Global Health: An Interdisciplinary Overview

Global Health:
An Interdisciplinary Overview

Course Guide

Written by

Samantha Battams, PhD, BA (Hons)

Didier Wernli, MD, MA

Rafael Ruiz de Castaneda, PhD

Slim Slama, MD, MPH

© University of Geneva

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 Table of Contents

Instructions ...............................................................................................................................5
Module 2. Introduction to Global Health concepts....................................................................7
1. Background: Definition of global health and introduction of concepts ........................7
2. Foundations of Global Health..........................................................................................11
2.1 An ecological or ‘systems’ perspective......................................................................11
2.2 Social determinants of health approach ...................................................................12
2.3 Human rights based approach to health...................................................................16
3. Summary of module 2.....................................................................................................17
Module 3. Emerging trends in Global Health: Infectious Diseases ..........................................18
1. Background: What are infectious diseases?....................................................................18
2. The fight against infectious diseases: Overview of strategies.........................................19
3. The Big Five: Pneumonia, Diarrheal infections, HIV/AIDS, TB & Malaria ........................23
3.1 The GBD (Global Burden Diseases) 2010 Study and the Big Five ..............................23
3.2 Pneumonia and Diarrhoeal Diseases.........................................................................24
3.3 HIV/AIDS....................................................................................................................26
3.4 Tuberculosis (TB).......................................................................................................27
3.5 Malaria ......................................................................................................................28
4. Neglected Tropical Diseases: Key issues .........................................................................28
5. Emergent and re--‐emergent infectious diseases: Key issues ...........................................29
6. Summary of module3 ......................................................................................................30
Module 4. Emerging trends in Global Health: Noncommunicable diseases, mental disorders
and disability .....................................................................................................................31
1. Background: What are NCDs? .....................................................................................31
2. NCD Prevention Strategies and Policy/Initiatives .......................................................33
3. Health sector treatment and control issues for chronic diseases ...............................37
4. Global NCD Policy and Monitoring..............................................................................39
5. Mental health, mental disorders and links with NCDs................................................40
6. Disability, Ageing and Health ......................................................................................42
7. Summary of module 4.......................................................................................................43
Module 5. Governance for global health, health systems and financing..................................45
1. Global health governance ...............................................................................................45
2. Actors within global health .............................................................................................47

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 3. Instruments for global health..........................................................................................48
4. Key challenges for global health governance..................................................................49
5. Universal health coverage and health systems financing ...............................................52
6. Human Resources Issues: Appropriately Skilled Professionals and the Brain Drain .......54
7. Summary of module 5......................................................................................................55
Module 6. Foreign policy, trade and health ............................................................................56
1. Introduction: the development of global health diplomacy ...........................................56
2. What is the role of nation States? The challenge of creating bridges between health and
foreign policy.......................................................................................................................57
3. What interests do States and regional organisations pursue with regard to health and
why?....................................................................................................................................58
3.1 Security......................................................................................................................59
3.2 Development.............................................................................................................60
3.3 Human rights.............................................................................................................61
3.4 Global Public Goods ..................................................................................................61
3.5 Moral and Ethical Arguments....................................................................................61
3.6 International trade ....................................................................................................61
4. Natural and human--‐m ade disasters and conflict: humanitarian and emergency
responses ............................................................................................................................64
5. Summary of module 6.....................................................................................................66
Module7. Research, development, innovation and technology for global health ..................67
1. Global health research, development and innovation policy and strategy ....................67
1.1 The global health research policy context.................................................................67
2. Intellectual property, access to medicines and health................................................70
3. Technologies for global health ........................................................................................71
3.1 What are healthcare technologies? ..........................................................................71
3.2 Information and Communication technologies: telemedicine, eHealth and mHealth
........................................................................................................................................74
4. What is social innovation? ..............................................................................................75
5. Ethics, bioethics and RDI .................................................................................................76
5.1 Ethical issues and other key challenges for eHealth and mHealth............................76
5.2Bioethics.....................................................................................................................78
6. Summary of module 7.....................................................................................................79
Module 8. The environment, sustainable development and health........................................80
1. What is the relationship between health and sustainable development? .....................80

