed, but factors such as unnecessary and inappropriate use of these drugs, along with lack of availability, increased pharmaceutical costs and consequently the use of poor quality samples have increased the resistance manifold. Economical factors surround the selection and distribution of antibiotics in many areas, and when this happens, the quality and methods of application of drug regimes becomes severely compromised. The end result is the loss of mutual health of public (Janes, 2003).
Much of the blame of damage falls on the physicians and other health care professionals. Many may try to fit into the popular assumption or practice of health in a particular area, leading to lack of effort in the area of research or development. Lack of knowledge among many within the health industry about the proper usage of antibiotics is another main reason for the current scenario. Other epidemiological factors claimed to play an important role in antibiotic resistance are the hygiene and disease conditions of a community, homes, clinics and health care provision centers. Lack of availability of drugs or poorly framed drug delivery systems have also led to exaggeration of the current situation (Janes, 2003).
In the US the leaning towards the supply side has lead to increase in the costs of pharmaceuticals as well, an issue under intense debate. USA is responsible for the export of much of the drugs to other countries, and this increase in the costs can lead to decrease in the affordability of such nations, thereby affecting the supply of drugs. The issue remains of intense debate till today (Hussey, 2004).
Recurrence of tuberculosis: An impending health disaster
Drug resistant cases of tuberculosis are becoming a serious area of concern in the health arena globally. What previously was termed as multi-drug resistant tuberculosis or MDR has now been renamed extensively drug resistant tuberculosis due to the recent resistance to the drugs isoniazid and rifampin. This is especially a worrisome problem as more than half of the patients detected with XDR tuberculosis claim they never had the incidence of disease before. XDR tuberculosis has been found with a very increased frequency among the HIV positive and AIDS patients. This strain of tuberculosis has become a very deadly and lethal condition, with a high death rate averaging only 16 days. With the first report of its presence issued in 2006, the strain has been found in many parts of the globe and is showing increased mortality associated with it (Raviglione and Smith, 2007).
The development of resistance in this strain is alarming health care personnel of the possibility of the development of other such resistant strains of diseases that have been poorly managed. Tuberculosis treatment regime is perhaps one of the most extensive ones in treating infections and one which requires the utmost adherence to the drug regime. Unfortunately, many of the patients lose the patience of continuing with the drugs when the symptoms become sub-clinical. These repeated attempts of stopping drugs and resuming them with the return of the symptoms are the main reasons why tuberculosis, one of the forgotten and past diseases, has resurfaced again with deadly consequences. Tuberculosis XDR, remains a very serious threat to health, as it is easily spread and can be fatal to any one who acquires it (Raviglione and Smith, 2007).
The sad part of the whole situation is that the healthcare systems are emphasizing for the creation of methods and infrastructure that has been ignored from the very first days of tuberculosis diagnosis. There has been always an emphasized account of the need for better laboratory services, infection control and infection detecting facilities, and spreading knowledge about prevention. Much of the problem has risen due to the poor compliance of the patients with the drug regimes, and therefore it is imperative to introduce programs that ensure patients take their needed doses and drugs for the required period of time (Raviglione and Smith, 2007).
Examples of public health: Health situation in Australia
The Australian healthcare system is one of the better healthcare systems in the world. Diligent efforts have been placed to improve the quality of the healthcare system, and this effort is reflected in the improved health of the Australians. Australians now enjoy longer life expectancies than before, with reduction in overall infections and diseases. The infant mortality rate had dropped 4% from the previous year at 4.8 deaths per 1000 live births in 2003. Similar reductions have been seen in the women death rates at birth, along with improved fertility rates. However, the minorities such as Aborigine and Torres Strait Islanders still do not have good health provision and care delivery. Consequently, it is these populations that are suffering most from illnesses. Disease prevention, immunization and screening programs are the most developed areas in Australia. There has been however, an increase in the death rates due to chronic illnesses such as lung cancers and heart diseases. Both cancers and heart conditions are responsible for approximately half of the total deaths per year. This is therefore the main area of concern among the health care providers, to provide good health care to the areas and communities suffering from ill health (WHO Australia, 2005).
The public health care system of China: A transition
China has taken the health of its public very seriously. This is evident from the fact that china started to improve its health care sector since its formation. Within the span of only four years, the life expectancy rose by ten years, and the infant mortality rates decreased by thousands. It has continued to develop itself since then, and therefore, the Chinese health care system can be considered one of the progressive health care systems of the world (UN China, Health Overview,2002).
Also, china is an avid supporter and a keen participant in all global health related forums. However, china still has a long way to go. For china displays the same patterns of difference in the access to health care as many other countries. The health care facilities in the rural areas is poor and consequently, the quality of health in such areas is very low compared to other more developed areas of china (UN China, Health Overview,2002).
Areas of concern in china is the extremely high prevalence of Hepatitis B, liver cancers, tuberculosis, cardiovascular diseases, smoking and HIV and AIDS. The extremely high prevalence of these diseases constitutes the highest number of preventable deaths that take place in china each year. It is for these health issues that china is working to create prevention and awareness programs, and increasing financing with in the health care sector (UN China, Health Overview, 2002).
The Chinese health care system is undergoing many changes in order to improve its health care system. In the wake of health calamities such as SARS, the Chinese now believe in stricter application of protocols to prevent any further disasters. It is also working towards creating a better emergency and calamity handling situations. The transition is increasing in pace with increasing time and shows good results.
UN is also among those institutes that are interested in improving the health care system of China. For the UN, the objectives are simple: to improve the quality of healthcare as well as improving the access of public to it. These include improvements at all levels from improved sanitation to the introduction of research cells in areas of health. As education is the key factor in improving the health outcomes, efforts are being placed to increase literacy rates and education providence to children (UN Goals in China, 2002).
China has recently witnessed some of the biggest health epidemics of the world in the recent years. These epidemics had nearly destroyed the current health care system as it was not able to cope with the intensity of the problem. The only silver lining after all these events was that it served as a wake up call to the health officials and led to improvements in the health care sector. This no doubt is another one of the missions of the UN in china. In this regard, the china health will strive to improve its reproductive health sector and create awareness among the public about different reproduction related issues (UN Goals in China, 2002).
Europe and its health care system
Europe is among those areas of the world which have evolved their healthcare system with the times. The current European models of health care may not be the perfect in the world, but still hold some of the top ranking positions globally. The reason for this top position lies in the constant efforts to provide a healthcare system that is able to deliver better care to the patients with minimal inconvenience. It is not surprising therefore, to find introduction of new and radical health care systems in such countries.
The positive aspect of the European health system is that it has been able to identify the key problem areas in its health care, and by directly tackling the issues, is improving itself considerably. Now Europe is shifting itself from the older healthcare versions of public finance, equity and access problems to create a system accessible to all. The introduction of the hybrid system in health care systems is therefore, one of the best and most dynamic examples of visions to improve the healthcare arena. Hybrid models are essentially systems that are being implemented so as to come up with better healthcare systems, based on the findings of the past healthcare systems (Koyne et al, 2002). There is much study done in this area in Europe, and now example models of such systems are also present such as of France, which is among the high ranking healthcare systems of the world.
Privatization is perhaps the biggest change that has taken place in health systems. Where previously the reliance was only on the government sector, current private healthcare setups are now playing a vital role in improving public health crisis. Examples of such interventions include Global Partnerships for Health which collaborated with International Diabetes Foundations for the provision of insulin to the needy patients. Another such example is the institution of same pricing in pharmaceuticals. As stated before, France is the best example case of privatization and how it can be beneficial in improving the health care systems. But simple privatization has not been enough to come to this position. Other factors that contributed include openness to foreign investments, technological assets, skilled labor, the geographical position of France with in the EU, and organized infrastructure. Without these factors, France may not have achieved the level of health care that it enjoys now (Koyne et al, 2002).
The key in success understands the value of tradeoff in any given structure. In healthcare, this refers to the ultimate rush to reach the highest efficiency within the system. While gurus say the thought is indeed commendable, it can eventually lead to ignorance of many other factors, such as waiting times, or post surgical outcomes. Therefore, although efficiency is very important in gaining a good health structure, it must be carried out with inclusion and understanding of other factors as well (Koyne et al, 2002).
UK is among the forerunners in the debate and efforts to improve the health care system for its public. And it is perhaps this advancement in the health sector that new debates are starting to take place. These include passionate debates about the involvement of the government in the health of the public, including food, water etc., which policies and institutes are better and which options to be excluded from the health care system altogether, the costs and the methods of provision of services and many others. The efforts of the government to improve its people’s health are not without reason (Jochelson, 2005). The time dependant increase in the rates of sexually transmitted diseases, obesity, smoking and alcoholism with their corresponding effects on the health such as mother to fetus disease transmission, cardiovascular diseases and pulmonary complications etc. take up much of health care reservoirs. This is perhaps the revision of the efforts that were taken to improve the air quality of UK London, which led to massive changes in the travel sector. Yet while this and other such examples are good indicators of the government’s sincerity towards the public, the public now demands the right of decision making in choosing for them what they want rather than being handed down with options. The Wanless debates, the media contributions and legislations and policies are all testament to the fact that the UK government takes its responsibility seriously and intends to improve the health quality of its public in due time.
