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Global Health below we explore the issues affecting it. How can we achieve it?
Shifting Demographics and Lifestyles
Ageing and a rise in non-communicable diseases are changing healthcare needs. People are both living longer, and suffering more dramatically from the effects of their bad habits.
The world’s current population of 7.6 billion is expected to increase to 8.6 billion by 2030 - and then jump to 9.8 billion by 2050, according to the United Nations’ 2017 revision of The World Population Prospects. Meanwhile increasing life expectancy will lead to a doubling of people in the world who are at least 60 years of age or older by 2050, and then a tripling of that age group fifty years after that.
Much of this population expansion will be the result of reductions in mortality, both from infectious disease and for those under five years old. However, it is being offset by the rise of non-communicable diseases, which are often linked to unhealthy behavior as people age.
Primary prevention, detection, screening, and treatment of non-communicable diseases, and palliative care for the terminally ill, are all often missing from health systems in these countries, which are more often designed to respond to acute infections. Potential low-cost solutions for reducing risk factors (such as comprehensive control of tobacco products) exist for both governments and the private sector. Innovative partnerships across sectors including health, finance, transportation, education, and agriculture will be required.
The World Health Organization has reported that as of 2015, these diseases accounted for 70% of all deaths worldwide, and three quarters of them occurred in low- and middle-income countries. Nearly half of non-communicable, disease-related deaths in these countries occur before the age of 70, and are therefore considered premature - and the majority result from cardiovascular disease, chronic respiratory disease, diabetes and cancer stemming from tobacco use, excessive alcohol use, poor diet, and a lack of physical activity.
The health care costs and reduced productivity associated with these non-communicable diseases force millions of people into poverty every year, and stifle development in vulnerable regions. Adequately responding to the twin challenges of these diseases and ageing populations, not to mention increases in mental health disorders and violence, will require major changes to health care systems, especially in low- and middle-income countries.
Environmental Health and Climate Change
One of the greatest environmental threats to human health is air pollution. Many low- and middle-income countries do not monitor air quality, and either lack effective emission control legislation or simply fail to enforce legislation. Air pollution and climate change are having a serious impact on global health.
Nearly one quarter of all global deaths are a result of the environment, according to the World Health Organization’s (WHO) 2016 report Preventing Disease Through Healthy Environments: A Global Assessment of the Burden of Disease from Environmental Risks.
As a result, their populations face a disproportionate disease burden. In addition to outdoor exposure to air pollution, WHO estimated in 2016 that almost 3 billion people around the world were still burning biomass fuel and coal indoors, in order to cook or to heat their homes, which resulted in more than 4 million deaths annually.
In 2018, WHO estimated that more than 80% of people living in urban areas (that monitor air pollution) are exposed to air quality levels that exceed the organization’s limits - and that 97% of cities in low- and middle-income countries with more than 100,000 inhabitants do not meet WHO air quality guidelines (the figure falls to 49% for high-income countries).
Air pollution is also a primary contributor to climate change, which has generated global health risks including changes in vector-borne disease patterns, water scarcity, food insecurity, and violence.
These threats are most severe for vulnerable populations like children, the elderly, and the poor. Additional measures are needed in order to reduce exposure to air pollution and mitigate the effects of climate change, and decrease disease rates and mortality.
United Nations Sustainable Development Goals, and the Paris Agreement on climate change, have recognized this need and provide goals and targets in order to prioritize action (though one of the world’s biggest sources of carbon emissions and pollution, the US, has announced plans to withdraw from the Paris Agreement).
New and expanding research disciplines, including Planetary Health (which takes into consideration all the natural systems that human health depends upon) and the collaborative approach known as One Health, have drawn increased focus to the complex, interconnected relationships between the earth’s natural systems and species. These approaches recognize that the health of humans, animals, and the environment are closely interrelated, and promise to broadly advance our understanding of environmental impacts.
Sustainable Development and Universal Coverage
Poverty is a persistent impediment to achieving good health worldwide. The World Health Organization has estimated that about 1.2 billion people around the world are living in extreme poverty - a significant cause of poor health outcomes, as people with limited resources face greater exposure to risks and disability due to inadequate sanitation, food, shelter, and medical care.
The cost of health care is also a major contributing factor to poverty; according to a 2016 WHO fact sheet, 100 million people were being stricken with poverty due to health care costs every year, and 150 million people were suffering financial catastrophe every year because of out-of-pocket expenditures on health services. In addition, a 2017 report published by the World Bank estimated that roughly 800 million people are spending more than 10% of their household budget on health care, while nearly 200 million people must spend one quarter of their household budget on health care.
In 2015, the United Nations adopted Sustainable Development Goals in order to help the global community address complex, interconnected issues related to poverty, global health, human rights, economic growth, environmental sustainability, and equality.
The third development goal features targets including the reduction of the burden of NCDs, and achieving universal health coverage by 2030 - including access to quality health services, effective and affordable essential medicines and vaccines, and protection from related financial risk.
The cyclical nature of poverty and sub-optimal health outcomes is evident in both high- and low-income countries. A major contributing factor is the rise of non-communicable diseases (NCDs), such as cancer or diabetes, and related risk factors that can burden individuals, their families, and entire communities; these include impoverishment from long-term treatment and care costs, and a loss of income due to reduced productivity.