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 1.1 Economic development and health...........................................................................81
1.2 Social equity and health: Gender as a social determinant of health .........................82
1.3 Environmental protection and health: Case study of the food system.....................82
2. Environmental protection and health issues ..................................................................84
2.1 A major challenge of our time: adaptation and mitigation of climate change .........84
2.2 Global climate change: health implications and inequities.......................................85
2.3 Water, sanitation and health ....................................................................................85
3. Millennium Development Goals and the post--‐
2015 agenda of Sustainable Development Goals (SDGs)......................................................86
References.........................................................................................................................100

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Instructions

Welcome

Welcome to Global Health: An Interdisciplinary Overview! This course consists of the

course guide, including discussion forum activities and assessments, along with presentations
by a range of presenters, from the University of Geneva, The Graduate Institute, WHO,
UNDP, WTO, IUCN, Medicines Patent Pool, among others. You will benefit from the
insights and perspectives of multiple contributors involved in global health research, teaching,
policy and practice across disciplines and sectors. Your enjoyment and benefits from the
course will above all depend on your participation within this course, and we very much look
forward to your participation through the discussion forums and peer assessment activities.

This course aims to present an overview of global health issues, from an interdisciplinary
perspective. The learning outcomes for this course are below. By the end of this course,
student should be able to:

1. Understand the concept of global health, and how this differs from public health and
international health.

2. Identify key elements of a social determinants of health approach and the relationship
between inequity within and across countries and health.

3. Understand what is meant by a human rights framework for health.

4. Identify and analyse emerging issues and trends in global health.

5. Describe key international governance institutions and financing mechanisms for

global health.

6. Understand the contribution of research, development and innovation to global

health.

7. Understand the relationship between foreign policy, trade, the environment and
health.

8. Apply critical reasoning skills to a global health problem.

How to use this guide

Each week there will be key readings which includes the Course Guide material for that
module. We suggest you:

1) Firstly, read the course guide for that module

2) Watch the video associated with a particular topic and do the Multiple Choice
Questions at the end of the week
3) Read the key readings associated with a particular topic (highlighted in green).
4) Participate in the discussion forums (highlighted in yellow)

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Key and Further Readings

Each week, aside from the course guide, there will be 3-7 key readings (highlighted in
green). Further readings are non-essential readings we have included for you to follow up if
you are particularly interested in that specific topic. Throughout the text there are also links,
for quick further information about a topic if you are interested in exploring the topic further.

Note: Please register on The Lancet website in order to have access to key readings from this
journal: http://www.thelancet.com/. For week 1, please also register with the BMJ:
(http://www.bmj.com/) in order to have access to the key reading from this journal.

Discussion Forums

At some points in the course guide, you will be invited to participate in the discussion forum
(highlighted in yellow). This discussion is non-assessed activity, usually based on a reading.
We invite you to participate by inputting your perspective based on the reading/s and
experience, and commenting upon the input of other students.

Assessment

The Multiple Choice Questions appearing after every video will be graded and worth for the
final grade.

Please note that it is necessary to complete the assessment in order to get a certificate of
completion for this course.

We hope you enjoy the course and look forward to working with you,

Best Regards

Dr Samantha Battams,

Course Director, on behalf of the Global Health: An Interdisciplinary Perspective team

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Module 1. Introduction

General Introduction by Prof. Antoine Flahault

Personal Presentations by Prof. Antoine Geissbuhler, Prof. Louis Loutan, Dr. Samantha Battams,
Dr. Didier Wernli, Dr. Slim Slama, Dr. Rafael Ruiz de Castañeda
Module 2. Introduction to Global Health concepts

Battams, S, Wernli, D & Slama, S

Relevant learning outcomes:

Outcome 1: Understand the concept of global health, and how this differs from public
health and international health.

Outcome 2: Identify key elements of a social determinants of health approach and the
relationship between inequity within and across countries and health.

Outcome 3: Understand what is meant by a human rights framework for

health/human rights based approach.

Outcome 8: Apply critical reasoning skills to a global health problem.

