Global Health: Crash Course Public Health #9

Summary

Crash Course Public Health explores the complexities of global health, emphasizing the need for worldwide health equity. It discusses the historical context, starting with the WHO's establishment in 1948, and highlights the shift from communicable diseases like smallpox to non-communicable diseases like cancer. The video also addresses the challenges of foreign aid, using Haiti as an example, and stresses the importance of global cooperation and addressing systemic issues to achieve sustainable health solutions.

Takeaways

• 🌐 Global health is a public health approach focused on improving health for everyone worldwide and eliminating health equity gaps due to factors like nationality, income, and gender.
• 📈 The leading causes of death in most places are not communicable diseases like malaria or the flu, but rather non-communicable diseases such as cancer, heart disease, and diabetes.
• 🏛️ The World Health Organization (WHO) was established in 1948 with the goal of achieving the highest possible level of health for all peoples.
• 🌱 The eradication of smallpox in 1977 was a major success for the WHO and global health efforts, showcasing what can be achieved through coordinated international action.
• 💉 Communicable diseases, such as smallpox, HIV, polio, Ebola, and COVID-19, have been targeted by global health initiatives, though not all have been eradicated.
• 💼 Income level is a significant indicator of whether a country's leading cause of death is communicable or non-communicable, with non-communicable diseases being more prevalent in high-income nations.
• 📊 The burden of disease, measured in years of life lost, reflects the impact of communicable versus non-communicable diseases, with different patterns in high- versus low-income countries.
• 🚫 Aid dependency can be a short-term solution that may not address the deeper systemic issues that contribute to a country's health challenges.
• 🌾 The example of Haiti illustrates how historical events and foreign exploitation can lead to long-term dependency on aid and food insecurity.
• 🌱 Sustainable solutions to global health issues require addressing the root causes of poverty and injustice, not just providing immediate relief.

Q & A

What is the primary focus of global health?

Global health focuses on improving health for everyone in the world while eliminating health equity gaps that result from factors like nationality, income, and gender.

When was the World Health Organization (WHO) established and what was its primary objective?

The World Health Organization was established in April 1948, with the primary objective of attaining the highest possible level of health for all peoples.

What was the leading cause of global human death when the WHO was formed?

When the WHO was formed, the leading cause of global human death was communicable diseases, which are spread through pathogens like bacteria and viruses.

What was the WHO's approach to eradicating smallpox?

The WHO aimed to eradicate smallpox by ensuring that not a single person on Earth had the disease, so it could never be spread again. This was achieved through interventions, educational campaigns, and mass vaccinations.

Why are non-communicable diseases now the leading cause of death in most places?

Non-communicable diseases have become the leading cause of death in most places because as the rate of communicable diseases has decreased, these non-infectious diseases have made up a greater proportion of deaths.

How does a country's income level relate to the leading cause of death?

In high-income nations, non-communicable diseases generally account for around 80 percent of the disease burden, while in low-income nations, communicable diseases account for more than 60 percent of the burden.

What is the issue with relying on foreign aid for long-term solutions in countries like Haiti?

Foreign aid can lead to aid dependency and mask deeper systemic issues. In Haiti's case, cheap imported food makes it difficult for local farmers to compete, leading to less home-grown food and increased aid dependency.

Why did the Haitian government call for an end to international food aid in 2010?

The Haitian government called for an end to international food aid because it wanted to focus on developing infrastructure and workforce for sustainable economic growth, rather than just providing short-term food relief.

What are two areas where global health efforts have been consistently inadequate?

Two areas where global health efforts have been inadequate are mental health, which receives much less attention and funding than other forms of healthcare, and maternal health, where preventable causes still lead to a high number of deaths.

What is the importance of disease surveillance in global health?

Disease surveillance is crucial in global health as it involves the systematic gathering, analyzing, and interpreting of health data, making it accessible to everyone, which aids in early detection and response to health threats.

What ethical question does the field of public health grapple with regarding the concept of 'we'?

The field of public health grapples with the ethical question of who is included when referring to 'we', questioning whether it refers to a neighborhood, a country, or the entire world, especially when considering health as a shared global phenomenon.

Outlines

00:00

🌍 Global Health: A Complex Endeavor

The paragraph discusses the interconnectedness of global health and how it transcends political and geographical boundaries. It highlights the complexity of global health, noting that communicable diseases are not the leading cause of death in most places. The script introduces Vanessa Hill and the Crash Course Public Health series. It also touches on the broad definition of global health, which aims to improve health worldwide and eliminate health equity gaps due to factors like nationality, income, and gender. The historical context provided includes the establishment of the World Health Organization (WHO) in 1948, marking a global movement that recognized health as an international human right. The WHO's role in setting health standards, data collection, disease monitoring, and emergency response coordination is explained. The paragraph also covers the historical significance of communicable diseases and their impact on global health, using smallpox as an example.

