Course Introduction | Essentials of Global Health with Richard Skolnik

Welcome, I'm Richard Skolnick, your instructor for this course. Today we're going to talk about the concept of global health and we're also going to speak about the outline of the course. By the time you finish this session, I hope that you'll be able to discuss the meaning of global health, why the study of global health is so important, the main objectives of the course, how the course is organized, and the approach that the course will take to enable your mastery of the learning objectives. Let's begin with some vignettes about the good news in global health. The first thing that I'd like to say is there is good news in global health. There's been some very important progress globally in the last several decades in improving human health in a large number of countries. Here's a slide, for example, that shows a healthcare worker in Africa carrying out what looks to be a prenatal visit on a pregnant woman. And the number of women dying of pregnancy-related causes globally has fallen by 45% since 1990 and it's now below 300,000 per year. The second picture shows a child playing under a bed net. Of course, we hope that the children, in fact, all people living in malaria-endemic zones, will sleep under these bed nets. But the net, in fact, is a long-lasting insecticide-treated bed net, and their growing use has contributed to significant declines in the number of cases of malaria and deaths from malaria worldwide. In fact, malaria deaths per 100,000 people have declined by about 25% since 1990. The third picture shows a village in sub-Saharan Africa in which people are lining up to receive drug administration against one or more of what we call the neglected tropical diseases. These include a number of the so-called wormy and parasitic diseases. There's been enormous progress in the last few decades, especially the last decade, I should say, in getting out such medicines and reducing the problem of diseases like onchocerciasis, schistosomiasis, and blinding trachoma. The final picture shows a young child being vaccinated against polio, another disease against which there's been dramatic progress. The number of polio cases globally has declined from about 380,000 in 1988 to about 100 last year, and the world is working hard to eradicate polio. You probably want to study global health to learn about the good news. However, you probably also want to study global health to understand the key issues that continue to affect the health of many people and how those issues can be addressed. As shown in the next slide, there's an important unfinished agenda and other parts of the agenda that continue to emerge. So look at 2013, for example. There were over 17,000 under five child deaths every single day in the world. There were that year 1.5 million AIDS deaths, an almost equal number of people who died from tuberculosis, almost 600,000 people who died of malaria, as we said, almost 300,000 maternal deaths, more than a billion people who were infected by one or more of the neglected tropical diseases, and about 1.3 million people dying of cardiovascular disease in low-income countries alone. Now, the comments we've made and the vignettes that we presented all refer to the field that's generally considered to be global health. But let's pursue further with the help of our students what this notion is about. Elizabeth, when we talk about global health, what does that mean to you? What do you consider to be parts of global health? I would consider global health to consist of population-based sort of public health strategies that are implemented in hopefully cost-effective ways at the most vulnerable members of our populations. And what's global about that, Elizabeth? Where's the global part? And I promise you this is a discussion my friends and I have all the time. Well, the global part could refer to just simply any country on the globe, or it could refer to strategies that are implemented across several nations. And Rachel, what does global health connote for you? For me, I think about health issues that affect many people across the globe with specific focus on poor and marginalized people in low- and middle-income countries. And Emily, how about you? I think about the collaboration between countries to identify and then implement the most effective programs. Let's look at the next slide that briefly outlines some of the areas that people generally consider to be part of what we call the study of global health. What we think about is global health as an area for study, research, and practice. It refers often to the health of populations, as the students have said, in a global context. It places a priority on improving health and achieving equity in health for all people. And it also deals with issues that transcend national boundaries and require cooperative action, like the recent outbreak, for example, of Ebola. Now, I personally never tire of working in global health, something I've done for a long time. And I believe there are a number of reasons why it's so important to study global health and why it's so valuable to work in this field as well. So, Shailen, why do you think anybody should study global health? Or why did you study global health? Well, I think there's many different reasons. But I think that the topics are very broad and there's a lot of different areas of focus that people can express interest in. So, for example, for myself, I'm interested in maternal and child health and reproductive health. And I think that there's a lot of room for improvement with regards to