ASB @NLM Part 2: Health Without Boundaries-Rethinking Global and Domestic Health Lecture

Being on the NIH campus afforded me some very unique opportunities with regard to access to the NIH Video Cast Archives.  Many of the video casts on the site are available to any interested party but some have location and IP address restrictions.  While on the NIH campus, I was able to view a lecture from the Department of Health and Human Services Secretary’s Global Health Lecture Series by Dr. Julio Frenk, Dean of the Harvard School of Public Health, on Health Without Boundaries: Rethinking Global and Domestic Health.  Much of the lecture’s content comes from a March 2013 article in the New England Journal of Medicine, Governance Challenges in Global Health.   He was a really engaging speaker, and had one of the best Prezi presentations I have seen in a long time, and the material presented challenged public health officials as well as the average Joe or Jane global citizen to reconsider the distinction between the terms global and domestic.

Dr. Frenk’s main message is that there is a”no longer a boundary between global and domestic health because the nature of interdependence is so deep in today’s world that the distinction has become meaningless”.  Global is not the the opposite of domestic.  We are living in a time of new world health order and there is an increasing importance on health in the global agenda.  Health has ceased being the exclusive domain of experts, which has in turn changed the nature of our discourse about global health.  This is due to expansions in funding, including a 4 fold increase in developing countries on their respective health expenditures, growing pluralism and the addition of approximately 175 actors in the global health arena (Global Civil Society Organizations, NGOs, and Academic Initiatives), and what Dr. Frenk classifies as the health revolution of the 20th century,  the dramatic increase in life expectancy.

Shifts in patterns of disease have also affected the health landscape.  The three trends identified were:

1. Age of Death – from young people to an increase in older people dying from disease

2. Causes of death – from external reasons to behavioral reasons

3. Experience of disease – a shift from acute episodes of disease to chronic conditions

The traditional view of global health has been that health problems travel south to north with technologies and solutions moving north to south; we need to realize that anything that happens anywhere in the world affects the entire world.  There is a global transfer of health risks due to climate change, the movement of people, adoption of risky lifestyles (such as unhealthy diets), variance in occupational and health safety standards, trade in harmful products, and the spread of medical technology.  The essential functions of today’s global health system include the production of global public goods, management and equality across countries, mobilization of global solidarity, and stewardship.  To date, most effort has been focused on the mobilization of global solidarity seen in humanitarian assistance, technical cooperator, and development financing.  Dr. Frenk believes more effort needs to go into stewardship and cross sector health advocacy.  There needs to be global health system rule and priority setting, convening for negotiation and consensus building and evaluation for mutual accountability.  He stressed form should follow function; the consensus around the main functions of global health initiatives will determine their future architecture.  He closed the lecture by going through two examples of the Department of Health and Human Services influence on the global healthy system: the Food and Drug Administration and the Affordable Care Act.

I never thought that a public health lecture would be one of the most memorable parts of my Alternative Spring Break experience at the National Library of Medicine but I am very grateful to have had the opportunity to explore the NIH Video Cast Archive.

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