05:03

🛑 Eradicating Smallpox: A Global Health Triumph

This paragraph details the WHO's mission to eradicate smallpox, a disease that was killing millions annually. It describes the global efforts and strategies employed, including interventions and vaccination campaigns, which led to the successful eradication of smallpox by 1977. The paragraph then contrasts this success with ongoing battles against other communicable diseases like HIV, AIDS, polio, Ebola, and COVID-19. It shifts focus to non-communicable diseases, which are now the leading cause of death globally, caused by genetic, environmental, and behavioral factors. The WHO's 2019 report on the top 10 global causes of death is mentioned, with non-communicable diseases accounting for 74% of deaths. The burden of disease is discussed in the context of a country's income, with high-income nations experiencing a higher proportion of non-communicable diseases and low-income nations facing a greater burden from communicable diseases. The challenges of aid dependency and the historical context of countries like Haiti are used to illustrate the complexities of global health aid and the need for sustainable solutions.

10:06

🌾 The Paradox of Food Aid in Haiti

The paragraph explores the challenges of food insecurity in Haiti, a country that relies heavily on food aid from wealthier nations. It explains how cheap imports can undermine local agriculture, leading to a cycle of dependency and the displacement of local farmers. The deeper systemic issues contributing to food insecurity, such as unemployment, education, and trade policies, are discussed. The Haitian government's call for an end to international food aid in favor of developing infrastructure and workforce is highlighted as a move towards sustainable economic growth. The World Food Programme's initiative to buy local foods from Haitian farmers at market price is cited as an example of revitalizing the agricultural sector. The paragraph emphasizes the need to balance short-term needs with long-term solutions in global health aid.

15:08

🌐 The Global Reach of Health Issues

This paragraph emphasizes that global health issues are not confined to distant places but can affect any location, as demonstrated by the COVID-19 pandemic. It points out that mental health and maternal health are areas where global health efforts have been lacking, despite their significant impact on the global burden of disease. The importance of global cooperation, disease surveillance, and addressing the root causes of health inequities through actions to combat poverty and injustice is discussed. The paragraph concludes by reflecting on the ethical question of 'who' is included in the concept of 'we' when discussing global health, suggesting that viewing health as a shared global phenomenon can help find answers and foster a sense of collective responsibility for health.

🎬 Behind the Scenes of Crash Course Public Health

The final paragraph provides information about the production of Crash Course Public Health, giving credit to the production team and the American Public Health Association. It invites viewers to support the show on Patreon to help keep it free for everyone and directs them to additional public health content on the APHA's YouTube channel. The paragraph also mentions the filming location and the people involved in making the series.

Keywords

💡Global Health

Global Health refers to the health of populations in a global context. It encompasses the efforts to improve health and achieve equity in health for all people worldwide. In the video, global health is discussed as a complex field that goes beyond geographical boundaries, emphasizing the interconnectedness of health issues across different countries and cultures.

💡Communicable Diseases

Communicable diseases are illnesses that can be transmitted from one person to another. They are caused by pathogens such as bacteria, viruses, and parasites. The video mentions that historically, these diseases were the leading cause of death worldwide, but their impact has been reduced due to advancements in public health.

💡Non-Communicable Diseases

Non-communicable diseases (NCDs) are not transmitted between people. They are caused by a combination of genetic, environmental, and behavioral factors. The video highlights that NCDs, such as cancer, heart disease, and diabetes, are now the leading cause of death globally, especially in high-income countries.

💡Health Equity

Health equity refers to the absence of avoidable, unfair, and remediable differences among groups of people. The video discusses health equity in the context of global health, aiming to eliminate disparities in health outcomes due to factors like nationality, income, and gender.

💡World Health Organization (WHO)

The WHO is a specialized agency of the United Nations responsible for international public health. Established in 1948, it sets international health standards and coordinates responses to global health issues. The video mentions WHO's role in eradicating smallpox and its ongoing efforts against other diseases.

💡Pathogens

Pathogens are disease-causing microorganisms, such as bacteria, viruses, and parasites. They are the cause of communicable diseases and can spread through various means, such as respiratory droplets or bodily fluids. The video uses the term to illustrate how diseases can transcend borders.

