8: Global Health and Behavioral Medicine

INTRODUCTION

Global health and behavioral medicine intersect in two important ways. First, mental, neurological, and substance use (MNS) disorders affect every community in the world. We relate to MNS disorders at a local level, where they are embedded in our customs, culture, and context. MNS disorders also exert global influence, through their massive burden of disease, the human and economic costs of treated and untreated illness, and their secondary (often less visible) effects on the outcomes of other health conditions.

Second, the integration of behavioral, social, and biomedical sciences can improve health care globally. Adapting interdisciplinary lessons to tackle local problems may result in more effective, efficient, and responsive health care delivery. Similarly, understanding the interdependence of social determinants, health, and development may inform enlightened approaches to promoting health and empowering communities.

An interdisciplinary approach also has important implications for health worker training. Health workers in all settings should be trained to treat and prevent behavioral, social, and biological problems. They should be taught communication, leadership, and team membership skills. Burnout among health workers begins during training and leads to a range of dysfunctional behaviors. While learning to care for others, health workers should also be taught to care for themselves.

The intersection of global health and behavioral medicine is a complex and rapidly evolving area. With the goal of offering students a concise entry point into the relevant issues, we have organized this chapter into four sections:

1. The global treatment gap.

2. The need for new models of care.

3. The importance of context.

4. Health worker training and support.

THE GLOBAL TREATMENT GAP

The Problem

To appreciate the global treatment gap, we must first understand the level of need. One in four people will suffer from a mental illness in their lifetime. Major depression is the third largest contributor to the overall global disease burden and is expected to be the number one contributor by 2030. The World Health Organization (WHO) estimates that nearly 850,000 people commit suicide annually. Eighty percent of these suicides are in low- and middle-income countries. As a group, MNS disorders (including conditions such as depression, substance abuse, schizophrenia, dementia, and epilepsy) account for 14% of the overall global disease burden. According to a recent report by the World Economic Forum, the direct and indirect costs of mental illnesses totaled 2.6 trillion dollars in 2010 alone. By 2030, the cumulative costs are expected to exceed 15 trillion dollars. Underlying these staggering financial costs is a flood of measured and unmeasured human suffering.

Despite the enormous need, MNS disorders have received scant attention globally. Why is this the case? The following section presents a brief gap analysis, charting a cascade of inadequate global response from policy, to funding, to treatment.

Policy Gap