Part of this debate lies in the lack of clarity about the role of government and how much it can be involved in the improvement of the health of its people. While the public may appreciate the efforts, it may still eye them skeptically, if not involved properly in this regard. The debate in this matter will continue, as it is only in after thought and the actual implementation of the policies do we ascertain and calculate their benefits and pitfalls (Jochelson, 2005).
the UK is currently active in reducing the concentration of alcohol abuse with in its population, which is among the highest ranking preventable causes of death among men. This is especially in the case of underclass and uneducated sectors, where alcohol dependence is seen the most. Efforts such as prohibition to drink below age of 18 were good efforts, but this has not reduced the number of people taking up drinking after the age of 18. Interventions such as increased taxing and costs, restriction of availability, advertisement banning and increased awareness are some of the other effective interventions in this regard.
Similar efforts have been put into smoking which is thought to cause extreme debilitation and morbidity and mortality around the world. Here too the increase in the costs of tobacco related products have shown a decrease in its consumption, thereby effectively reducing smoking. Similar approaches have been applied to smoking as in alcohol, and the results are visible due to decreased number of smokers.
Many other such interventions are being undertaken by the UK government, some of which include drunken driving, introduction of safety seatbelts, increasing education about different aspects of diseases and as to what causes them. These public interventions are hoped to improve the overall health of the public, and with it will reduce the number of hospital entries due to preventable causes (Jochelson, 2005).
Africa: A region under time clock of disaster
Africa is perhaps one of the most neglected regions in every aspect of global health and economy. Yet it is the region which is in most need of attention. Many problems exist in the African soil, which with time are escalating rather than diffusing. This rise in Africa’s problems call out for attention, yet surprisingly, the effort placed in this region is very paltry. Some of these problems include the economic decline and destruction of the economical system, increasing international debt with no chances of being repaid, increased morbidity and mortality associated with AIDS, HIV, Hepatitis, and XDR tuberculosis, and complete lack of resources (Godlee, 1994).
Africans are however working with many international organizations to improve its health care system. In this regard it is working towards improving its access to clean water, creating better hygienic conditions and improving proper access to care. Among other initiatives is the effort to educate and create awareness among the people to create better outcomes.
The situation of public health in India
India is one of the disastrous examples of the public health care system. The Asian subcontinent suffers from the same issues as Africa, and the severity of health issues is increasing due to high population numbers of this region. The lack of health care structure is acutely felt only one percent of the entire Indian population is able to afford private health. This one percent population is among the 1.2 billion people who do not have any health infrastructure to go to. The main reason for this decline in the health system is the complete lack of health care funding given by the governments. In most of the cases, the government takes the funds from the health care side to be put in other areas of social policies. This is especially true in the case of defense spending which are almost higher than any other sector in India (Lokhandwala, 2000).
It is in these conditions that health care facilities are provided to the people, with equally drastic results. The compromised standards of care lead to increased morbidity and mortality rates, and with the passage of time, even health care professionals are growing weary of the outcomes in this area (Lokhandwala, 2000).
India is one of ticking time bombs for many of the diseases that are prevalent today. The rates of HIV and AIDS as well as hepatitis are growing at alarming rates, and there is no count about how many people have been unknowingly infected by these diseases. There are increased rates of obesity related diseases, as well as malnutrition, respiratory illnesses, malaria, asthmaa and tuberculosis. India is one of the regions where XDR tuberculosis strains have been found. In an area like this, the present of this strain could mean death of literally thousands of people, as there is absolutely no method or resources to tackle calamities as these in the Indian health care system.
The Indian population has poor access to medical facilities as well as medicines, which leads to further deaths which could be preventable. Also, the high illiteracy rates, combined with social and cultural taboos, the restrictions imposed upon women, neglect of mother and child’s health, and high rates of mother and infant mortality rates are some of the added burdens this society bears. South Asian region is one of the most known regions for its smoking, tobacco eating and other such related habits, which are known to cause oral and respiratory conditions. The lack of literacy has led to complete lack of awareness about the basic life measures such as clean water etc. Water is a scarce entity, and many o f the children each year die due to water contamination and related gastrointestinal diseases.
There is complete lack of infrastructure in any area of health which is why environmental pollution is prevalent, and in such a condition, the diseases such as asthma due to air pollution is not hard to find. The recurrent floods, droughts and other such calamities also wreak havoc on the already decomposing health care system.
The complete inadequacy of the health care system is seen in the light of the recent tsunami incident that wiped out most of the population of India and other countries as well. It was only thoroughly intense international funding and help was it possible to start the rehabilitation process. Were it left to the Indian health care system, much more loss would have taken place.
The heath care system in India is experiencing the most brutal assault there is possible through many cuts , lack of funding, policies and lack of infrastructure, legal and illegal issues that are plaguing the current healthcare system.
Effect of global climatic changes in the current health care scenario
The role of climate in the current health system is a relatively new phenomenon, but which is already showing massive potential for destruction, morbidity and mortality. The recent extremes in the whether conditions have led to fostering of many disease conditions, with consequent increased disease incidences, such as malaria, diarrhea and protein malnutrition. The lack of forming concrete long term plans to control these disease epidemics is another reason why over 3 million deaths occur annually through the three diseases mentioned above alone (Lendrum et al, 2007). The global weather changes are expected to increase in intensity, meaning that casualties due to disease, famine, drought, malnutrition and starvation, all will also increase. Unless a concrete plan is devised to handle the situation, there will be more unnecessary deaths and morbidities in the times to come.
With the changes in the earth’s ecosystem, human kind faces two potentially lethal foes. One is the mother nature itself which is getting affected by the intense pollution and changes with in the environment. The other is the risk we face from our own produce, waste, pollution etc. the changes in the environment are both inclusive and global, meaning that they include all areas of human existence and progression, as well as all the human beings of the world (Low and Gleeson, 1998).
Such times require “adaptation” to the current weather changes. Preventive measures at the moment are perhaps the most practical and long term solutions to these problems, which will help reduce the severity of the damages in the future as well. The current epidemics in animals and poultry such as SARS are just one area where climatic changes are causing human deaths. For such particular cases, the introduction of surveillance and response systems will be most effective and economical. Provision of water in adequate quantities in draught affected areas is another important innovation required for the future. But despite all these efforts, there is a need to address the issue of environmental pollution and addressing the problems that are negatively affecting the climate. The emission of green house gases has lead to increase in the global warming and therefore, fuel preservation and use of environmental friendly fuels is the requirement of today. As WHO claims, the improvements in the climate conditions can lead to drop of disease percentage by as much as 25%. (Lendrum et al, 2007).
The relationship with the environment is something that humans have failed to acknowledge and understand ever since mankind began. While nature was the first reality man came across with, he still misunderstood it and took it for granted. The result is now a reality faced by mankind to either help protect and preserve nature, or be perished along side it. The true significance of this relationship was ignored on the fight of man vs. nature. Now mankind realizes the threat that poses itself in the degradation of earth itself (Low and Gleeson, 1998).
It is under these circumstances of important environment related decisions and health policies that the application of the precautionary principal is considered the best. This is because this principal holds to account the person who enforces or implements the particular health of the person as well as the environment (wickepedia, 2007).
The emergence of global health and its significance
It is perhaps in the light of such catastrophic climatic changes that the concept of global health has gained such roots. However, climate is not the only factor affecting change. The emergence of war and conflict, disease and disaster, famine and distortion of human rights all have led to the importance of global health in the maintenance of a healthy future.
Contrary to appearance, such catastrophes can have very serious impacts within the health care systems, as they lead to sudden increased, intense and long term loads that may continue to show their effects after a long time. These effects can be morbidity and mortality, disability, and increased healthcare costs to provide such people with care and monitoring. Many emergencies and disasters come under such incidents, and are not limited to global and climatic changes alone. Human disasters and wars, violence etc. can also pose serious life threatening conditions that may warrant immediate attention.(Working Together to Improve Global Health). In most of such situations, the largest complication lies in the caring of the refugees that require food, shelter, healthcare and protection. Such people are often the victims of the cruelest crimes of humanity including rape, and therefore, not only physical help and care, but also emotional and psychological as well, to help them stand back on their feet. Countries that have experienced such crises include Angola, Bosnia and Herzegovina, Congo, Nepal, Rwanda, Sudan and Uganda, where armed conflicts and violence claimed the lives of millions and left others in morbid and terrible conditions. Displacement, loss, fatigue and famine, illness, sickness and death are just some of the consequences of such emergencies and catastrophes, and it is at this point that the need for healthcare can be acutely felt. The high death rates seen in displaced populations mainly result from malaria, cholera, measles, nutritional deficiencies, diarrhea and respiratory infections.
The effect of such catastrophes is not only physical but psychological as well, meaning much effort is also needed to address this part of rehabilitation of the people. Psychological counseling therefore, must be made a part of the treatment and care of people undergoing such disasters. Also, identifying the areas that are under threat from natural calamities is important, and healthcare services should coordinate accordingly with the governments to formulate crisis management cells. Understanding the rehabilitation process is essential for improved health care and future of such survivors. The basic necessities of food, shelter and healthcare are just some of the factors that require immediate attention. Identifying the needs of children and pregnant women is another area of concern (Working Together to Improve Global Health).
