When I am making my ‘To Do’ list at the start of each week, I always prioritize each item on the list in order of ‘importance.’ Global health policy makers have the same task, but they are essentially deciding which populations and peoples’ lives are the most ‘important.’ As policy makers and policy analysts begin developing a new ‘global health agenda’ for the 7+ billion people in the world, global health trends are used as a baseline to create effective and sustainable approaches to addressing international health concerns. In most cases, the global health priorities are in reference to issues discussed at the WHO board meetings, or problems that receive the most funding from international and national health agencies, or items frequently discussed on the front page of the New York Times, or public health problems receiving the most ‘hits’ on Google.
During a morning coffee chat with my good friend, Dhammika, about global health priority setting, he made an interesting point: we need to take a holistic approach to setting priorities in public health. We need to “take a step back, [and look at] what the major threats and challenges the world as a whole is facing today and then look at what effective ways public health can address and contribute to these challenges.” During our discussion, we came up with four challenges that the world faces: global warming, feeding the growing population, energy, and a potential pandemic. While the biggest capacity that public health could play a role in would be in feeding the population, global warming, and the potential of a pandemic; the health sector could do very little in terms of energy. So how can we prepare for health interventions in response to the said world threats: global warming, increasing population trends, and the possibility of a pandemic? Preparedness often transpires in the face of scientific uncertainty. Events such as an influenza pandemic or a hurricane cannot be anticipated with accuracy, but protecting public health remains crucial.
Many factors of global warming are linked to a combination of several things related to global health such as population growth, livestock (which also has to do with food production), and water and sanitation. Droughts, for example, affect ecosystems and migrations, which directly effect food and water shortages and malnutrition. Another example is flooding, which can cause food and waterborne diseases as well as vector-bone diseases. To combat this, health interventions such as public education, water treatment, watershed management, vector control, medical prophylaxis and treatment, and vaccinations should be considered at the top of the ‘global agenda’ as we prioritize emerging issues. To address population growth, policy makers need to develop family planning and reproductive health policies and services, which could involve researching new insights and innovative solutions to population growth.
Feeding the growing world population presents a number of challenges and opportunities for global health interventions. President Obama’s global hunger and food security initiative, Feed the Future, aims to collaborate with ‘developing countries’ to reduce hunger, poverty and under-nutrition. The cross-government initiative incorporates a broad range of interventions, from technical interventions such as working with farmers on scientific mechanisms and management skills to health interventions such as strengthening delivery systems for maternal and children’s health. It is expected that maternal and children’s health systems will need to be intensified to support an estimated increase in world population. In a 2011 UN Report, it was estimated that the world’s population would reach 9.3 billion by 2050. This explosive increase will create greater challenges and barriers in feeding our population; to invest and prioritize policy making towards family planning to help stabilize the rate at which the world population is increasing would be a great first step in keeping food on our already scarce shelves.
The third challenge facing global health is the potential for a pandemic. It is vital that the international health community makes increased efforts to detect outbreaks and respond to them effectively. However, we do not have the systems in place to detect outbreaks fast enough, or the capacity to produce vaccines quick enough, or public health care work force to do it. Different global systems and tools are in place to help address the threat of a pandemic. The Public Health Agency of Canada developed the Global Public Health Intelligent Network (GPHIN), which has been an effective tool that provides accurate and timely information on global public health issues. As an early-warning system, GPHIN detects potential public health threats in which, institutions such as WHO, international governments, and non-government organizations can use to quickly react to public health incidents. GPHIN is just one tool that is in place to help detect early signs of a pandemic. Another contributing factor under the umbrella of a potential pandemic is power inequalities between countries. Power inequalities play huge roles in how countries respond to these outbreaks. For example, many countries have the capacity to stockpile drugs and some countries produce their own, while others countries that cannot stockpile drugs, vaccines or produce their own would literally not make it through a pandemic. Decision makers need to prioritize detecting outbreaks and responding to them.
When trying to make priorities for the entire world, 7+ billion people, there will always be populations that are going to get the short straw. Sure, we can use common indicators to assess priority in the health field such as trends in treatment coverage, changes in perceived priority, changes in financing and institutional involvement and bibliographic trends, but taking a more holistic approach, taking into account the ‘global agenda’ and looking at the threats that the world has is more effective.
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