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We interviewed Professor Tiziana Leone, one of the lecturers on IR218: Global Health: Science, Politics and Development, who discusses some of the global health issues the world faces today.
How do you define global health, and why is it important to address health issues on a global scale?
Global health encompasses many dimensions and as such had been defined in several ways: “an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide”; or “those health issues that transcend national boundaries and governments and call for actions on the global forces that determine the health of people.”1. The core to its body of research is a transnational concept that sees global health as affecting both the rich and the poor and knowing no borders. Above all, global health research sees the need for a truly multidisciplinary approach from behavioural sciences, anthropology, epidemiology, international relations, sociology, demography, economics, and public health among others.
What are some of the most pressing global health issues today, and how can they be addressed effectively?
There are possibly three key issues that are the most pressing in global health: the increase of non-communicable diseases in low-resource settings; the re-emergence of communicable diseases globally; and health in crisis (e.g.: conflict and climate change).
Focussing on the last one, there is a need to highlight parallels between the two, as well as highlighting the uniqueness of events. Conflicts, for example, do not impact health and health systems in the same way. The most direct impact is the casualties, but the indirect effects can be as big, if not greater, and are felt in the long term.
Whether a long-term conflict (e.g. occupied Palestinian territory/Israel, Yemen) or a short-term one (e.g. Iraq), the destruction of infrastructures, brain drain of health workers, lack of supplies of medicines and vaccines all contribute to an increase in the burden of disease and mortality. Lack of access is probably one of the most impactful and can work in many ways, from checkpoints, road blocks, to the destruction of transport routes.
On the other hand, the impact of devastation following climate disaster will have in the short term an impact on mortality, disease (e.g. increase in cholera due to water contamination), and mass migration. In the long term, it will depend on how the reconstruction of infrastructures and health systems will go, and on how this might impact the long-term health of individuals.
Studying the impact of conflict or weather events and climate variability on human health requires appropriate specification "exposure". The main challenge lies in the appropriate scale of analysis, and the choice of any lag period between exposure and effect, will depend on the anticipated nature of the relationship.
Within such settings, the real challenge in the field is to accommodate the several types of uncertainty and the diversity of the impacts. We also need to account for uncertainties about the future characteristics, behaviours, and coping capacity of human populations.
How do cultural differences and beliefs affect global health interventions, and what strategies can be used to ensure that interventions are culturally appropriate and effective?
The culturalist explanation is more and more challenged. The key focus should be on making health interventions context-specific in relation to not only culture but also livelihoods, poverty and social exclusion. One key example is the work done on a community empowerment-based response to HIV through which sex workers take collective ownership of programs. 2. It showed the push beyond the culturalist approach.
Furthermore, one of the key driving forces of global health research is the recognition that epidemiological events, transitions and changes are not simply replicated across countries. While some patterns exist (e.g. the impact of public health and medicine on mortality decline), the tendency to set trends in the Global South as a replication of those in the North, is shifting. A greater attention to cultural understanding and local communities and empowerment is needed to tackle diseases more effectively. A clear example has been the treatment of Neglected Tropical Diseases in sub-Saharan countries. Studies have shown how a top-down approach and standard medically driven approaches can be unsustainable.3. A growing body of research shows how this awareness is needed across a wide range of diseases.
How can digital technologies and data be leveraged to improve global health outcomes, and what are some challenges in doing so?
Global health is part of the data revolution where big data, traditional sources (e.g. census), administrative data and health records meet. Never before has there been a drive to improve statistical systems and the introduction of the Sustainable Development Goal 17 is proof of a real commitment to utilise a wider spectrum of information.
Digital platforms should be part of this revolution. By opening the path to new ways of collecting and analysing data on health, they are progressively being integrated in low-income settings into service provision and monitoring. The use of m-health and e-health, for example, has introduced the potential for increasing institutional value in the form of more effective service delivery.4. Their use within health services will be key in transforming the development of stronger health systems.
How do you see the future of global health evolving, and what role will science, politics, and development play in shaping it?
COVID-19 showed us once more how science on its own is not able to deal with pandemics. The intersection of social epidemiology, public health, politics, anthropology, and behavioural economics all need to be involved in dealing with the response to crises. Health is a highly political topic and even more so in low-income settings. It is not possible to talk about development unless we tackle health.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852240/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394498/
3. https://pubmed.ncbi.nlm.nih.gov/27428062/
4. https://onlinelibrary.wiley.com/doi/full/10.1111/isj.12353
Professor Tiziana Leone
Professor in Health and International Development, Department of International Development
Tiziana Leone is a Professor in Health and International Development at the London School of Economics. Tiziana’s research agenda is focused around maternal and reproductive health, including a lifecourse approach to women’s health. Before working in academia she was a statistician in the UN Statistics Division where she coordinated technical cooperation on census and civil registration data collection in Low Income Countries.