COMMENTARY
Global health - multiple definitions, single goal
Ana Marušić
Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
ABSTRACT
Although there is a wealth of research on and attention of both the public and the researchers about global health, there is still some controversy and uncertainty about the real meaning of the term "global health". In a multidisciplinary and intersectorial field such as global health, common definition is important for clear and effective communication among all involved in global health.
Key words: global health health communication multidisciplinary research
There are several definitions of global health currently available [1-5]. This introduces uncertainty and ambiguity not only for health professionals but also for the general public. The confusion is logical, as "global health" is a relatively new concept in medicine. There were 9243 publications containing the term "global health" as of 14 January 2013 (search term "global health" [All Fields]). The first article with "global health" in the title was published in 1966 [6], addressing global health factors important to Canadian mobile forces. There were only sporadic articles addressing this topic until the eighties, when up to 10 articles on global health were published each year, with an increase to up to hundred articles per year in the nineties. The explosion of global health research starts in the 21st Century, with an increase from 110 published articles in 2000 to 1250 articles in 2010. This increase continues at even steeper rate, with 1714 publications in 2011 and 2268 in 2012. Despite this clearly increasing trend in global health research "global health" is not a concept recognized by the Medical Subject Headings (MeSH) - the "controlled vocabulary thesaurus used for indexing articles for PubMed" [7]. In MeSH, "global" is associated with two world wars (I and II), terms introduced in 2005, and in "global warming", the term introduced into MeSH in 2010.
Some countries, like Canada, had a special panel that chose the best definition for the national strategy directions in global health [8]. They decided to first agree on a common definition to ensure clear communication among multiple sectors and disciplines involved in global health work [8]. The Canadian panel chose the definition of Koplan, et al., published in 2009 [3]:
"Global health is an area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual-level clinical care".
A recent exercise in inductive analysis of global health definitions identified primary and secondary characteristics that play a role in the definition [8]. Primary characteristics were those that were essential to the definition of global health: 1) equity (in health status and access), 2) global conceptualization (as opposed to international or supranational perspective, 3) causes (of health issues), 4) means (for health activities), and 5) solutions (to address health issues) [8]. The definition of Koplan, et al. [3] had all of these primary characteristics in comparison to other 4 definitions [1, 2, 4, 5] in the inductive analysis [8].
Secondary characteristics were considered those aspects of a definition that provide more detail about global health, calibrate and improve the understanding of the concept: 1) source of obligation (the duty of the more privileged ones to help those with fewer resources [9]), 2) multidisciplinary approach (involvement of many other professions and disciplines together with health professionals), 3) actors (individuals or groups as agents of global health), and 4) reactive/proactive (provision of global health) [8]. None of the analyzed global health definitions [1-5] had all secondary characteristics [8].
The definition by Koplan, et al. [3] was the only one including multidisciplinarity, accentuating the fact that global health "involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration". I would argue that multidisciplinarity is perhaps not a secondary but a primary characteristic of global health - and the reason why definitions of global health are needed. Canada recognized this need to empower different actors, sectors and the public to communicate among themselves and produce meaningful outcomes. We should also pay more attention to the multidisciplinary nature of global health and engage and learn more about other disciplines that can affect global health, such as economy [10]. Without such collaboration, as well as global communication [11], the meaning of "global health" will remain as elusive and controversial as it is now.
REFERENCES
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2. The European Commission. Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions. The EU role in global health. Brussels: EC; 2010.
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9. Nelson SH.The West's moral obligation to assist developing nations in the fight against HIV/AIDS. Health Care Anal 2002;10(1):87-108.
10. Rudan I, Marušic A, Campbell H. Balancing investments in existing and emerging approaches to address global health priorities. J Glob Health 2012;2(1):10101. DOI: 10.7189/jogh.01.010101
11. De Castro P, Marsili D, Poltronieri E, Agudelo Calderón C. Dissemination of public health information: key tools utilised by the NECOBELAC network in Europe and Latin America. Health Info Libr J 2012;29(2):119-30. DOI: 10.1111/j.1471-1842.2012.00977.x
Address for correspondence:
Ana Marušić
Department of Research in Biomedicine and Health
University of Split School of Medicine
Soltanska 2, 21000 Split, Croatia
E-mail: ana.marusic@mefst.hr
Accepted on 14 January 2013.