There are 3 parts to week 1:

1. Background: Definition of global health and introduction of concepts
2. Foundations of Global Health
3. Summary of the week

1. Background: Definition of global health and introduction of

concepts

This week will introduce the concept of global health. Global health is a relatively new field
and there is currently some debate over its definition. Common definitions of global health
include:

“Global health is an area for study, research, and practice that places a priority on
improving health and achieving equity in health for all people worldwide. Global
health emphasises transnational health issues, determinants, and solutions; involves
many disciplines within and beyond the health sciences and promotes inter-
disciplinary collaboration; and is a synthesis of population- based prevention with
individual-level clinical care.”(Koplan, 2009, p.1995)

“[…] those health issues that transcend national boundaries and governments and
call for actions to influence the global forces that determine the health of people. It
requires new forms of governance at national and international level which seek to
include a wide range of actors.”(Kickbusch, 2006, p.561)

Key to the definition of global health are the following points:

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• Processes of globalisation affect global health, thus global health is a
transnational issue
• Central to the new concept of global health is the process of globalisation.
Globalisation has been defined as “the widening, deepening and speeding up
of worldwide interconnectedness in all aspects of contemporary social life,
from the cultural to the criminal, the financial to the spiritual”(Held, 1999,
p.2)…“processes contributing to intensified human interaction in a wide
range of spheres (that is, economic, political, social, environmental) and
across three types of boundaries—spatial, temporal and cognitive—that have
hitherto separated individuals and societies (Lee, 2004, p.12).Globalisation
has meant that the determinants of health are now common across borders, as
a range of health issues and threats now transcend national boundaries
(Kickbusch, 2006).
• Globalisation can potentially have both positive and negative effect on health.
Because of the multiple and complex globalisation processes that impact
health (figure 1), the overall effect of globalisation on health is difficult to
assess. On the one hand, it is contended that globalisation fuels development
which in turn alleviates poverty and enhances health (Feachem, 2001).Some
globalization processes have the potential to positively impact upon health,
for example globalisation has led to greater access to health communication
resources (e-health and m-health), greater sharing of health information,
access to medicines and technologies. Civil society movements for health
also gain strength from global participation (e.g. the People’s Health
Movement, Democratising Global Health Coalition) and are enabled by
global media and modern communication resources.
• On the other hand economic globalisation which entails greater market
liberalism (including liberalisation of health services) has been linked to
greater health inequity across the globe (Baum, 2001; Stiglitz, 2009). The
global economic crisis has been associated with mental health and substance
abuse problems as well as an increase in the rate of suicide (Wahlbeck &
McDaid, 2012;Stuckler et al., 2009).International travel has led to the wider
dissemination (and speed of dissemination) of pathogens and infectious
diseases. Through global marketing and trade by transnational corporations in
the food system, greater access to and consumption of unhealthy (energy
dense) food/beverages has occurred, creating some of the conditions for the
rise of non-communicable diseases. Globalisation also has the potential for
greater conflict or cooperation between States, depending upon the
circumstances.

• Collaborative or collective action across countries is required

• The nature of health determinants and risks arising from globalisation means
that health has increasingly become a transnational issue (Kickbusch, 2006;
Frenk & Moon, 2013). Traditionally a national priority, health has now
become a component of foreign policy and international relations. Thus the
link between processes of globalisation and health has led to the development

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 of global health and health becoming a transnational, cross border issue
which requires international cooperation for its governance.

• Intersectoral and interdisciplinary action is required for global health

• Central to the concept of global health is the consideration of health issues
which transcend national boundaries (Kickbusch, 2006), and which have a
range of social determinants (see section 3) that require intersectoral and
interdisciplinary approaches. The rationale for these approaches is that, given
the complexity of current global health challenges, and the social
determinants of health contributing to health problems, no single sector or
discipline alone can provide the solutions required. It is, however, the
integration of diverse sectoral and disciplinary perspectives that increase our
understanding of complex phenomenon such as the impact of climate change
on health, or the migration of health personnel from low and middle income
to high-income countries.
Due to its intersectoral and interdisciplinary nature, a range of strategies are
employed for global health, across sectors, from primary health care
measures including public policy and legislation to primary care and
individual medicine. A range of sectors are involved, including public health,
law, trade, economics and foreign policy to name but a few.