Trends of health within American continents
As with other nations, the statistics of American regions is primarily affected by the different socioeconomical factors prevailing in that region. Regions such as Guantemala show highest maternal death rates of around 40%. This is in correlation with the fact that this region shows the lowest female literacy rates. As mentioned above, the Guantamela example clearly recognizes the role played by investing in social areas such as education, sanitation etc. the American continents also are showing the same correlation of health with the economic standing of the country and the area. Areas with improved living standards show improved human development with improved health statistics. Similarly, a good income level determines a good amount of money that can be spent on health, improving health outcomes. America however, also shows the most stark inequities when it comes to income levels, standards of living and the provision of basic health care facilities. These inequities can be appreciated with in the countries as well as between the countries. Therefore, inequities are a prevalent feature in the American region.
Even more important trend seen in this regard is the allocation and the distribution of resources as being the major factor in the success of a country’s health care system. This is independent of the income levels of the people living there, displaying a good example of the fact that a proper allocation method can help succeed a health care program with in a poor country, despite the limitation in the resources.
In such a scenario, the American countries need to establish a good method to improve the health care systems overall, instead of ignoring the other members of the continent. This is strategically important on the geographical level as well, as America is separated from the other continents of the world and therefore, to ensure a better health in the region, must strive to work in cooperation. This is a big effort to undertake and for it to succeed there must be the collection of proper statistics and information in order to plan policies and institute them successfully (Assessing the Population’s Health, 2007).
The role of USA in the decline of healthcare systems in other countries
In many countries, the health care systems are failing due to the heavy sanctions placed upon them. This is leading to a decline in the public health systems, which in turn is leading to poor health and infrastructure. The result is no doubt more morbidity and mortality due to lack of, funding, resources, staff or pharmaceuticals. The healthcare sector is among the most affected in such situations as it is the most neglected area of concern in a country where sanctions are affecting millions of lives every day. America has also played an important role in placing sanctions on many countries, and is therefore, directly responsible along with other sanction imposing countries, for the decline of health care systems in such locations. While in defense, America states that it is not imposing of limiting any country to invest in its health care system, the truth remains. In any country that is affected by war, famine or economic sanctions, there is very little effort that can be placed at the healthcare sector, with out providing for other more important areas such as commerce etc. Two countries are a major example in the current scenario. These include Cuba and Iraq.
Cuba is a country that is under much controversy with regards to the healthcare sector. Both sides blame the other for the country’s decline. Cubans claim that the imposition of sanctions is the main reason why there is no growth and prosperity in the country and that imposition of sanctions has further complicated the already fragile and volatile situation of the country. The American government thinks otherwise. Americans claim that by imposing sanctions, it is giving the Cubans the right to elect their own leader and is helping the Cubans move in the right direction. Whether the American way of thinking in this matter is correct is a massive subject of debate, but the main affect on the health care sector remains the same. While Cuba may have been receiving medical supplies and humanitarian aid, it still remains incapable to providing quality healthcare services to its people. And whether the American government accepts it or not, it is responsible for it due to the sanctions imposed on Cuba.
Iraq is another country where the effects of war have wreaked havoc in the structure of the society and the government. A region where there has been
The situation of public health in the United States
There is a massive collection of literature present about the health system of the United States and most of it points to the inadequacies of the system. Healthcare system of the United States although is the most expensive in the world. Yet it is one of the poorest managed ones as well. Many factors are responsible for the poor health care system in the USA, and the problems keep escalating. It is feared that the health system of USA is on the brink of catastrophic failure.
This is not just the thought of the public but is felt profoundly by the many physicians and healthcare personnel as well. The advent of insurance based policies has led to major changes in the system. Where previously, the healthcare was based upon the patient and doctor relationship, it is now based on the third parties, such as insurance, claims etc. The result is there is more emphasis on the modes of payment and receiving profits rather than actual provision of care. The quality of care is naturally suffering, as the physicians are forced to work in an environment where their decisions are controlled by the third parties, and where cost becomes the main decisive factor in the provision of care to the patient. Geyman (2002) voices the opinions of his fellow colleagues when he states that is impossible to work optimally in a system that is facing so many problems. The invasion of the insurance companies has spanned in all areas of health care, and includes nursing and home care, dialysis programs and even Health Maintenance Organizations. In other words, the insurance companies have set themselves in every step and ladder of the healthcare system, making it virtually impossible for physicians to assert their professional authority in decision making process.
Mean while, the health care system of America continues to fail. More that 40 million Americans are without health insurance, of which 20% of the uninsured cannot afford it even if offered by their employing agencies. Meanwhile, the costs and expenditures in the health care provision continue to rise as the quality of care constantly reduces. The system has therefore become “unsustainable, overly complex, inefficient system with poor performance” (Geyman, 2002)
The different efforts in the contribution towards managed care have not resulted in the kind of positive response that was expected at the time. As the experts had predicted, the efforts were not long term and were not able to prevent the increasingly high costs in the health. The per capita spending of health of the US remains higher than of other OECD countries. Along side the GDP cost percentage for the US is 13.9 % when compared to other countries with 8.3%.(Hussey et al, 2004).
The things that are contributing towards the US the health sector have been conveniently described by Hussey and colleagues. As mentioned above the GDP spending is higher than other developed countries with better health care systems. Similarly, the price of health care is higher in America than in other countries. (Hussey et al, 2004) This is solely based on the “labor-intensive” market that the health market has.(Hussey et al, 2004) This distribution is also affected by the wider area of the United States. Similarly the dominance of the supply side of the health side has also led to increased pricing and unfair distribution of market power in the US health care sector. This reversal of power to the supply side is the main reason why the other nations are able to enjoy better health care facilities and costs and lower GDP when compared to the USA (Hussey et al, 2004). The complexities in the administrative procedures are another reason why the current American health system suffers from problems.
Did racism contribute to the current public health sector of USA
Although America claims itself to be open, fair and tolerant to different races, the major role of different races within the American public health was seen at a much later time. This was at a time when the rights of the black races were acknowledged and fully supported by the government. It was after the efforts of King that some hope was seen for this race community in the actual contribution towards health care. The issue was not skin deep. The core problem and concern was the lack of black health personnel and consequently the lack of care delivery towards the black population. These arguments were supported by very strong facts of twice the number of infant deaths and five times the deaths of the black mothers compared to white counterparts. The issue of racism still remains till today, although there is more awareness and more interest in the society to counteract it. The examples of blacks being classified as schizophrenic more times than their white mentally ill patients are one of such discriminations that warrant debate (Garrett, 2003).
The problems still persist in some manner even today. There is still a lesser number of blacks and still lesser numbers of other racial groups in the higher levels of health care. This trend is not only seen in the USA but in other countries of the world as well such as the UK. It raises questions in the health care sector of today that whether health care is delivered because of the skin of a person. The image remains with the American health system and it will be a while before America can prove that it is not segregating races within itself.
What is motivating America to contribute towards global health?
Current analysts claim many factors are responsible for the sudden and intense interest of the USA in the health care sector both within and outside the country. Kassalow (2001) expertly has divided them into three areas. First reason he claims is simple narrow self interest of the American government. Americans in the past remained largely unconcerned about the health problems of the world due to its geographical location. With the advent of cross national and transatlantic disease transfer, it is not possible to do so any more. The primary diseases of concern have been the revival of the resistant diseases along with transmissible ones. Such diseases have largely spread through trade and travel, and are reminiscent of the one of the first examples of cross border diseases, the black plague. Such diseases are largely resistant to current antimicrobials and drug regimes, which increases the need to create liaisons to come up with solutions. The crux of the problem is that such diseases are expected to occur and more will arise due to antimicrobial resistance. Creating partnerships to ensure protection from such diseases is therefore a top priority.
The second reason Kassalow states is because of “enlightened self interest” of the American government. This is in light of the findings that health and social capital are directly related to each other, as seen in the examples of Russia, where health deterioration became a major cause of discontent among the public. Health status is also a large determinant of the political stability as well as the economical growth and stability. War is among such causes where health structure is affected (Kasselow, 2001).
The third reason is humanitarian perspective of provision of health to all. Good governance is usually predicted if it includes provision of good health among its priorities. Provision of good and healthy infrastructure is a boost to the government itself as the public approves of such arrangements. America is one of the strong nations of the world, and therefore it becomes and ethical and moral responsibility for it to provide health needs for other countries. It can do so in many ways; by providing relief and rescue support, by engaging in research and development in the health care sector. By providing debt relief and removing sanctions, and creating meaningful partnerships with other countries of the world. There by enhancing its own position by creating a positive picture of itself (Kasselow, 2001).
Bioterrorism and public health in United States
Almost all countries in the world face the danger of falling victim to bioterrorism. This new weapon of destruction can cost more lives if uncontrolled than perhaps any other method of terrorism. The problem lies in its easy spread and easy transportation to other areas. What could be a harmless virus can be transmitted faster than any bomb or explosive and may start showing signs long after a major population has been infected. Many such case examples exist, for example anthrax, SARS and many other such lethal viral infections can claim millions of lives and may require much time before they can be brought under control. Such incidents of bioterrorism reinforce the long stated claim that only a sound health care system can protect against such major threats and prevent any severe damage (Garrett, 2003).