💡Healthcare Access

Healthcare access refers to the ability of individuals to obtain appropriate and affordable health services. The video discusses the disparities in healthcare access across different countries and income levels, highlighting the challenges faced by low-income nations.

💡Disease Surveillance

Disease surveillance is the systematic collection, analysis, and interpretation of health data to inform public health action. The video mentions surveillance as a critical tool in global health for monitoring and responding to disease outbreaks.

💡Aid Dependency

Aid dependency refers to a situation where a country relies heavily on foreign aid for its economic and social development. The video uses Haiti as an example to discuss the challenges and potential negative consequences of aid dependency.

💡Mental Health

Mental health is an aspect of overall health that affects how people think, feel, and act. The video points out that mental health is a significant but often neglected part of global health, with a large portion of the global burden of disease attributed to it.

💡Maternal Health

Maternal health refers to the health of women during pregnancy, childbirth, and postpartum periods. The video highlights maternal health as an area where global health efforts have been lacking, with many preventable deaths occurring each year.

Highlights

Health is a global concern that transcends political and geographical boundaries.

Communicable diseases like malaria and the flu are not the leading causes of death in most places.

Global health aims to improve health for everyone and eliminate health equity gaps.

The World Health Organization (WHO) was established in 1948 to monitor and improve the world's health.

The WHO's mission is to attain the highest possible level of health for all peoples.

Communicable diseases were the leading cause of global human death when the WHO was formed.

Smallpox was eradicated worldwide by 1977 through global efforts led by WHO.

Non-communicable diseases, such as cancer and diabetes, now cause most deaths globally.

Income level is the biggest indicator of whether a country's leading cause of death is communicable or non-communicable.

Aid dependency can be a short-term solution to deeper problems in global health.

Haiti's history of foreign exploitation has led to its current food insecurity and reliance on aid.

Global health issues are not confined to low-income countries; high-income countries also face challenges like maternal health.

Mental health accounts for a significant portion of the global burden of disease but receives minimal funding.

Disease surveillance is crucial for global health cooperation and addressing health inequities.

The field of public health grapples with the ethical question of who 'we' are when discussing global health.

Crash Course Public Health is produced in partnership with the American Public Health Association.

Transcripts

Humans across the globe have become very  interconnected–and so has our health.

No matter how we try to slice  and dice up our planet with  

political and geographical boundaries,  health remains a species-wide concern.

In some cases, our health has blurred  these boundaries. And in other ways,  

human health has been decided by them.

But with over 7 billion people living in about  200 different countries across the planet,  

global health can be … complicated.  Challenging. Even surprising.

Like, it turns out that the communicable  diseases we often think of as the biggest  

killers–like malaria or the flu–actually aren’t  the leading causes of death in most places.

So then…what is? And, how do entire countries  provide care for each other? And what if a country  

doesn’t want help from other countries? And what  if the “help” actually harms other countries?

Hi, I’m Vanessa Hill, and this  is Crash Course Public Health!

INTRO

So one sort of obvious problem with the term  

“global health” is that it can  feel very big and unspecific.

And this is partly because it needs to be!  After all, we’re talking about a whole planet!

In general, we can think of global health  as a public health approach that puts  

emphasis on improving health for everyone  in the world, while eliminating the health  

equity gaps that result from things  like nationality, income, and gender.

How successful is it at accomplishing  those goals? Well…it depends. We’ll get to that.

But first, a little historical context.

The question of when human health became a  global phenomenon is really up for debate.

Like, did it begin during the industrial  revolution of the 18th century when the

world saw huge spikes in international trade and  development? Or was it back in the 13th century,  

when Genghis Khan conquered around 9 million  square miles of territory? Or, like, was it at  

the dawn of the human species, when our early  ancestors began their migration out of Africa?

These are all good answers to the question.  But let’s fast forward to April 1948,  

with the establishment of the World  Health Organization, or the W-H-O.

By this point, human civilization  was indisputably a very global phenomenon– 

as made evident by the fact that  we’d just come out of our second World War.

So, the United Nations formed the WHO,  

a special agency dedicated to monitoring  and improving the world’s health.

The WHO’s Constitution declared that  the organization’s objective

“shall be the attainment by all peoples of the  highest possible level of health. ”

This was one of the first global movements that  

basically established health as  an international human right.

Which feels like it should’ve been obvious from  the start, but I guess we needed it in writing?

The WHO is basically in charge of making a  vision board for the entire planet’s health.