• Global health is integral to sustainable development efforts

• Health is strongly linked to sustainable development, which refers to
simultaneous social, economic and environmental development (see week 6
for further discussion).
• Health has become central to development efforts (i.e. international aid, now
referred to as development assistance) and there has been a significant
increase in financing for health in the development arena. There are a number
of health goals within the Millennium Development Goals: six of the
‘Millennium Development Goals’ related to health or the role of the health
sector. We will discuss further the health related MDGs throughout
subsequent weeks.

• Health is a global public good

• In current debates, it is said that health should be seen as a ‘global public
good.’ This means that having it does not diminish its access to others (non-
rival), that its consumption should not exclude its availability to others (non-
excludable), and that it should be freely available to all. From this
perspective, the market, due to a lack of incentive, can not be left to produce
this good which benefits all, and governments (and multilateral
organisations) are required to adopt strategies to ensure that people have
better access to it. Furthermore, in a globalised world, the creation of global
public health goods depends on international cooperation (Kaul & Faust,
2001).

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 • Global health as an advocacy movement that aims to achieve ‘Health for all’
‘Health for all’ refers to 1) the even distribution of health resources across
the world, leading to greater health equity, and 2) an international civil
society movement calling for health for all and the empowerment of citizens.
The concept was introduced in the late 1970s, and in 1981 the World Health
Assembly adopted the ‘Global strategy for health for all by the year
2000.’Global health is an advocacy movement as well as an area of
education, research and practice (see the People’s Charter for Health, 2013
http://www.phmovement.org/en/resources/charters/peopleshealth).

Figure 1:Conceptual framework for globalisation and population health.

Source: Huynen, MMTE., Martens, P., Hilderink, HBM. (2005). Health impacts of
globalisation: A conceptual framework Globalization and Health 1:14 . Available from:
http://www.globalizationandhealth.com/content/1/1/14

Videos:

102. Ms. Petra Lantz (UNDP) on “The relationship between global health and development”

Video: Experts views on global health (informal discussion on global health from course
participants).

Key Readings:
Battams, S.,& Matlin, S.(2013).Discussing a definition of Global Health. Global Health
Diplomacy Briefing, The Graduate Institute, Global Health Programme, Geneva (see The
Global Health Programme:
http://graduateinstitute.ch/home/research/centresandprogrammes/globalhealth/publications/po
licy-briefs.html. Please see this resource for a brief discussion on the various definitions of
global health.

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Discussion Forum Activity
Read the ‘Discussion a definition of global health’ policy briefing (see Key readings, above).
Also watch the video where different experts in this course discuss their views on global
health.
What are the key differences in definitions provided? Use the discussion forum to write in
your own words how you think global health has emerged as a distinct field, separate from
public health or international health.

Other (external) videos:

1. Global Health Education Consortium: http://youtu.be/CpygXxaShuU
2. Prof. Hans Rosling at the recent Stockholm Global health Conference on health in the
post2015: http://youtu.be/8gY5BSFPlME

Further Readings:
Koplan, J.P., Bond, T.C., Merson, M.H., Reddy, K.S., Rodriguez, M.H., Sewankambo, N.K.
et al. (2009).Towards a common definition of global health. The Lancet, 373(9679), 1993-
5.http://www.thelancet.com/journals/lancet/article/PIIS0140673609603329/fulltext
Beaglehole, R.,& Bonita, R. (2010).What is global health?. Global Health Action, 3:5142.
http://globalhealthcenter.umn.edu/documents/whatisglobalhealth.pdf
Organisation
Brown, T. M., Cueto, M., & Fee, E. (2006).‘The World Health Organisation and the
Transition from International to Global Public Health’. American Journal of Public Health,
96(1), 62–72.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470434/

2. Foundations of Global Health

There are several conceptual/theoretical foundations for global health. We describe three of
them below which we consider to be essential to understanding global health issues and
responses.