The problem of bioterrorism is not limited to United States only, as any country with the potential of developing biochemical weapons can use it. Therefore, the misnomer that only particular countries are involved in producing such weapons is not true and every country can be a victim of such activity. The problem can get especially out of control if the health care system of the resident country is not developed adequately to face the challenge. It is in light of these issues that it becomes important to have sound healthcare systems globally, with added feature of having the ability to coordinate them with any healthcare system worldwide. The need for the global health care system is felt more now than ever before.
Such bioterrorism has become the new face of conflict that is motivated by religion or political extremes. It is more difficult to tackle with as it is independent of any government and rather is an independent effort by some to enforce their will on others. Bioterrorism became more dangerous than outright wars and conflicts because it instills a fear that cannot be tackled through diplomatic maneuvers, wars or outright dialogues (Garrett, 2003).
As opposed to war where the majority of victims are soldiers and army personnel, such bioterrorist events can include a very wide circle of people. The most vulnerable are the medical and paramedical staffs themselves, who is the first to come in contact with such agents. The effects of such events are like ripple waves, which continue to expand continuously.
In light of these possibilities, current government accepts the role that federal government can play in promoting and improving public healthcare systems. Many efforts are put into it, where along with improving the healthcare systems
While it is claimed that bioterrorism is carried out by fanatics or extremists, it is interesting to know that the current scenario presents itself from much contribution of the major developed countries of the world. Countries like America for many years developed biological weapons of their own, which were kept in secrecy due to morally offensive implications it carried. The sixties and the seventies became the peak times for the development of biological weapons. At the same time however, there became increased public resistance to war and any activities that pertained to it. The voice of the people apparently won, for America along with many other countries discontinued their biological efforts. Another reason may be that the true implication of a bioterrorist attack and the lethality of such weapons were for the first time realized. (Garrett, 2003) It is this course of events that has now risen again in the forms of anthrax attacks and many other such bioterrorist events taking place. The event triggered intense crossfire of nations of who is responsible for the creation of these weapons. This debate continues with the chief countries accused being Russia, Iran, Korea etc. The world truly becomes unsafe day by day.
Importance of a global health for America
Global health is an important concern for the American society and government. Until now, American government did not place emphasize on the important role health can play in the global economy. However, with changing situations in the global arena, the option to use health as a strategic tool for creating positive relations is becoming quite alluring. This is in light of many factors, among which is the global bioterrorism threat as mentioned earlier. America is learning from the previous failed models of government and the factors which contributed to the decline of such states. It now realizes how much health can affect the public outlook about the government and how it can be used against the government to create instability. With the current increase in the global disease incidence, American aid and partnerships in health care areas will be a major boost to the economy, will improve the current deteriorating ties with the world, and will help America increase its hold in the global scenario (Kassalow, 2001).
Similarly, America now realizes the role that global development can play in improving the outcomes for America itself (Center for Global Development, 2002). This is in alignment with the ideals that America was founded on; life, liberty and pursuit of happiness. Also, America does not want to promote any conditions that may contribute to conflict, and discord with in regions, and factors such as education, health, economic stability and sanctions etc. all play a crucial role in the progression of negative or positive outcomes. America is now one of the biggest exporters of the world, and for its sustainence, requires that the countries be in peace. America however, contributes very less of its budget for the development of other countries, which does not even amount to 1%. Overall, the American public supports the notion of the development of poor countries in order to rid themselves of the problems their societies face. This in turn, they believe, will help improve the outcomes and outlooks of the Americans themselves (Center for Global Development, 2002).
What has America done so far to improve its health care
The evolution of health care in america has seen many ups and downs and continues to do so at faster paces than ever. Now Americans are living with life expectancies of average 60 years compared to only 50 decades ago. There was subsequent decrease in the infant mortality rates, as well as infectious diseases heralded a new beginning of chapters in the health care system legacy.
As mentioned before, America displayed some of the clear concepts seen in the development and prediction of quality of health care in any system. With the increase in health, was an increase in education and public health awareness, and vice versa. Concurrent to these changes were increasingly improved living standards for all the races in America. Introduction of health awareness programs and educational materials was able to reach more Americans than could be attained through any other means. In this era, the largest contribution towards health is attributed to the sanitation departments and their structural planning, which led to a huge portion of improvement in the health care sector (Cutler and Miller, 2004).
In other words, if we were to outline the true beginnings of the 20th century public health initiatives and successes, we would first and foremost mention the role of public health and sanitation. America then came across the bacterial introduction and evolution, where by it realized the role of bacteria and other such organisms in the progression of disease and how medicine can be used to prevent and destroy such infections. Hence a second wave of health care emerged, which saved countless lives and decreased morbidity and mortality by astounding numbers. The realization of the fact that impure and dirty drinking water is the main vehicle for administration and transport of bacteria, further development ensued about how water can be purified. In effect, the introduction of a proper irrigation and sewage system was perhaps the best decision made in the area of health care, which shaped the current outlook of the American health system (Cutler and Miller, 2004).
Theoretical perspectives behind the old and new health care systems
Public health systems seriously lag in its theoretical aspects, which is the reason why there is a constant look out for any theories that can help in the formation of good basis for future public health systems. This lack of theoretical perspectives may be due to the current shift of the nature of public health from a biological aspect into one that is more social in its domain. (Potvin et al, 2005) This simple shift has led to the failure of many of the previous theories, which now demand a new set for survival in to a globalized economy.
Public health however, cannot be understood without understanding the various fundamentals of the society in which it takes its roots. Environmental and social factors can play a key role in the progression of the various societal ills. For example as Potvin describes, the use of drugs in illegal manner is a perfect model where health priorities can be redefined and subjected to critical analysis. Now instead of categorizing the issue in terms of law and order, public health initiatives have helped bring out the humane and addictive side of the issue (Potvin, 2005). Now the role of health is fast becoming very important in addressing the many social issues such as HIV, AIDS, Hepatitis, sexually transmitted diseases, smoking, alcohol etc (Potvin, 2005).
Current challenges in the public health can be divided in to two areas: “the formulation of the program theory and developing a theory about evaluation” The program theory requires the recognition of various factors and determinants that play a major role in the formation of the health society. It is under these influences that programs such as PRECEED have been developed, which solely aim to indicate objectives that make public health system.
The other issue by Potvin is the development of evaluation theory. This theory is aiming to identify the effects of different programs that are improving social outcomes. Both these theories along with others are working towards the making of theoretical perspectives in pubic health (Potvin, 2005).
Who and its recent problems regarding health provision
Global health suffered immensely due to the faulty systems of the WHO. While the aims of WHO have been commendable to reform world health, very little has been carried out. This is due to faulty planning, failure to understand the health care systems of the area, the geopolitical and environmental factors that have been neglected in planning, and the lack of timing and consistency. The result is an increased criticism over WHO’s inability to carry out global health strategies, and the lack of judgment in how to carry out these reforms. Many works of literature have come out since then, which have all focused on the course of progression of WHO initiatives and plans and why such programs came to sad conclusions (Yamey, 2002). Almost all agree at one point that the WHO efforts and ideals were left behind, leaving incompetent health care policies to follow. This led to diversion among the investing agencies to other areas of health care fields such as the World Bank etc. increasing the downward slope of the WHO. The change of leadership in the 90s with the arrival of Gro Bruntland was a breath of fresh air to the crumbling health department. And as true to her promises and commitment, Bruntland restored confidence of donors in WHO. But analysts still state that this was only the outline restoration of the problem. Bruntland’s efforts have not shown many results at the country’s levels, which is raising new concerns. During this time, the role of donors in influencing the manner of monetary spending came into light, and how they could ensure proper utilization of the money. This however, still was not a good plan, for this influence of donors meant that WHO would not be able to plan any future or long term plans (Yamey,2002).
Most of these problems arise from the problems occurring in the regional levels of WHO. The division of the six regional offices has led to more problems in the healthcare setup of WHO as contrast to what was thought before. Much of these organizations are now focused towards regional politics, and are now under influence the political figures and policies, thus limiting their efficacy as healthcare personnel are cut out from the main decisions. The need for structure and correspondence within and in between the regional offices is essential to plan programs accordingly. This recent contribution to the atrophy of the health system needs to be addressed before any progress can be achieved (Godlee, 1994).
Medication deficit in developing countries
More than one third of people can be saved from dying with infectious diseases if they had proper access to the medicines. This is the reason why most of the deaths occur in poor countries. The poor infrastructure of medication is the main reason why health statistics are poor in these areas. This has led to decline in the economic status of the countries, which in turn have led to further deterioration of the regions such as African continent. The debate usually at this point shifts to calling the pharmaceutical companies as the bad guys, but in reality, it is the lack of infrastructure of health that has led to poor distribution of the drugs. The lack of global efforts to the degree needed is another reason why this problem may not be solved sooner (Mercurio, 2006).
Apart from the contribution of the countries in improving the health care systems, the main need is for the provision of resources and funds for establishing them. Such resources of funding are many and one of the major contributors is the public itself. This aid is frequently seen when disasters such as the earthquake of Pakistan, tsunami of South Asia, AIDS and starvation crisis of Africa etc. were witnessed. In other words, the provision of funding is there but needs to be rerouted to areas where it is not considered to be needed. Tuberculosis, malaria, SARS, AIDS, and HIV are some of the most prevalent diseases yet the funding for such causes is inadequate. If the media and health industries were to focus on the devastating numbers of deaths per year around the world due to these conditions, there will be more interest in providing funds to alleviate the problem. In summary, the need for adequate funding and resources for medication and donation to health will help improve the condition of health in globally afflicted areas (Mercurio, 2006).
