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Global health, it has been noted, is not a discipline; it is, rather, a collection of problems. A leading group of scholars have defined global health as the study and practice concerned with improving the health of all people and achieving health equity worldwide, with an emphasis on addressing problems that are transnational. No single review can do much more than identify the leading problems in applying evidence-based medicine in settings of great poverty or across national boundaries. This chapter introduces the major international bodies that address these problems; identifies the more significant barriers to improving the health of people who to date have not, by and large, had access to modern medicines; and summarizes population-based data on the most common health problems faced by people living in poverty. Examining specific problems—notably AIDS (Chap. 189) but also tuberculosis (TB, Chap. 165), malaria (Chap. 210), and key noncommunicable diseases—helps sharpen the discussion of barriers to prevention, diagnosis, and care as well as the means of overcoming them. The chapter then discusses the role of health systems and the problem of "brain drain" on those systems. It closes by discussing global health equity, drawing on notions of social justice that once were central to international public health but have fallen out of favor over the last several decades.


Concern about health across national boundaries dates back many centuries, predating the Black Plague and other pandemics. The first organization founded explicitly to tackle cross-border health issues was the Pan American Sanitary Bureau, which was formed by 11 countries in the Americas in 1902. The primary goal of what later became the Pan American Health Organization was the control of infectious diseases across the Americas. Of special concern was yellow fever, which had been running a deadly course through much of South and Central America and posed a threat to the construction of the Panama Canal. In 1948, the United Nations formed the first truly global health institution: the World Health Organization (WHO). In 1958, under the aegis of the WHO and in line with a long-standing focus on communicable diseases that cross borders, leaders in global health initiated the effort that led to what some see as the greatest success in international health: the eradication of smallpox. Naysayers were surprised when the smallpox eradication campaign, which engaged public health officials throughout the world, proved successful in 1979 during the Cold War. The influence of the WHO waned during the 1980s. In the early 1990s, many observers argued that with its vastly superior financial resources and close if unequal relationships with the governments of poor countries, the World Bank had eclipsed the WHO as the most important multilateral institution working in the area of health. One of the stated goals of the World Bank was to help poor countries identify "cost-effective" interventions worthy of international public support. At the same time, the World Bank encouraged many of those nations to reduce public expenditures ...

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