1. An ecological of ‘systems’ perspective on health (links to below)

2. Social determinants of health approach
3. Human rights based approach to health

2.1 An ecological or ‘systems’ perspective.

Rather than seeing health from a biomedical perspective, this perspective sees health as the
result not only of biological factors but also psychological, familial, social, economic,
cultural, environmental and structural factors (micro, meso and exo levels of influence) and
most importantly the interrelationship between all of these factors. Keleher and Murphy
(2004) state that:

“Health is the outcome of complex interrelationships and interdependencies between

human beings, the determinants of health, and the broader environment in which they
exist.”

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This ecological perspective can also been referred to as a ‘systems approach’. Within health,
this approach blurs the traditional boundaries between sciences, social sciences and
humanities and tries to reconcile the long-term split between population based approaches and
healthcare focused on the individual. It also provides the basis for working in ways which are
cross-sectoral, engaging sectors other than health. It ties in with the ‘social determinants of
health’ approach discussed below.

Videos:
103. Prof. Roderick Lawrence (UNIGE) on “Ecology and public health”

Key Readings:
Lang, T., & Rayner, G. (2012).Ecological public health: the 21st century’s big idea?An essay
by Tim Lang and Geof Rayner. British Medical Journal,
This paper can be accessed after
345:http://www.bmj.com/content/345/bmj.e5466.
registration for a 14 day trial.

Other (external) videos:

Geof Rayner at the Geneva Health Forum on (ecological) public health:

Rayner, G. (2013).Geneva Health Forum 2012 - Interview with Geoff Rayner. Retrieved June
2013 fromhttp://youtu.be/LLeQHljyRuU

BMJ Podcast of Geoff Rayner on ecological public health:

Rayner, G. (2012, August 24).Ecological public health. Retrieved June 2013 from
http://www.bmj.com/podcast/2012/08/24/ecological-public-health

Further Readings:
Rayner,G., & Lang, T. (2012).Ecological Public Health: Reshaping the Conditions for Good
Health. Routledge.

Smith R., Beaglehole, R., Woodward, D., Drager, N. (Eds.)(2003).Global Public Goods for
Health: health economics and public health perspectives. Oxford, Oxford University Press.

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K.(1988). An ecological perspective on
health promotion programmes. Health Education Quarterly, 15(4), 351-377 (a well cited
article on an ecological perspective from the health promotion field).

2.2 Social determinants of health approach

“The social determinants of health are the conditions in which people are born,
grow, live, work and age, including the health system” (see WHO website
http://www.who.int/social_determinants/en/).

“Social and economic conditions and their effects on people’s lives determine their
risk of illness and the actions taken to prevent them becoming ill or treat illness when
it occurs.” (World Health Organisation [WHO], 2013).

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The circumstances within which we live are not predetermined, but they are rather shaped by
the distribution of power and resources including economic resources at different levels
(global, regional, national and local). These conditions create health inequities – “the unfair
and avoidable differences in health status seen within and between countries” (WHO, 2013).
Health inequity should be distinguished from health inequality, the latter of which refers to
differences in health status between populations.

The social determinants of health is also a term used to broadly describe the political (e.g.
extent of democratic governance) economic and social ‘determinants’ of health, or conditions
within which people live. The social determinants of health include the social gradient
(concept described below) along with housing, education, child development, culture, food,
work conditions and unemployment (see the key reading for this week by Wilkinson &
Marmot, 2003 and WHO, 2008, along with the Dahlgren & Whitehead, 1991 model, see
figure 2 below).The social determinants of health also include gender, racism and
discrimination. Racism and discrimination may particularly affect refugees, migrants and
ethnic minority populations, who may experience social exclusion and have fewer legal rights
or less favourable social positions, leading to health inequities (WHO, 2010). There are also
specific social determinants of Indigenous health, which include racism and the long term
effects of colonisation and racist historical policies and practices (e.g. the removal of
Indigenous children from their parents in Australia between 1909 and the 1970s, leading to
the ‘Stolen Generations’).