Theories forming the healthcare systems: A brief overview
The advent of public health and its growing influence led to many changes in the healthcare sector. Suddenly, two groups formed, one claiming that the current improvements in health were due to the medical advancements in health. The other however, claimed that this major decrease in mortality rates was due to increase in the public health measures such as sanitation, public awareness etc. It is now accepted that both have played an integral part in the progression of the other, yet still, the debate goes on. Many of such theories and hypothesis have gone into the health care systems and made them what they are today. Yet still, many continue to evolve which are expected to either create new health systems, or modify the ones already present.
The biggest controversial and debated theory was one proposed by Thomas McKeon, who claimed that the healthcare system’s increased effectiveness was not due to the medical sector itself, but by the different societal contributions in improving their level of living. He claims that it is actually public efforts and improvements in the quality of nutrition that have led to lesser mortality rates. He aims to highlight the role of social and public methods that took place along side the different economical, social and medical reforms in the 18th and the 20th centuries, and which he claims have not received proper recognition. He claims that it is these reforms that have created new vistas in epidemiology sectors of health, and without which modern medicine could not have evolved into the present state (Harris, 2004).
McKeon’s Theory however, does have its loopholes, for it fails to identify the role of public hygiene, and the identification of the virulence and infectious factors and has placed most importance to the value of improved nutrition in the improvement of health. McKeon’s theory was perhaps most significant due to the intense debate it instituted about the role of various factors that improved health in Britain, and the contributory roles of different factors such as public sanitation, medical progression, identification of disease processes etc (Harris, 2004).
Contemporary health care delivery systems have been broadly categorized into four types based on their nature of modus operandi and their origin. Many of these systems are traditional systems that have been at service since the inception of public health. However, the newer systems available are evolutions of these systems along with hybridization and blending of the four types. The modus operandi dictates many of the functions of the system and therefore, are the core setup behind them (Coyne et al, 2002). UK, Sweden and Denmark are the examples of the socialized medicine system where the per capita costs are low, making them cost effective, and where the systems are governed by the state, which some how limits the privatization sectors. An entirely different form of system is the socialized insurance system which allows insurance coverage to all the citizens of the country. This system becomes superior in respects that it ensures the insurance coverage of the basic medical necessities. Social insurance system’s most successful example is Canada, where the health care coverage is ranked one of the best in the world. A similar supplemental insurance plan of socialized insurance is seen in Australia and France, which promises potential for the private sector, as mentioned above (Coyne et al, 2002).
Mandatory health insurance is very common in Germany, where there is a trend for sickness funds and insurance coverage for the unemployed. This insurance plan is also seen in Japan and Netherlands; however, it is responsible for the high per capita costs reported by these countries.
The United States of America currently follows the voluntary insurance system. This system is the “provision of specific medical services to a specific segment of the population.”(Coyne et al, 2002) The system gives the highest per capita costs among other health care system.
With increased interest and revival of the public health’s role, new theories are also emerging. For example, Fidler (2002) is of the opinion that theories of public health that were formulated in the past such as Gostin’s theories of public health laws. Fidler argues that current theoretical perspectives should be able to include different nations, and must focus on the provision of quality global health, rather than study the effects of globalization on the public health (Fidler, 2002).
It is not that hard to see how radically different this theory is in the current quest of brail of health care. Instead of creating comparisons, analogies, criticisms or defensive proposals, Fidler’s theory is in fact a practical approach for reaching the desired goals in health care. In this aspect, the globalized theory is the need of health care, says Fidler, and accordingly the law of public health. To bear in mind is the fact that this area is very much ignored compared to its counterparts which are medical and health care laws, which overshadow this important area of health care. Fidler claims that Gostin’s theory is inadequate for the current times because it fails to address the issue of globalization in light of provision of health care to all globally. Also, his theory is not able to assert the need for more cooperation between countries with regards to health, especially in the highly connected world of today. Thus globalization, which has been considered a threat, and an area of concern in the manners of law, must now be considered in the terms of the potential role it can play in the development of this area. (Fidler, 2002) Gostin’s theory does not emphasize the need for global cooperation and help in the development of a healthy world. The new players of cooperation and diplomacy with in the health care between the countries remain unspoken of in Goston’s theory. And therefore, FIdler asserts the need to come up with theories that specifically recognize, assert and plan global health.
Main issues in global public health
The world health report in 2006 was able to highlight ten particular areas where global public helath was facing problems. It ranks the first problem as being the lack of data about the statistics regarding various issues in health. It claims that under five mortality rates are inadequately documented. This is even more so of a problem when calculating infant mortality rates. The reliance of predicted statistics rather than calculated and actual statistics also is causing difficulties in estimation (World Health Statistics Part I, 2007).
The WHO report however, gives a better condition in calculating the estimates for HIV patients. This is due to improved screening methods and calculation estimates that have been presented and implemented in many countries around the globe. Although it does not give an accurate number which can only be attained should HIV tests are carried out on each person each year, it gives a good picture to calculate and estimate trends and areas in need of further growth.
The report projects a decrease in the non-communicable diseases in the coming years, but despite this there will still be an increase in the prevalence of these conditions as the numbers of the elderly population will increase with time. Such conditions also include tobacco consumption apart from stroke, heart diseases, cancer, HIV and AIDS and COPD (World Health Statistics Part I, 2007).
The WHO statistics are keeping a close eye on the growth quality of the children and the fulfillment of their nutritional requirements. Stunting of growth is very prevalent around the globe with more than 30% of children suffering from it. This pattern is most concentrated in the areas of Africa and Middle East as well as South Asia. The identification of such nutritional deficits has led to an increase in the efforts to educate local public is providing their children with good quality nutrition. Unfortunately, these are also the areas where there is increased poverty, famine, disease and economical decline. Identification of these factors contributing to malnutrition is educative for future health planning (World Health Statistics Part I, 2007).
WHO believes that there should be a proper method of collection of death rates in different areas of the world, along with estimated about morbidity and mortality and factors that have led to death. This data, WHO believes is essential to learn the different trends in the health of individuals, their standards of living, their life expectancies and the areas of health where focus is needed. This is especially true in poor states, where poverty is causing a decrease in the life expectancy of individuals. Of the many factors identified as causative of deaths in such areas, tobacco usage is one of the highest ranking in causing morbidity and mortality. Tobacco accounts for more than 80% of the 8.3 million death rates among the low economical countries (World Health Statistics Part I, 2007). The more perplexing issue is the lack of information about the true number of individuals who are smoking. The health care resources in dealing with tobacco issues in such areas are inadequate to meet the needs of the people. One of the causative factors reverting many people towards tobacco is the increased prevalence of depression world wide. Depression is causing more harmful effects than any other disease, due to its slow, hidden and life time effects. Recent surveys and reports emphasize that depression is responsible for increased morbidity and mortality among individuals, and can make prognosis of a disease even worst (World Health Statistics Part I, 2007).
Inequalities in health are another burden mankind has to bear in health area. As economical divide among the rich and the poor increases, there is continuing lack of resources available for the poor; where as the rich are in disposition to experience the best of healthcare technology has to offer (World Health Statistics Part I, 2007).
One of the positive outcomes in this report was the decrease in the incidences of tuberculosis. There has been a progressive trend towards reduction of tuberculosis cases. However, the emergence of extremely resistant variants of tuberculosis is fast becoming an area of concern for all healthcare providers globally (World Health Statistics Part I, 2007).
Women and child health: A continuously evasive issue
Perhaps the greatest indicator of the quality of health care delivery in any area can be assessed by looking at the quality of care provision for women and children, as well as the infant and mother mortality rates. If these estimates are to be assessed, it will be evident that the majority of the current health care systems have failed miserably in providing maternal and child care. This is a catastrophe in the face of the programs available that are effective, cheap and long term, currently implemented, but in such poor state that the results seen are negligible. This effect is seen the most in Africa and the South Asian region (Freedman et al, 2005).
The biggest enemy in the current situation of women and child health are the lack of awareness and education, cultural, religious and social taboos, and plain discrimination due to gender. As long as the role and position of women as equals and partners in all aspects of life is accepted and appreciated, it is very difficult to expect any significant changes to occur.
Many countries boast of reduction in infant and child as well as mother deaths, yet the numbers of deaths per year are still astonishingly high. 4 million of the children are dead within a month of their birth, with the remaining 6.8 million children dying before the ages of 10 (Freedman et al, 2004). The African regions show the same numbers of death among children. The numbers of mother mortality are even harder to calculate based on the scanty and poor quality records of women. Some estimate these deaths to be half a million per year, but experts believe that it is in fact many times more than anticipated. This does not include the women who suffer from complications and debilitations due to pregnancy. Violence, abuse, sexual assault and diseases, continue to plague women till today. This gender imbalance presents itself with utmost brutality, making it seem that all the efforts done so far in health care have been useless. Such health care interventions still fail to address more than half of the world population, including children.
