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International health, global health or public health

By Bistra Zheleva | 23 Jul, 2013

I read this on the BMJ recently and it made me wonder - is this really the correct title to give to this kind of work? Would love to hear thoughts from the rest of the group.



Jeanne Leffers Replied at 8:17 PM, 23 Jul 2013

Your question is provocative because all the terms are often used in similar ways, though the issues Mary Black raises make me wonder how international health should really be defined. When we examine the competing interests, the economic disparities that most often occur between "host country" workers and visitors, the enormous differences in resource availability and the need for solid partnerships, it is evident that the definitions will differ depending upon the perspective of the host or visitor. I would love to learn more from those in this group with thoughts to share about how we distinguish these terms and what I, as an American, must consider in my global work.

Soojin Jun Replied at 11:16 PM, 23 Jul 2013

I get what the author intended for the title...I might have named maybe something like "What is the definition of international health?", echoing the concern that Jeanne mentioned. As world's population is moving and immigrating globally at every direction, and especially for US population, I feel any of the term, global, public, international, or US health mean the same in a big picture.

I look at it this way. US is a mini-world; our population is so diverse and unique which gives us so many challenges in healthcare delivery. I personally lost my father partly due to language and cultural barrier; oh, I understand and know how healthcare can especially kill people with these barriers. Yet, innovation serves them last because it is so challenging. However, this seemingly disadvantageous point can be an advantage for global, public, and international health if we can find solutions here; US population is like a cohort for the world. If we can find a solution here, we can scale it to solve the world's problem; that is why, to me, global, public, international, and US healthcare mean the same. Sooner innovations grasp this, better healthcare delivery will be available for all.

Jonathan Pincus Replied at 2:15 AM, 24 Jul 2013

Interesting I like the concept at the end that anyone working in other than their native country is involved in International health. There is a notion that "exchanges" are always unidirectional from the wealthy country to the country with less resources. In some sense its an odd notion that just because we have more resources we have more knowledge. The fact that we can get certain outcomes (and not even close to the best in the world) for a per capita expenditure of $8,000 somehow automatically makes us experts at telling those who have $50 per capita to spend how to spend that money - we would have trouble providing even the billing for our health care for that cost. As some of the case studies point out there are strong parallels between many situations in developing countries and those in relatively resource poor areas in the US and other wealthy countries. How much of what we "bring" to the table is just our resources, access to resources and education which are mostly just an accident of birth geography. When I was briefly in Tanzania, a hospital was unable to start their ARV rollout due to lack of lab services. They had tried for months to resolve the problem. In under a half an hour, the American with no understanding of the country was able to call a US based NGO and broker an intro to a US DOT lab nearby and arrange for labs including funding for patient transportation and food so treatment could start the next day. Did I have any public health or international training or experience? no, any special understanding of the problem? no, I was an American and that opened doors for me beyond the level of my qualifications or abilities.

In fact, if we were more open to a true interactive global health exchange, perhaps the US could learn how to get far better outcomes for the amount of money we pay given that as one of the most expensive health care systems in the world, we have a life expectancy almost identical to Cuba a country that spends only about 8% per capita of what we spend on health care. But it's not just in health care where we have an idea that "exchanges" are only one way. If Bush v Gore had happened in a resource poor country we would have called for election monitors.

Samuel Tesema Replied at 11:06 AM, 24 Jul 2013

I agree, the name international health is controversial so does the
practice. A local health expertise is always required for the international
employee to work while the reverse is not true. The work load is always
tilted in favor of the international health expert. If by luck he has
eprevious xperience working in similar setup in his new assignment he will
be busy working on checking "what is there for me to add' rather then share
whatever he has. The salary and other benefits are incomparable. Donors in
most instances, make sure that the post goes to their fellow country men
and they have high actual money return value with very low net support
going to beneficiaries. The recent discussion on aid effectiveness should
be able to address this. Going forward Local experts should stand tall
than international health experts in providing services to their community.

Bistra Zheleva Replied at 1:11 AM, 25 Jul 2013

Thanks for the comments. I agree with most everything said but I still am not sure what the answer is... There is a whole field of study dedicated to global health, we are writing this in Global Health Delivery Online, the term has become very widely used. If we think about it, it assumes that we, the external global people, are delivering health care to the internal people, which many of us would say we are not. In my work we don't use the term very often, we call it capacity building in health care, but it seems to be very popular in academia. Public Health degrees are just that and then there are the Global Health degrees. Medicine and Nursing are also supposed to be different but are they really? We probably don't have an answer and maybe it is just semantics but I still find it interesting that someone is asking, it makes sense to ask.

Jon, great to "see" you virtually, hope all is OK with you and your family!

Soojin Jun Replied at 10:03 AM, 25 Jul 2013

@Bistra. I understand your concern and I wish there is a way to deliver healthcare internationally. I can definitely relate because my father passed a way a week before his flight to his country in a hope to get more comprehensive care more affordably than here; he had a very short time to make a right decision and his health quickly deteriorated because we were not guided right way due to language/cultural barrier, and not to mention all his savings were hitting bottom. If he had right resources available to guide him to the right choice, he would have made a better decision in the short time that he had and definitely would have more days to live. I am trying to form a bilingual healthcare professionals' community that patients can express their concerns and manage their health directly. I see and hear limitations in using interpreters in that they are not necessarily medically trained and also providers/healthcare professionals have to rely on their abilities to correctly translate; also providers expect that it will take longer time to diagnose and care for the patient but without fruitful outcome. And even in people with same language without an interpreter, don't we misunderstand each other because of misinterpretation? I don't know what you do in terms of international health, but if you think you can help me in any way, please let me know. My email is . Thank you.

Bistra Zheleva Replied at 11:01 PM, 25 Jul 2013

Soojin, very sorry to hear about your father... It sounds like a terrible experience and it must be difficult to deal with...

What the author is trying to say is that health care delivery should be the same everywhere. It should be evidence based whether it's in France, the US, Ukraine, Philippines or Togo. I also realize there is a reason why we call this field "global health". It fills a void, in a variety of ways, in another country where access to care is inadequate or lacking. I suppose there are a lot of parallels between say, rural health in the US and health care in a developing country. But we don't call the inadequate number of pharmacist in South Western Minnesota a "global health delivery challenge", we call it a health delivery challenge. And maybe there are things that are more typical for Togo than for Minnesota, I don't know. It just that it feels like global health should mean something that is the same for all nations, not only North to South assistance.

I did a quick search online and found this article, I remember reading it when it came out. It's an interesting discussion:

This is also interesting to read:

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