A social determinants approach is an ‘upstream’ approach focusing on the causes or

determinants of illness, whilst traditional approaches to health have been referred to as
‘downstream’ approaches, treating only the symptoms or diseases themselves. Concepts such
as ‘upstream’ and ‘downstream’ are introduced in the classic reading by McKinlay (see
below).

A social determinants of health approach calls for intersectoral strategies such as the ‘Health
in All Policies’ approach, which considers the impact upon health of policies in non-health
sectors, such as trade, housing or the environment (we discuss this approach further in week
4).For example, insecure housing (i.e. with insecure tenure), unaffordable housing (i.e.
leading to ‘housing stress), overcrowding in housing, or housing without basic services (e.g.
sanitation and clear water, power) can seriously impact on health. The health sector can work
with the housing sector to work on appropriate tenure arrangements and guidelines for
eviction processes or the urban planning sector to ensure that good urban planning facilitates
housing developments having access to employment, transport and social services (WHO,
2011).

The social determinants of health are extremely important in an understanding of global

health inequities and inequalities, and patterns of health and illness across population groups
and countries which we will discuss over the next two weeks. In the reform of the World
Health Organisation, it has been decided that strategies to address the social determinants of
health will be incorporated across programmes of the organisation (see Battams 2012, below).

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 Figure 2: A social model of health: in this model, health is influenced by a range of
determinants.

Source: Permission granted by the Institute for Future Studies: Dahlgren G, Whitehead M.
(1991). Policies and Strategies to Promote Social Equity in Health. Stockholm, Sweden:
Institute for Futures Studies. Available from: http://hiaconnect.edu.au/resources/about-hia/

The Social Gradient of Health

The social gradient of health refers to the differences in health at each step of the social scale
within societies; the lower the step, the lower is one’s life expectancy and more common is
disease and disability. This is a result of having less access to the social and economic
resources required for health. The social gradient is most apparent when we consider health
status across countries. However the social gradient effects all people, even within the
wealthiest countries:

“if you look at under-5 mortality rates by levels of household wealth you see that
within counties the relation between socioeconomic level and health is graded. The
poorest have the highest under-5 mortality rates, and people in the second highest
quintile of household wealth have higher mortality in their offspring than those in the
highest quintile. This is the social gradient in health.” WHO, 2013:
http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/

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In one of the extra videos for this week, Sir Michael Marmot, Chair of the Commission on the
Social Determinants of Health, discusses life expectancies across countries according to
income group at the country level (high, middle, low income countries), using WHO figures.

Video:
104. Prof. Claudine Burton-Jeangros (UNIGE) on “Social determinants of health”

Key Readings:
Executive Summary of Commission on the Social Determinants of Health (2008) ‘Closing the
gap in a generation’. http://whqlibdoc.who.int/hq/2008/WHO_IER_CSDH_08.1_eng.pdf

Wilkinson, R., & Marmot, M. (Eds.) (2003). Social determinants of health: The Solid Facts.
WHO Library Cataloguing Data (for a definition of social gradient, and other social
determinants of health).
http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf

Other video:
Interview with Michael Marmot from You tube:
http://www.youtube.com/watch?v=LdoGi7IyQ2Q

Discussion Forum Activity:

Read the Wilkinson and Marmot (2003) reading. Reflect upon what you understand by the
‘social gradient’ of health and the ‘social determinants of health’ approach. Does this differ in
any way from your previous concepts of health?

Further Reading:
Fair Society, Healthy Lives (The Marmot Review). Strategic Review of Health Inequalities in
England 2010.http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-
marmot-review

McKinlay J: (1974) A case for refocusing upstream: the political economy of illness, in A.J.
Enelow, J.B. Henderson (Eds.), Applying Behavioural Science to Cardiovascular Risk,
American Heart Association, Dallas (1975), pp. 7–17

WHO, (2010), How health systems can address health inequities linked to migration and
ethnicity, Briefing on policy issues produced through the WHO/European Commission on
equity project. Copenhagen, WHO Regional Office for Europe.
http://www.who.int/hac/techguidance/health_of_migrants/en/