The biggest problem in this regard is the lack of structured data that could reveal the current statistics and health situation of women and children alike. This becomes even more difficult in areas such as Africa and south Asia, where only time and constant efforts will enable a start in change (Freedman et al, 2004).
Trends in public health in the last two decades
There is no confusion in the part that the current public health has risen from the health care systems of the past. However, it is mainly the trends of public health from the eighties and the nineties that have shaped the current position of it around the world. The 80s and the 90s were times of many changes including technological development, increased medical advancements and discoveries, and increased emphasis on the institution of globalization in to the healthcare sector. These two decades can be conveniently considered as the center stages where the initial concepts and fabrications of global public health developed. Therefore, these two decades became the future references for further development in public health.
Although this helped matters initially, the basing of these two decades for referencing, comparison, observation and other such purposes may not have been a wise strategy. Reason being that this era of public health was one of transition and experimentation. This was the era where the researchers and policy makers were experimenting with ideas to create a better public health care infrastructure. Along with this core interest were involved the interests of developing an international public health care system, an increase in awareness and competition with the health care systems around the globe, and the advent of understanding the problems associated with global epidemics in the current century. Researchers at the time were for the first time comprehending coming out of their own shells and considering health care as a global phenomenon, a concept that remains alien to many parts of the world till today. Interests in cooperation and exchange of medical knowledge along with fierce competition to establish supremacy in this regard also came in to play. The situation therefore became a ground for set up of future health care system, where there were at the time no rules, no background information and no clear ideas about the future trends in the health care.
Therefore, to base many of the healthcare systems of today and comparing them to the systems of the past becomes an area of debate and consideration. These two eras of healthcare were in no way perfect, then why comparing them? However, there are many things one must know about these two eras to understand the many problems that face public health care today.
The 80s and 90s era saw the major impact of low mortality rates and their impact on health for the first time. The first ever transition was felt from the health of the past, and the effect of simple measures such as hygiene, maintenance, infection control and pure water provision services was truly appreciated.
Proposed new systems in a global world and methods of implementation
Many proposals exist for the creation of an ideal global health care system which is applicable in all countries. The goals remain the same although the systems may be different. But all in all, health care experts believe that in order to create a progressive healthcare system, the central role should be given to the government, with proper financing and care, along with accountability towards the public. Such systems are supposed to be universal so as to reduce the chasm created between the rich and the poor, and the socioeconomics states between different groups of people. There should be a balance to include all sectors of the society in to the health system and not become exclusive for only the rich or only the poor portions of the populations. Proper organization of the structure is essential if such a system is to survive its already existing counterparts. Along with is required the proper financing decisions. This could be done by proportionate fee payment by the patient according to the social status, pooling, healthcare financing, need based funding and expenditures, and creating equal opportunities to access healthcare facilities to minimize social class differences (Global Health Watch, 2006).
Many also suggest creation of a decentralized system, which is able to provide the local areas according to the needs of the public there. The key in this system will lie in the flexible approach to accommodate various systems and organizations which will help create good health systems according to the need of the area, and yet be equipped to handle main issues of healthcare (Global Health Watch, 2006).
The potential role of leadership in the health care industry
Human resource development has been a neglected area in the health care industry. This fact has led to more people taking part in ventures that help develop this area. For all experts in health care now know that for any health care initiative to take off and become successful would require a dedicated and far sighted leadership.
This area is therefore among the many areas that are the focus of developing systems of health care. This area in itself is highly complex and is therefore divided in to a series of departments or areas of expertise. All the major contributors of the world have now developed separate areas of human resource development structures in their health care provision. The areas under this department are the supply and demand of the health care professionals, workforce development and their integration to specific areas such as Africa, innovation and coordination. With further research, this area is fast becoming an essential component in order to sustain the health care systems. This area also focuses on development of itself, and works towards increasing funding for itself, so as to produce better results, and increase awareness among professionals about its importance in the healthcare sector. Also, in its focus is the development of long term programs that help produce long term planners and not rely on short term training strategies to address only current or more pressing issues (Boufford, 2004).
The human resources development can be further divided into various areas with different leaderships in order to reach its targets. Two of the most common leadership terminologies are the leadership at the country and the global levels respectively. Both the leaderships are relevant and necessary for each other, and failure of one will mean failure of the other. Country leaders are able to understand, communicate and implement strategies that are akin to the problems of the country and the region, and therefore devise methods that will ensure health care provision of that region. Such a leader will then be able to convey to the global leader the health care problems of the country or region, and will plan with him or her to devise methods to alleviate the problems. The global leader in turn will coordinate the different health care programs carried out in various countries, and coordinate support accordingly (Boufford, 2004). Both of these leaders will also be responsible for the creation of health sector development models, in order to create institutes that research and plan based on these lines. Other areas of interest and development in human resource would be the monitoring of the global trends such as immigration in health, information flow, the current developments in the technologies, the commercial and the environmental factors, the identification of the diseases and the cultural and religious norms of a region, and the role of war, crime, famine and destruction on the health systems of the world. A good leader will in such cases seek to work in cooperation with the governments in order to instill effective change (Boufford, 2004).
Perhaps the biggest challenge in this regard will be the diversity a leader will come across with even within a country. Every area is a complex center of activity, where factors such as culture, religion, economy, living standards, politics and many others influence health care setups. Creating a system that is both beneficial and at the same time in accordance with the norms of the area is a major challenge a leader will face from time to time. The leader therefore, becomes the major determinant of the success or failure of the health is intervention (Boufford, 2004).
The hybrid model
The hybrid model is considered a potentially useful tool to manage the current health care crisis. The hybrid model, as explained above, is the utilization of the properties of the different healthcare systems to come up with a better health system. These systems are based on the older systems, but have the capacity to reinvent themselves should the need be. It can be therefore, thought akin to merging of the past and the present, where the basic knowledge of the past can be utilized to fabricate better health care systems of the future. Hybrid systems have the added advantage of having the ability to cope with the times, and absorb external influences to better maintain it self. It therefore, can be an excellent example of a healthcare system that is open to debate and change, should the need arise (Coyne et al, 2002).
Creating alternatives to reform healthcare systems
The current health care system has started to acknowledge the need for reform in the healthcare sector. In the US, four types of changes have been proposed to improve the health system. For supporters of incremental change, they state that there is no need to completely overhaul the health system, and that if incremental steps of improvement are introduced, the current healthcare system with foster very well. The potential of it being implemented as well as succeeding lies in the fact that the investor interest remains, and major changes will be avoided. But promoting the interests of the investor companies will be useless in this manner, as the efforts placed through this method will remain insignificant leading to low or non productive results, and the problems will still remain. In its competition is the employer based insurance system, created post World War II where the employers offer health insurance to their people. However, apart from serving the interests of the insurance companies, it also fails to meet the targets or provide any real solution to the problem. This is in light of the fact that a large majority of employed Americans are still uninsured. The increased healthcare systems costs have coupled with low employer insurance costs, making it hard for employers to get adequate healthcare. Also, such systems remove an employer from the insurance should he or she leave the company, due to which the person may be forced to remain in the job to ensure his or her insurance. Universal access to healthcare in this method remains unfulfilled (Geyman, 2002).
The recent introduction of the consumer choice health programs as possible replacements also requires much thought before implementation. Many claim that although this system is being strongly supported and promoted, it is a system that is based on assumptions and expectations for the better. This in many gurus’ eyes will not take place, leading to further degradation of the system. The system aims to shift insurance from the employer to the consumer; however, such an attempt will still not ensure access and cost problems. And finally any tax subsidies, vouchers or materials of sort provided by the government will not ensure provision of desired care.
The introduction of the single payer system perhaps would be the best bet against providing good health care facilities and system. This system has been put up for consideration many times before, but not implemented. This system can be considered the first to promote universal healthcare as it will provide coverage to all. There will be an increased role of the federal and state governments and fee-for-service basis would be instituted for the physicians. Benefits of this system are very tempting, for it will solve not only the issue of universal coverage, but also will be able to save $150 billion per year, making it the most cost effective healthcare solution available at the present. It also offers good quality of care and access. The main challenges against this system lie with the insurance companies, which would suffer should this system comes into practice. These and other such issues can make the implementation of this system much more difficult (Geyman, 2002).
Steps to institute change
Creating a perfect global health care system will be futile until we identify the different statistics and findings of the systems. For this purpose, certain steps are necessary before commencing of a perfect healthcare system occurs. These include human resource planning, resource generation, creating different methods of financing, removal of user fee structures, improving the health care management, coordinating and harmonizing the different health systems, involving the community, shaping private sectors, and creation of a district health care sector.(Global Health Watch, 2006)
Health reform proposal in America by Jackson Hole Group
The report of the Jackson Hole Group has demonstrated many flaws in the health care system of America.america at the moment is suffering from some of the basic health care planning materials such as electronic patient history archives and record keeping. It also sheds light on the different frequent but futile attempts to improve health care structure in America, and basis these problems on three main reasons. There is reluctance to let the doctor patient relationship suffer in any way, the government’s own fear of putting much at risk and the “lack of public institutional memory or continuity of responsibility for the policies tried” (Ellwood, 2003).
