Critical Issues in Global Health
Global approaches to health began to be conceived as rich nations embarked on the exploration and colonization of poor nations in the tropics. For much of the first half of the 20th century, these approaches were focused on gaining an understanding of the pathophysiology of infectious diseases endemic to warmer climates and devising the means to cure them. In the latter half of the 20th century, the use of airplanes increased international travel, allowing the import and export of various infectious agents with increasing ease. Other factors contributing to the spread of disease were the mass migrations caused by war, civil strife, hunger, and natural disasters. Such migration has influenced the changing face of global health. The past century also witnessed the industrialization of previously nonindustrial countries and the globalization of trade. In some regions, these trends have led to economic improvement, the control of many infectious diseases, and a shift toward a focus on chronic diseases. But these epidemiologic transitions have also drastically affected some countries by requiring less sophisticated societies to face modern health challenges. Global health today has a much different face from the one it had in 1902, when Sir Ronald Ross won the Nobel Prize in Medicine for his work linking malaria and mosquitoes. Today, the field of global health encompasses infectious and chronic diseases, environmental and occupational health, injury prevention, war, and hunger, as well as research and the implementation of health care programs. And it involves politics. In order to achieve success in combatting poor health, the international community has come to appreciate the need for partnerships, both among countries and international organizations and between public agencies and private industry. In Critical Issues in Global Health, Koop, Pearson, and Schwarz have assembled contributions by prestigious leaders in the area of public health who here share their insights into what they see as the most pressing issues in global health. The editors have grouped the essays into three main parts, covering countries, continents, and the world; organizational landscapes in global health; and organizations, management, leadership, and partnerships. The relatively short chapters address past successes, current challenges, and possible future advances in public health. The first essay, by Gro Harlem Bruntland, the former director general of the World Health Organization, establishes the tenor of the book. Bruntland points to the tremendous gains in life expectancy that were made over the past few decades; however, she also points out that severe poverty hinders more than a billion people from reaping the rewards of the "health revolution." Bruntland lists four challenges for the 21st century: "first and foremost," a reduction in poverty; second, the need to address threats that arise from economic crises, unhealthful environments, and risky behavior; third, the development of effective health care systems; and, fourth, the expansion of the knowledge base related to health. Throughout subsequent chapters, after discussing experiences with various topics in health care, the contributors delve into areas that, in essence, revisit these four challenges. Critical Issues in Global Health is an excellent overview for those with an interest in improving global health. It is expansive in its coverage, which is both a strength and a weakness. Although the book provides an overview of many important topics in global health, each chapter is only that, an overview. Readers will use the book as an introduction to the subject of global health, but they will need to search for other works that provide more coverage in depth. The pressing health issues of today are covered, but the challenge is to predict what influences -- the severe acute respiratory syndrome is a recent example -- will affect the world's health in the future.John R. MacArthur, M.D., M.P.H.Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.