What is Global Health?

What is Global Health? I give a lecture on global health to second year medical students and always struggle to define this-the definition ends up being a sort of 'catch all' term to describe anything relevant to health that does not respect political boundaries.

Rowson and colleagues explore the evolution of the "global health" concept and definition in their article "Conceptualising global health: theoretical issues and their relevance for teaching" (full text can be found here). They discuss the discipline's roots within 19th century "international health," a construct that largely focused on protecting European and North American infection control and colonial interests. The field evolved in the 20th century to address major public health menaces such as malaria and smallpox, and later became more comprehensive including public health policy, a broader focus on economics as well as other factors.

Rowson and colleagues cite my favorite modern definition of the field: Koplan et al defined 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."

Rowson and his colleagues do not provide a suggestion for a new definition, however, they discuss definition features that are still being debated. Specifically, they note 3 key things:

1) The "object of knowledge" associated with the field (what topics are covered? what is the scope of coverage?)
2) The "types of knowledge" associated with practitioners in the field
3) The "purpose of knowledge" within the field

Rowson et al argue that any definition of global health should avoid the inclusion of value-laden terms such as "equity." They note that inclusion of values in the definition implies that people who do not ascribe to the defined value are not practicing or studying global health. Although this argument is sound and academically "true," I still prefer the aforementioned Koplan definition that emphasizes health equity.

The article by Rowson and colleagues is an excellent overview of how the field of global health has evolved and what it encompasses; moreover, it succinctly highlights the key features that are still being actively debated.