In such state, the group declares there is a need for federal and state government collaboration in standardizing different aspects of healthcare. Such a medical system would require it to be able to withstand and handle the current rising costs in medicine, along with improved quality and performance levels. This as mentioned above can be very easily managed through the use of computerized methods and record keeping. It also insists in involving the consumer or the public in the decision making process, instead of carrying out the decisions by themselves. Medicine and health care is a rapidly progressing field and therefore requires dedicated personnel focused only in incorporating the newest and most up to date technologies in the health care. And finally this group emphasizes the need for health insurance coverage for all Americans, a problem that continues to exist till today.
This reform proposal is unique in that it is able to provide the most concise and accurate analysis of the health care system as well as steps and methods to reform and improve it. It is indeed a very important document in the help towards building america’s future health care system (Ellwood, 2003).
Other initiatives and efforts towards global health in America
Initiatives carried out in global health arena are under debate as to the exact relevance of global and international intrusion in the health. Some analysts are adamant that while globalization is a very fancy addition in the area of health care, it is in effect nothing and that nothing much has changed since globalization effects started to be felt. The argument on the terminologies still reigns, about the correct meaning of the words global health and international health. Some call globalization as the concept pertained with negative changes in the health care sector, while others claim the word international as the root of all evil. The debate may seem irrelevant, but it holds within the manner of communication and the true realization of the nature of effects that current shifts in health care trends have resulted in. American researchers are now set on finding waysto clarify the terminologies and the positive and negative connotations associate with it,and as to how these changes in both the global and international perspective can affect the future outcomes. This debate includes many other areas of health, such as ethics and the paradigm shifts that are taking place. The identification of the exact role of globalization on the mankind and health care sector is perhaps the most important factor that will help plan out future policies and strategies (Walkup et al, 2001).
Creating partnerships in global health
As countries realize the evolution of public health into a global phenomenon, there is increased understanding about the role of partnerships in the areas of health, and their advantages. Although slow to take off with much apprehension, the trend for health partnerships is increasing with positive results at their tow. The most common areas of partnerships have included the fight against AIDS, HIV, Hepatitis, tuberculosis and many resurgent infectious diseases. The results are obvious about such contributions. Global partnership initiatives have helped come to global light many of the health issues that may not have been addressed should left unreported. This increased attention has helped increase in the global funding to address the issues, and increasing research and development in the areas. Global partnerships have been specifically helpful to those populations with low income scales, and have provided cost effective solutions to the areas. Since these partnerships are in sync with the national health care systems, there is a definite improvement in the outcomes regarding health care policies and processes (Buse, 2007).
Global partnerships however, do have their share of problems. The private sector in such partnerships is overrepresented when compared to the governmental sector, and WHO etc. are underrepresented as well. The contribution of the donor parties gives them influential role in the decision making processes in health, and may ignore the more relevant issues in this regard. They may also be unable to compare the private and public cost differences and their effects on the program. The resources may not be properly allocated, undermining the outcome of the strategy. Such GHPs may ignore the potential role of government health systems which may in effect be beneficial for them. Finally, GHPs may not be able to adequately utilize the human resource potentials of the areas, and thereby again influence the outcomes of the interventions (Buse, 2007).
In such circumstances, the efficacy can be increased of GHPs through the following ways. GHPs must work according to the international practices of the health care system and must work according to the health care systems of the country. The influence of donor parties can only be removed through a balanced representation of the contributing partners. The public and private institutions both must work together in order to succeed, and must institute rules and regulations that ensure proper working and planning. Partners must be selected carefully, who must be resourceful to help propagate program. Also such partners must have a positive environment so as to achieve good results (Buse, 2007).
Methods to improve the health care systems
Currently, many initiatives and proposals are underway to improve access to health care systems. These include introspection and audit, and different methods to assess the efficacy of various methods on the overall betterment of the system. Such systems are apt to improve the outcomes of the different problems associated with health sectors and in doing so will be able to provide better quality of care to the public.
Introduction of health survellaince tool
Researchers agree that the introduction and integration of the health surveillance tool is essential for the proper planning of the health systems around the world. By estimating the condition and status of health of a population, the health surveillance tool can predict the nature and severity of interventions required in a population group. Intense interest in this area has led to its development with the introduction of many kinds of surveillance systems. These include passive and active surveillances, routine health information systems, categorical and integrated surveillances, syndromic surveillances and behavioral risk factor surveillances systems to name a few. Surveillance systems have shown much response and promise since their application. Some of the successful stories include the global response to SARS, the approaches to Avian Influenza in Thailand, Ebola in Uganda etc.
Surveillance systems have been extremely effective in studying the trends in the refugee populations. Some of these include the refugee efforts of Thailand-Cambodia, and more importantly the influx of Afghan refugees in Pakistan. The survey carried out between 1980 and 2002 consisted of growth and nutritional assessments of the Afghan populations. The findings have helped immensely in the planning and development of these populations. Most of the refugee problems encountered shared the same problems of lack of food and accommodation, stress, strife and violence, uncertainty of the future, and the mixed reactions faced by such persons by the government and the local populations. In such situations, surveillance systems were adopted to find out the main problems of the area, the methods which could be employed to alleviate the refugees’ problems and to help reduce the numbers of morbidity and mortality.
The future surveillance systems will be more in depth findings with the recognition of trends and the factors affecting the situations of health in certain regions. In such scenario, surveillances will help in improving delivery of health care to those in need of it, and help allocate better the resources that are provided to relieve the crisis (White et al, 2007).
The application of surveillance systems is many in different types of health care systems. They can be helpful in diagnosing problems with the environment and environment related catastrophes and disasters. Surveillance systems can be carried out to calculate the rates of injuries, and their consequent morbidities and mortalities. Other areas where surveillances can be used include bioterrorism, complex emergency surveillances, and chronic disease surveillance.
The introduction of policies to improve public health
The current problems that are seen in the public health system of America lie in the lack of proper policy designing that is crucial to any sector’s success. Although many efforts placed by the governments in their respective countries should be lauded, the truly successful policies have been those that have included and involved public efforts and views. Such types of efforts have increased trust among the public with their government, and consequently the efforts placed in such manner have brought improved results. For example, the community and health collaborations to decrease the use of tobacco among adolescents can be easily reached if both were to work together in schools and colleges (Acosta, 2003).
Financing the health systems of the world
As mentioned above, the lack of funding and financing in the low income countries has led to the deterioration of their health systems, which are needed in order to improve these countries increased mortality and morbidity rates. The lack of resource from the developing countries, including the United States, has led to the increase in gap between the health systems of low and high income countries. Yet it is these low income health systems that suffer the most. The number of people that are currently residing in the low income countries amounts to 2.5 billion, who do not have the adequate resources to access health care. In these countries, the need for funding from external sources is fast becoming a demand rather than a need. As these countries cannot afford to spend more than what they already are of their GDP on health care. Many initiatives have come forward to address the issue, and among them are the budget support programs in countries where the health care foundations are sound. Such loans have been applied in certain countries with increasingly encouraging results. Introduction of health programs with insurances etc. have also shown immense promise and will continue to affect the outcomes in a positive manner (Financing Health Systems, 2006).
Funding to countries based on “performance based financing” where local governments are given support through funds is another manner that is gaining popularity. Similar to this action is the efforts to improve the private sector and include it within the health care. This area has been much ignored worldwide, particularly in the poor countries and its introduction can help achieve many of the targets that the governments plan (Financing Health Systems, 2006).
This financing however is mainly achieved through the donor parties, and this adds many dimensions in the already complicated scenario of health. Donor parties, as mentioned above inadvertently get increased hold in the saying of allocation of funds. This can affect their continuation and consistency of funding. Therefore, terms and conditions are needed that ensure a consistent cooperation of the donor parties and the formation of programs that are not influenced by the donor parties, but are made according to the needs of the area and the people living there. Increasing cooperation between the donor parties, the government sectors and the policy makers can help make good projects for the future and outcomes (Financing Health Systems, 2006).
Conclusion: How to improve the American health care system
American health care system has evolved immensely during the years. The decrease in the morbidity and mortality rates through out America is an indication of the diligent efforts the government is placing towards increasing the quality of public health. However, diseases such as chronic diseases of the elderly came to the forefront to become the biggest killers of the times. In current times the diseases due to primary causes such as water insanitation etc. have dramatically reduced. Other causes of disease in current times include obesity, high blood pressure etc.
This shift in the disease rates is creating priorities in addressing new diseases for prevention and treatment. Now the shift is towards treating heart and lung conditions, increasing prevalence of cancer, tobacco and alcohol abuse etc (Ricketts, 2007).
This is coupled with the increase in the number of people in American who are without insurance, and the continuously growing number of people who will be out of insurance. This lack of compassion for the persons to be given even the basic life support has generated much heated response in the countries around the world and within the American public itself.
Yet despite the health systems flaws and issues, there is much to fight for public health in the twenty first century. Frank (2002) believes that there are five reasons why public health will be more successful in the coming years. Although his suggestions are made based on the health care system of Canada, his findings and theories can be implemented in many other countries as well. He believes that in contrast to the world of before, there are no boundaries, and the world of the future is far losing these boundaries in areas of health, technological advancements and social issues. This means that more and more people will get exposed to foreign diseases, and more risk remains for such diseases to be carried to international boundaries.