access to reproductive health and contraceptives. And so, my interest in global health stems from my passion for that topic area. And Vivek, how about you? For me, I would say that healthcare really is a foundation. And so, if we can build stronger healthcare systems, we can ensure that people across the globe have better access to services, but also are set up on a trajectory towards better lives as a whole. Let's look at the next slide and see some of the reasons, again, elaborating what the students have said, for why I might think, the students might think, and others might think as well, it's so valuable to study global health. First, there are important ethical dimensions. People have to ask themselves, is it okay that 17,000 under five children die every day in the world, overwhelmingly, needlessly? Is it okay that 300,000 women a year or so continue to die of maternal causes, almost all of them being preventable? Two is, there's an important relationship, of course, between health and human productivity. And we know that the healthier people are, the better nourished people are, the greater the opportunities they have to enroll in school, thrive in school, complete school, go on in levels of schooling and become productive adults. And therefore, there are lots of reasons why it's very valuable to try to ensure that everyone is enabled to be as healthy as possible. And of course, when we go from the individual level, to the community level, to the national level, we also know that there are important links, not only between the health of individuals and their productivity, but also between the health of individuals, the health circumstances that societies face, like whether or not there's a lot of HIV or malaria, and the opportunities that countries have for engaging in and enabling economic and social development in ways that are fair and just and equitable. There are also important implications for global security and freedom. When HIV began to spread more widely, particularly in sub-Saharan Africa, there were a number of students of global health and a number of students of defense and security as well, began to look at and began to realize how important the HIV epidemic was to the success of Africa's development goals and efforts, and the possibility that epidemics like HIV could actually have important implications for security and for freedoms, both within countries and across countries as well. In addition, people and countries spend a lot of money on health. And surely as we look across countries, we want to learn from the experience of many of them and see what can be learned and what can be done to ensure that countries invest as wisely as possible, as efficiently as possible to get the maximum, enable the maximum amount of health for their people, hopefully at the least possible cost and as fast as possible. And lastly, as everyone certainly understands, given the recent outbreak of Ebola and the present outbreak of the Zika virus, I like to say that the health of anyone, anywhere is the health of everyone, everywhere. We're living in an interdependent world and it's important for all of us that everyone, everywhere be as healthy as possible. Now, given the importance of global health, the important progress made in the last several decades in addressing key global health issues, but also the large unfinished agenda that remains, this course has a number of important objectives. By the end of the course, I hope that you'll be better able than you are now to do a number of things. The first is to articulate key global health concepts. The second is to analyze key global health issues from a variety of perspectives. The next would be to discuss with confidence the burden of disease in various regions of the world, to outline the determinants of health and risk factors for that burden, assess key issues in equity, inequality, and health disparities, and articulate how key global health issues might be addressed in cost-effective, efficient, and sustainable ways. The course is comprehensive, but at the same time, it will be somewhat selective in its comprehensiveness, even though this might sound slightly contradictory or ironic. Thus, the course is going to focus on three areas. The first is the health of poor people in poor countries. The next is issues in public health that transcend national boundaries. And the last is critical public health issues that require global cooperation. To help you manage your way through the breadth of the course, it's going to be divided into six thematic areas. Introducing global health, the state of the world's health, health systems and getting value for money in health, cross-cutting themes, critical causes of illness and death, and looking to the future. To cover the material within these modules, there will be 31 sessions. The sessions will often begin with a story or a vignette about the topic to be covered. Each session will include my speaking. Often there'll be discussions with the students as well. And sometimes we'll have a guest joining us from different places in the world to help us elaborate on some of the key themes that we'll be covering. In addition, the course will include a range of assessment tools and of supplementary materials, and some in-class discussion with you as well. I hope you have a better sense than you did at the start of the session about what is global health and why it can be so important and valuable to study this field and to work in it. In the next session, we're going to cover key perspectives for looking at, understanding, and acting on global health problems.