In a progress report on the Sustainable Development Goals published by the UN in 2017, it noted that it will be necessary to avert an anticipated shortfall of about 18 million health workers by 2030, if it is to remain possible to achieve and sustain universal health coverage by that point; major shortages of such workers are a serious concern in nearly all of the countries in sub-Saharan Africa, according to the report.
Data Collection and Communication
Preparing for Pandemics
The efficient analysis of greater amounts of data is enabling better delivery of global healthcare. For policy-makers, analyzing health data can help them better understand the global burden of disease - and more efficiently monitor and evaluate public health efforts.
Technological advances are expanding the use of so-called big data, or complex digital information that can be quickly analyzed in unprecedented quantities in order to discern patterns and trends. However, there are emerging issues that can make the collection and application of this data problematic - related to quality, security, storage, and privacy.
The United Nations Global Working Group on Big Data for Official Statistics was established in 2014, to address these issues by creating standardized methods for capturing, managing, and processing data securely and ethically. Since then, a number of private companies have pursued health data-related efforts; Apple, for example, has worked with Stanford Medicine researchers to determine if the Apple Watch can be used to detect atrial fibrillation - and if Apple can then notify wearers that they require medical attention.
Simply improving the quality of data on health systems, prevention, reproductive health, nutrition, and demographics is not sufficient, however; more comprehensive information about the entire health ecosystem is required, related to mobility, infrastructure, insurance, consumption patterns, and climate. Big data can be used to develop innovative health data analyses and management practices, and improve decision-making; it can also be used to evaluate the cost-effectiveness of health practices, the social returns on investment in health outcomes, and to ultimately improve health systems and governance.
As the scientific community is learning to harness the power of anonymized data from mobile phone and internet use, prevention and treatment efforts can become more accurately targeted - to ensure the most efficient use of resources, and achieve the greatest possible impact. One example: a study published in 2017 in the journal PLoS Neglected Tropical Diseases described using Twitter posts to obtain high-resolution data on the spread of dengue fever in Brazil - which enabled researchers to quickly map new cases, and predict where it might spread next.
Advances in big data have also changed the way disease can be tracked and contained, by using unconventional data sources to identify disease clusters and disease mobility.
Public health outbreaks and epidemics are becoming increasingly complex, as the spread of the COVID-19 coronavirus across dozens of countries in early 2020 demonstrated. Public-private partnerships can enable more resilient responses.
The WEF’s Global Risks Report 2016 noted that as of November 2014, fewer than half of the health facilities in Liberia had been seeing patients, while the Liberian government estimates showed that from May to August 2014, skilled birth attendance was 27% below 2013 levels, measles immunization was down 50%, and overall health services were operating at 40% lower capacity. Later, the loss of these services during the height of the Ebola epidemic had a significant impact. By June 2016, more than 28,000 Ebola cases had been reported in Liberia, Guinea, and Sierra Leone, resulting in more than 11,000 deaths, according to the World Health Organization.
A continued failure to develop resilient health infrastructure and public health systems in much of the world has created vulnerabilities - and an increasingly globalized world makes rapid transmission a growing threat. Widespread vulnerability will unfortunately remain a fact of life until every country is able to develop comprehensive primary care services, garner an adequate number of healthcare workers and available medicines, and foster robust health information systems, infrastructure, and public financing.
Finding the fastest and most efficient channel to disseminate such information is important for fighting an infectious disease outbreak, and providing access to data for real-time monitoring and detailed analysis is essential - the better the information, the more certain decision-makers can be of their strategy. One key to better tracking the spread of viruses is to understand how people move around and interact on a daily basis. Big data enables the modelling of both how a virus spreads, and the potential for it to be contained.
Rather than relying solely on traditional partners and ways of working, new ideas, partnerships, and solutions are needed in order to adequately address these challenges. New technologies enabled by the Fourth Industrial Revolution in biomedical research and digital communications, often developed by non-traditional actors, are creating new opportunities to fight disease.
Mechanisms that better bring together public and private players in high-risk geographies in order to address emerging epidemics are likely to pay dividends, and more efficient use of both national and local actors for the purposes of early detection and response is critical.
Global Health Governance
Powerful forces have undermined efforts to protect and improve global health, necessitating changes to how we prevent, track, and respond to crises like COVID-19.
Global demographic shifts, environmental degradation and climate change, escalating humanitarian emergencies, technology innovation, and a growing global commitment to a universal right to healthcare are all driving change in different ways - and being addressed by global governing bodies and multi-stakeholder partnerships that increasingly recognize the links between health, poverty, and sustainable development.
The SDGs reflect a new understanding that today’s health and development challenges are increasingly complex, integrated and interlinked. SDG 3 exclusively addresses health, but health in the SDGs goes beyond SDG 3, with core health issues also residing in other goals. All SDGs influence – and are influenced by – health. Achieving health in the SDGs so that no one is left behind is a central tenet of the SDGs.
It requires whole-of-system, whole-of-government and whole-of-society approaches, which brings together various government sectors, civil society, academia, development partners and communities.