The other issue of concern is the emergence of a new group of epidemics such as obesity and obesity related conditions such as hypertension and diabetes, asthma and other respiratory ailments, coronary heart disease and abuse of drugs and mental diseases. The changes in the trends of health problems are indicating the need for better planning in preventing and treating these diseases in their early states (Frank, 2002).
The continued degradation of the environment is the second most important concern in the public health sector today. The lack of quality and access to pure water resources and the further addition of toxic chemicals and wastes into the water resources are increasing concern about the continual depletion of water resources. The damage to the ozone layer is increasing the risk of exposure to ultraviolet radiations, which in turn are increasing the numbers of cancer rates in the world. The introduction of wastes through smoke and vehicle wastes is another concern for the current health care researchers. Such introductions in to the earth, water and atmosphere of earth are increasing concerns about the outcomes of the future planet and how the human body will respond to these threats (Frank, 2002).
Frank claims the third most pressing concern to be the incomplete research being carried out in the pharmaceutical sector, which is leading to the introduction of drugs that are causing massive side effects. The toxic effects are also being seen in food and vegetables, medical etc (Frank, 2002).
These and other issues such as screening tests for various diseases, lack of health care personnel, the brain drain of the poorer nations, the lack of resources in health are and the lack of policies in the progression of health are system.
The public health system continues to evolve and develop, but many obstacles stand in its way. There is continuous need for the introduction of new policies and methods that can ensure that the public can have access to the health care facilities. Also, much research is required to improve the public health system of the world, in both the country context as well as the global context.
- Cristina M Acosta, 2003. Improving Public Health through Policy Advocacy. Community Based Public Health Policy and Practice Issue No 8.
- Assessing the populations health. Charting the Future for Health in the Americas. Quadrennial Report of the Director, 2002 Edition.
- John C Baldwin, 2000. Why Health Care is Failing in a Booming Economy. Western Journal of Medicine. 2000: 172(4):222-223
- Robert J. Blendon, Cathy Schoen, Catherine DesRoches, Robin Osborn and Kinga Zapert. Common Concerns Amid Diverse Systems: Health Care Experiences in Five Countries. 2003, Journal of Health Affairs- Volume 22, Number 3. Project HOPE- The People to People Health Foundation. 2003
- Jo Ivey Boufford, 2004. Leadership Development for Global Health. JLI Working Paper 6-1
- Brookings Institution, 2002. Failed States, Countries in Crises and Global Security: How Health Can Contribute to a Safer World. World Health Organization. S
- Theodore M Brown and Elizabeth Fee, 2004. A Role for Public Health History. American Journal of Public Health. 2004; 94:11:1851-1853-
- Kent Buse, 2007 Global Health: Making Partnerships Work. Briefing Paper. Overseas Development Institute.
- Margaret Chan, 2007. Public Health in the 21st Century: Optimism in the Midst of Unprecedented Challenges.
- David Cutler and Grant Miller, 2004. The Role of Public Health Improvements in Health Advances: The 20th Century United States. NBER Working Paper Series.
- Paul M. Ellwood, 2003. Crossing the Health Policy Chasm: “Pathways to Healthy Outcomes” Jackson Hole Group Briefing, 2003
- Richard G. A. Feachum and Jeffrey D. Sachs, 2002. Global Public Goods for Health. The Report of Working Group 2 of the Commission on Macroeconomics and Health. WHO, Geneva.
- Rich World, Poor World: A Guide to Global Development. Centre for Global Development, 2002.
- David P.Fidler, 2002. A Globalized Theory of Public Health Law. Journal of Law, Medicine and Ethics, 150.
- Financing Health Systems. Severe Challenges Exist for Low-Income Countries in Setting Health Priorities and Financing Health Systems. Disease Control Priorities Project. 2006.
- John Frank, 2002. Five Reasons for Stronger Public Health Services in the Twenty-First Century, 2002. presentation to Toronto Board of Health, 2002
- Lynn P. Freedman, Ronald J. Waldman, Helen D. Pinho, Meg E. Wirth, A. Mushtaq R. Choudhry and Allan Rosenfield, 2004.Who’s Got the Power? Transforming Health Systems for Women and Children. Summary version UN Millennium Project, Task Force on Child health and Maternal Health, 2005
- Howard Frumkin, 2002 Urban Sprawl and Public Health. Public Health Reports, 2002 volume 117
- Laurel Garrett, 2000. Betrayal of Trust: The Collapse of Global Public Health, 1st Edition, Hyperion Books, New York
- John P. Geyman, 2002. Family Practice in a Failing Health Care System: New Opportunities to Advocate for System Reform. JABFP 2002, Vol. 15 No. 5
- Global Health Watch, 2006. A Health Systems Development Agenda for Developing Countries. Civil Society Consultation Paper.
- Bernard Harris, 2004. Public Health, Nutrition and the Decline of Mortality: the McKeon Thesis Revisited. Social History of Medicine, Volume 17, Number 3, 2004. pp. 379-407(29)
- Craig R. Janes,2003. Theorizing Global-Local Linkages in Global Health Studies. Presented to 2003 Fullbright Visiting Scholars Conference, “International Cooperation in a Borderless World: Exploring the US Role in Global Health Governance, Washington.
- Karen Jochelson, 2005. Nanny or Steward? The Role of Government in Public Health. King’s Fund Working Paper 2005
- Jordan S. Kasselow, 2001. Why Health is Important to US Foreign Policy. Council of Foreign Relations and Millibank Memorial Fund.
- Joseph C. Koyne, Jefferey A. Kramer, and David Alexander Sclar. 2002. European Health Care Systems Under Stress: Emerging Hybrid Models. Center for Health Care and Insurance Studies, working paper series: Number 2002.
- Diarmid Campbell-Lendrumm, Carlos Corvalan and Maria Neira, 2007. Global Climate Change: Implications for International Public Health Policy. Bulletin of World health Organization, 2007, 85 (3)
- Yash Lokhandwala, 2000.Decline in Public Health Infrastructure in India. Indian Journal of Medical Ethics, 2000-8(3)
- Nicholas Low and Brendon Gleeson, 1998. Justice, Society and Nature: An Exploration of Political Ecology. Routledge, London Publication 1998.
- Peter Nsubuga, Mark E. White, Stephen B. Thacker, Mark A. Anderson, Stephen B. Blount, Claire V. Broome, Tom M. Chiller, Victoria Espitia, Rubina Imtiaz, Dan Sosin, Donna F. Stroup, Robert V. Toux, Maya Vijayaraghavan and Murray Trostle. Chapter 53 Public Health Surveillance: A Tool for Targeting and Monitoring Interventions. Publication of Disease Controlling Priorities in Developing Countries, 2nd Edition. Disease Controlling Priorities Project.
- Population Health, Section Five of Statistical Overview on Health and Health Care, 2006.
- Louis Potvin, Sylvie Gendron, Angele Bilodeau and Patrick Chabot, 2005. Integrating Social Theory into Public Health Practice. 2005, Vol 95, No. 4, American Journal of Public Heatlh, 591-595
- The Quality Conundrum: A Global Perspective on Healthcare Quality, 2006. Publication of PricewaterhouseCooper’s Health Research Institute.
- John Raeburn and Sarah Macfarlane, 2003. Chapter 14 Putting the Public into Public Health: Towards a More People Centered Approach. Book Global Public Health: A New Era. Oxford University Press, 2003.
- Veena Soni Raleegh, 1999. World Population and Health in Transition. BMJ 1999;319:981-984
- Bryan Mercurio,2006. Resolving the Pubic Health Crisis in the Devleoping World: Problems and Barriers of Access to Essential Medicines. Northewestern Journal of International Human Rights.Vol 5, Issue I, 2006
- Mario C. Raviglione and Ian M. Smith, 2007. XDR Tuberculosis-Implications for Global Public Health. New England Journal of Medicine 356;7, 2007
- Uwe E. Reinhardt, Peter S. Hussey and Gerard F. Anderson, 2004. US Health Care Spending in an International Context. Journal of Health Affaris, 23,no. 3(2004): 10-25
- Richard, Skolnik, 2007. Essentials of Global Health, Chapter 3. Health, Education,Poverty and the Economy. Jones and Bartlett Publishers, 2007.
- Diana Smith, 1999. What Does Globalization Mean for Health? Global Policy Form, UN, New York. Web.
- Thamas C. Ricketts, 2007. Improving America’s Health: Personal and Public Solutions. United Health Foundation, 2007.
- UN China home page, Goals and Objectives. Objective 1: Basic Social Services.
- UN China, Health Overview,2002 Thematic Areas.
- Ruth B. Walkup and Supinda Bunyavanich, 2001.US Public Health Leaders Shift Toward a New Paradigm of Global Health. American Journal of Public Health, 2001, 91(10):1556-1558
- Wikepedia, 2007 Precautionary Principal.
- WHO Regional Office for the Western Pacific, Australia, 2005. Web.
- World Health Statistics Part I, 2007 Ten Statistical Highlights in Global Public Health, meeting report Geneva. Web.
- Working Together to Improve Global Health. Part IV, Jones and Barlett Publishers.
- Gavin Yamey, 2002. WHO in 2002. British Medical Journal 2002;325:1107-1112.