MICHELLE AMRI, MPA
“I’m interested in global health.” Those of us who interact with like-minded individuals, hear this often. But what does this really mean? Does it mean the individual’s interest lies in the health of people everywhere? Or subsets of the globe? Or does it mean they are interested in health issues that represent global phenomena? Or perhaps, it means they just enjoy travelling and working on health projects internationally. Terms such as “global health,” are commonly used in this field, but often the meanings of these terms are not universal and leave room for speculation, which may result in misunderstandings or misconceptions.
It is the nature of work encompassed in global health that makes it difficult to define. Koplan et al. demonstrate the intricacies of global health, as it “can be thought of as a notion (the current state of global health), an objective (a world of healthy people, a condition of global health), or a mix of scholarship, research, and practice (with many questions, issues, skills, and competencies)” (1). The lack of a standardized definition is problematic for those working in global health, as it may lead to a lack of consensus among partners about priorities, objectives, or goals. Fortunately, Koplan et al. provide a definition agreed upon by a panel of multidisciplinary and international colleagues in an attempt to achieve a standardized definition. They define global health as “an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual-level clinical care” (1). However, even this definition is not accepted as a gold standard, as many different definitions of global health are drawn on in different settings.
When comparing the term ‘global health’ to ‘international health,’ it may seem like they are inextricable. Given that both include some aspects of ‘health’ and the world, this is true in some sense. However, the distinction between the two lies in their histories. ‘International health’ has a more straightforward history (1). For many years, work in the field of health abroad was referred to as ‘international health.’ Typically, this referred to work on infectious and tropical diseases undertaken in developing nations (1). In contemporary society, this term is often used interchangeably with ‘global health,’ so the distinction is not clear-cut.
So where does global and international health work actually take place? Typically, high-income countries extend support to those in low- and middle-income countries. However, the distinction of nations based on their wealth is now shifting to a designation of those countries receiving support as the Global South, whereas those extending support lying in the Global North. In addition to this new terminology, a recent distinction is now being made in addition to this. While ‘global health international’ work is in the Global South, as discussed above, there is also ‘global health local.’ This latter term refers to work occurring in local settings, but is focused on global health themes, such as marginalized populations of immigrants or migration. With a widely-held view that global and international health occurs abroad, new terminology, such as ‘global health local’, challenges our previously held views and in turn, how we conceptualize global health.
While these may seem like semantics, how we define our projects has important considerations for what the work entails. For example, whether we view global health needing to target the whole world, a region, specific countries abroad, or global issues at the local level, will significantly vary the breadth and scope of initiatives undertaken. Therefore, it is important to relay our understandings to key partners to ensure shared objectives can be reached. If your understanding of the work you seek to undertake in the name of global health differs from the perceptions of your partners, such as funders, this can have negative effects. For example, funders may withdraw funds at a later date as a shared vision quickly decimates. Ultimately, by conscientiously considering what we mean by ‘global health’, we can reduce misunderstanding and misjudgement. Because language shapes our views, it is with this that I urge you to consider how you define global health and what this means for your work moving forward.
Michelle Amri is a PhD Student at the Dalla Lana School of Public Health, University of Toronto.
1 Koplan, J. P. et al. Towards a common definition of global health. Lancet (London, England) 373, 1993-1995, doi:10.1016/S0140-6736(09)60332-9 [doi] (2009).