The neglected foundation of global health
Authors: Keith Martin, Zoë Mullan, Richard Horton
Journal: The Lancet Global Health (2015)

We live in a golden era of knowledge. Unprecedented in volume and matched with a revolution in information technology, there has never been a better time to implement the innovations and programmes proven to prevent or address most of the global challenges we face. Mobilising research for global health was the theme of this year's Consortium of Universities for Global Health (CUGH) annual conference. Held in Boston, MA, USA, on March 26–28, 2015, the event was attended by more than 1600 individuals, including a roster of leading researchers from around the world. The Lancet Global Health and CUGH have collaborated once again to provide you with this booklet and share with you the oral abstracts presented at the conference. The abstracts were selected from more than 1000 submissions and are representative of the meeting's six tracts, which frame some of the world's biggest challenges: communicable diseases; non-communicable diseases and injuries; education, training, and capacity building; governance, management, human rights, and economics; social and environmental determinants of health; and innovation, new technologies, and improvement science. However, within this inspiring mix of innovation existed a crucial piece of the global health enterprise that requires greater attention from all of us. Indisputably, an effective health system is vital to scale up and sustain public health programmes and biomedical inventions. But health systems do not exist in a vacuum. They rest on top of a broader ecosystem, the integrity of which has a profound impact on the social determinants of health, the health system itself, and the essential needs of people. This "other area" is the neglected foundation of global health. It is the political, judicial, and economic infrastructure fundamental to the stability, security, and prosperity of a modern society, one that can thrive in good times and respond effectively to threats in bad times. It depends on well functioning ministries of finance, public works, justice, education, the environment, social services, agriculture, and yes, health. The public service capabilities that underpin these ministries are vital to a nation's ability not only to provide health care but also to create the economic infrastructure needed to fund programmes, services, and the public infrastructure essential for economic and social stability. These structures are the bulwark against the conflict, corruption, and lack of capacity that devastate nations and are endemic to regions with the worst health outcomes. Without these structures, regions can quickly fall into an abyss. No amount of medical innovation and research can make a dent on this. For people to have access to quality public health, primary and surgical care, education, food security, electricity, transportation arteries, potable water, and sanitation, a competent public service and stable political environment is vital. It is the foundation that enables the sustainable capitalisation of a nation's human and natural assets and fosters the climate for investment that governments need to pay for the social goods that support people's security. If nations lacking these capabilities wish to rectify this situation, the global health enterprise needs to partner with them responsibly and effectively. These are non-medical skills and include finance, economics, engineering, management, law, political science, agronomy, veterinary sciences, and anthropology. These capabilities are required to build the competent public service and management systems any nation requires to scale up, sustain, and retain evidence-based research findings. Academic institutions, with their vast pool of professional human resources, are ideally positioned to play this role. However, professional silos will need to be broken down, the opportunities capacity building offers across research, education, and service must be embraced, and a particular effort must be made to include non-medical disciplines. The global health enterprise has not been as successful as it should at including non-medical skills in its activities. CUGH is trying to overcome this defect by trying to integrate medical and non-medical disciplines in its education, research, and service initiatives. The website has been modernised and interest groups have been created on the site that parallel many of the global health challenges we face. It is designed as a platform for knowledge sharing, collaboration, implementation, and advocacy. It also contains a large selection of training modules that CUGH's Education Committee has compiled. It is just one of the products the committee has put together that will help build skillsets and strengthen academic global health programmes. Please use it and share it with others. CUGH has also created two rosters of professionals: the first is for those wishing to provide longer-term training or service in low-resource settings; the second is for those interested in providing assistance during a humanitarian crisis. CUGH helped various organisations, including the Centers for Disease Control and Prevention, USAID, and Médecins sans Frontières, to find professionals with the appropriate skillsets to help stop the Ebola outbreak in west Africa. If anything laid bare our collective inability to respond effectively to a lethal outbreak, it was this. The relative absence of non-medical disciplines in global health activities presents a challenge and an enormous opportunity. Since medicine dominates the field, it is incumbent upon that community to reach out to its colleagues in other non-medical fields and include them in everything from training and advocacy to service. If we do this, we will be far more effective at scaling up and sustaining evidence-based interventions to achieve significant health gains. We declare no competing interests.