Battams, S (2012). The Social Determinants of Health and Civil Society Engagement in the
WHO Reform
and Beyond: Negotiations at the 65th World Health Assembly, Health Diplomacy Monitor, 3,
4. http://www.ghd-net.org/health-diplomacy-action/health-diplomacy-monitor

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2.3 Human rights based approach to health
Health is a fundamental, universal human right. ‘Health as a human right’ is enshrined in
international legislation and policy, e.g. the International Covenant on Economic, Social and
Cultural Rights. Specific legislation may also be focused on protecting the rights of
vulnerable population groups, e.g. The International Convention on Persons with Disability
also includes the ‘right to health.’ Many countries or regions also have their own human
rights legislation. The relationship between human rights and health is twofold; human rights
can support health (or their abuse can have dire consequences for health), whilst health is
important for the attainment of human rights. Health legislation, policy and service delivery
can itself potentially infringe upon human rights. A human rights based approach to health is
central to global health advocacy.

Case example 1 – Sexual and reproductive health and rights and development
Sexual and reproductive health and rights is an important area for global health and
development, and particularly women’s empowerment, but is often an overlooked or
underfunded area. Whilst maternal mortality has declined in alignment with the Millennium
Development Goal 5, universal access to care for sexual and reproductive health (e.g. family
planning, sexual health information, products and care, screening and treatment for sexually
transmitted infections, antenatal to obstetric care, safe abortion) is a distant goal, linked to the
lack of universal health coverage. This is also one area where stigma and discrimination
linked to social-cultural norms and practices may play a factor in people seeking information
and treatment. Here is a resource on the economic and health benefits of investing and sexual
and reproductive health, which illustrates well the social determinants of health:
http://www.guttmacher.org/pubs/AddingItUp2009.pdf

In 1994, there was a landmark International Conference on Population and Development

which adopted a Declaration (http://www.un.org/popin/icpd/conference/bkg/egypt.html) and
Programme of Action. This recognised the importance of reproductive health and family
planning and its links with development.
See also the 2008 United Nations Population Fund resource on Reproductive Rights and
Sexual Health
http://www.unfpa.org/webdav/site/global/shared/documents/UNFPA_SRH_Framework_Final
Version.pdf

Case example 2 – developed country, UK’s human rights approach to health service delivery
Some countries have introduced a human rights based approach to health within health
services. For example, the UK is a good example of a country which has introduced a human
rights based approach in the design and delivery of services. The UK has produced a range of
practical tools for a human rights approach to health and social services here: https://
www.bihr.org.uk/media/4w3bqxcj/putting_human_rights_at_heart_of_health_and_care.pdf

Video:
105. Prof. Philippe Chastonay (UNIGE) on “Human rights in a global health perspective: a
major challenge”

16
Key Readings:
The link between health and human rights:https://www.who.int/news-room/fact-sheets/detail/human-rights-and-
health

Discussion Forum Activity:

Access the above resources from these two case examples on a human rights approach to
health. As you explore these resources, consider what might be some of the key issues for a
human rights approach to health across countries. Discuss on the discussion forum.

Further Readings:
The ICESCR Article 12:
http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx
More information about sexual and reproductive health and
rights: https://www.who.int/teams/sexual-and-reproductive-health-and-research-(srh)/overview

3. Summary of module 2

In this week, we have discussed definitions of global health, the emergence of global health as
a distinct field, and foundational concepts of global health. We have discussed how global
health is:

• Cross border in focus, and subsequently an increasing component of foreign policy

and international relations
• Influenced by processes of globalisation, both negative and positive
• Intersectoral and interdisciplinary, and requires coordination and a range of strategies
and action across sectors, not just from the health sector
• Ecological, that is, influenced by a number of interrelated factors
• Normative, and is focused on ameliorating health inequity. It is concerned that health
is inequitably distributed within and across countries, and determined by the uneven
distribution of power and resources and other social determinants of health (e.g.
housing, child development, education, culture)
• Adopts a human rights based approach to health
• A global public good
• Strongly linked to development and development goals
• An advocacy movement along with an area of research, education, policy and
practice.

17
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