It sets international standards for health,  

collects and analyzes data from around  the world, monitors concerning new and  

old diseases, and helps coordinate emergency  responses and research between countries.

When the WHO was formed, the leading cause of  global human death was communicable diseases.

These are diseases that are  spread–or “communicated,” as it were–

from one living thing  to another through pathogens.

These are things like bacteria and viruses  

that are spread through respiratory  droplets, blood, saliva, and such.

A pathogen knows but two laws: reproduce  in an organism and spread to new ones.

It doesn’t notice or care when it  crosses the border from Egypt to Libya,  

or when it hitches a ride on a  redeye flight from Boston to Berlin.

And as people became better at moving  around resources and–well–themselves,  

they also got better at  moving these pathogens around.

Whether it was trade facilitated along the Silk  Road, or that spring break trip to Disney World,  

people have gotten really good at building germy  superhighways of trade, travel, and tourism.

Without a globally coordinated response,  eliminating a disease across the face  

of the planet is a bit like playing a game of  whack-a-mole, with a disease being squashed in  

one part of the world, only for it to pop up in  another part…and another part…and another part.

One particularly dangerous  communicable disease was smallpox.  

Scientists have found smallpox-like  rashes on Egyptian mummies,  

suggesting that humans have been dealing with  some form of smallpox for over 3,000 years.

And in the 20th century, smallpox  was still a major threat.

Historically, experts estimate  that smallpox killed more than  

300 million people since 1900 alone.

So in 1959, the WHO added a bold new mission  to its vision board: eradicate smallpox.

The virus was killing millions of  people each year, with outbreaks  

happening all over the world and  even spreading between continents.

Eradicating smallpox would mean  ensuring that not a single person  

on Earth had the disease so it  could never be spread again.

So, we got to work.

And after a couple of attempts, thanks  to effective interventions in dozens  

of countries and mass educational  and vaccination campaigns, the WHO,  

with the help of many public health workers,  succeeded. In 1977, the last confirmed case of  

naturally-acquired smallpox was identified  in Somalia–and then, smallpox was gone!

The WHO has led similar global responses  against other communicable diseases,  

such as in the fight against  HIV and AIDS, polio, Ebola,  

and COVID-19, though none have been as  successful as the smallpox campaign.

But global health isn’t just about germs  sneaking across international borders.

Today, most deaths are actually  caused by non-communicable diseases,  

also called non-infectious diseases,  

which are diseases that aren’t spread  through things like bacteria or viruses.

Instead, these diseases are caused by genetic,  environmental, and behavioral factors.

This is because, in general, as we’ve gotten  better at decreasing the rate of communicable diseases,

non-communicable diseases have come  to make up a greater proportion of deaths.

These are diseases like cancer, heart disease,  and diabetes. And health experts address them by  

managing them with medications and reducing risk  factors that contribute to their development,  

like tobacco use, physical inactivity,  air pollution, and unhealthy diets.

In 2019, the WHO reported that 7 of the 10 global  

leading causes of death were  non-communicable diseases.

And together they accounted for 74  percent of deaths around the world.

However, the biggest indicator  for whether the leading cause  

of death in a country is communicable or  non-communicable, is that country’s income.

We see this pattern reflected in countries’  burden of disease, which is a measurement that  

reflects the estimated years of life lost from  early deaths, injury, and illness from disease.

In high-income nations, non-communicable diseases  

generally account for around 80  percent of the disease burden.

Meanwhile, communicable diseases tend  to make up somewhere around 5 percent  

of this burden. (That last 15% is made  up of things like injury and accidents.)

However, the opposite is generally  true of low-income nations,  

where communicable disease accounts for more  than 60 percent of the overall disease burden.

And of course, these numbers were  reported in 2019, before COVID-19.

And the solution to this problem feels simple,  

right? Low-income countries  need more, you know, income.

Similarly, if they need resources like  food or doctors, other richer countries  

could step in and provide aid by  selling food to those countries  

at a low-cost or sending doctors to  provide more affordable healthcare.

Aid dependency is the proportion of a country’s  

government spending that is  provided by foreign donors.

Aid is often a simple, short-term solution to  what turns out to be a much deeper problem.

When we think about foreign aid,  it’s important to remember that  

high- and low-income nations didn’t  just pop into the world fully formed.

They are almost always influenced by other  global, economic, and political forces.

Like, consider Haiti, which in the  18th century was one of the richest  

and most productive colonies  in the world under French rule.

But after a successful rebellion against the  French that resulted in its independence in 1804,  

Haiti spent the next 120 years  paying reparations to France,  

which took up as much as 80% of Haiti’s revenue.

And in the 20th century, Haiti was subject  to an almost 20-year U.S. occupation,  

where things like forced changes to their  agricultural practices led to further instability.

Today, Haiti is one of the poorest  countries in the Western hemisphere  

with one of the highest rates  of food insecurity in the world.

In Haiti, nearly half the population requires  

food assistance and 1.2 million  people suffer from severe hunger.

But the solution to this food  crisis isn’t as simple as we may think.

Let’s go to the Thought Bubble.

So because of this aforementioned history of  foreign exploitation, Haiti hasn’t been able  

to sustain the agricultural and financial  resources necessary to feed its population.

So, Haiti relies on aid from other,  richer countries, like the U.S.

Today, over 80 percent of rice and nearly half of  all the food consumed in Haiti is imported.

In an attempt to make this food affordable,  

the countries exporting it often  sell it below standard market price.

However, as a result, local Haitian  farmers often can’t compete with the  

price of this cheaper imported food, which  can eventually put them out of business.

Suddenly, Haiti has even less home-grown  food, and so is even more dependent on aid.

Meanwhile, the deeper challenges underlying  Haiti’s widespread food insecurity persist,  

like lack of jobs, poor education,  and ineffective trade policies.

In fact, they might have even gotten worse,  since the need for a self-sufficient food  

system has declined, disguising the  extent of those deeper problems.

This is why in 2010 the Haitian government  called for an end to international food aid.

Instead of providing food aid,  international institutions can  

help to develop the infrastructure  and workforce necessary for Haitians  

to achieve sustainable long-term economic growth.

For example, the World Food Programme  has done this by buying local foods from  

Haitian farmers at market price to revitalize the  agricultural sector and tackle food insecurity.

Thanks, Thought Bubble. So  Haiti has a food problem.

But at a deeper level, it has a system problem,  

because it’s struggling to escape the  systemic injustices of its history.

Acts of global aid response must simultaneously  balance short-term needs, like hunger,  

with longer-term considerations,  like becoming truly food independent.

When we think about global health,  

there can be a tendency to think about it  as something that happens somewhere else.

But this is flawed thinking for a few reasons.  Like, as we saw in the COVID-19 pandemic,  

an “over there” problem can very  easily become a “right here” problem.

But there’s also another, deeper sense in  which this mindset doesn’t quite hold up.

Across the world, there are health issues  that we have proven to be pretty bad at  

addressing no matter where we  are or how much money we have.

This is the case with mental health. Using  WHO data from 2005, researchers estimated  

that mental health accounts for as much as  14 percent of the global burden of disease.

And yet, across the world, mental health care receives much less attention than other forms of health care.

In fact, an analysis of funding across 10  years found that health care development funds  

dedicated to mental health accounted for just  0.3 percent of all global healthcare spending.

Another area in which we have  collectively and consistently  

dropped the global health ball is maternal health.

The WHO estimated that in 2017, over 800 women  died every day from preventable causes related  

to pregnancy, mainly due to a lack of quality care  during pregnancy, and during and after childbirth.

And while as of 2019 ninety-four percent of these  

deaths occurred in low income  and low resource countries,  

rich countries like the United States continue  to see large variations in maternal health.

When it comes to addressing health at a worldwide  level, we must look to global cooperation.

One way we have of doing this  is with disease surveillance,  

or the systematic process of gathering, analyzing,  

and interpreting health data, and then  making that data accessible to everyone.

It also means having compassionate, honest,  and culturally sensitive conversations.

And it means following up on those  conversations with actions to address  

the root causes of poverty and injustice  that lead to health inequities in disease  

distribution and access to life saving  resources like vaccines and medications.

As a species, we’re still figuring  out what it means to share a planet  

and share the responsibility for  taking care of one another’s health.

The field of public health is constantly  grappling with an important ethical question:  

Who do we mean when we say “we”? Our  neighborhood? Our country? The whole world?

When we start thinking about our health  as a shared and global phenomenon,  

we come a bit closer to finding the answer.

Thanks for watching this episode  of Crash Course Public Health,  

which was produced by Complexly in partnership  with the American Public Health Association.

If you want to learn even more about Public  Health, head over to APHA’s YouTube channel  

to watch “That’s Public Health” a  series created by APHA and Complexly.

Crash Course was filmed in the Castle  Geraghty studio in Indianapolis, IN,  

and made with the help of  all these wonderful people.

If you'd like to help keep Crash Course free for  

everyone forever please consider joining  our community of supporters on Patreon.