Global Health CHAPTER 01

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PART I
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NOT FOR SALE OR DISTRIBUTION Principles, © Jones & Bartlett Learning, LLC

Measurements,
and the Health–


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Courtesy of Mark Tuschman.
1
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CHAPTER 1
The Principles and

Goals of Global Health
Courtesy of Mark Tuschman.
LEARNING OBJECTIVES
©ByJones
the end of this chapter, the reader will be able to do the following:
& Bartlett Learning, LLC © Jones & Bartlett Learning, LLC
■■ Define the terms health, public health, and global health
Discuss some examples of public health efforts
■■
Discuss some examples of global health activities

■■
■■ Describe some of the guiding principles of public health work
■■ Describe the Sustainable Development Goals and their relation to global health
© Jones & ■■ Briefly

Bartlett discuss the
Learning, global effort to eradicate smallpox
LLC © Jones & Bartlett Learning,
LLC
▸▸ Vignettes stronger than before. Getachew is one of about 1.2 mil-
B
lion people in Ethiopia who are living with HIV.2 He is
y 2005, polio was on the
© Jones verge of being
& Bartlett eradi- LLCalso one of about 37 million
Learning, people&inBartlett
© Jones the worldLearning,
who LLC
cated. That year, however, rumors circulated in are HIV positive.3 In Botswana, Lesotho, and Swaziland,
northern Nigeria that the polio vaccine was caus- more than 20 percent of all adults are HIV-positive.4
ing sterility. In response to these rumors, some commu- Laurie lives in Portsmouth, Virginia, in the United
nity leaders discouraged people from immunizing their States. She is 50 years old and has always been healthy.
children. Within months, polio cases began to appear Last weekend, she woke up with a headache, a high
© the
in Jones & Bartlett
area. Shortly Learning,
thereafter, LLC
polio cases spread from © Jones
fever, and & Bartlett
a very stiff Learning,
neck. Laurie was so sickLLC
that she
northern Nigeria to Sudan, Yemen, and Indonesia. The NOT FOR SALE OR DISTRIBUTION
went to the emergency room of the local hospital. The
global campaign to eradicate polio had been dealt a physicians diagnosed Laurie as having meningitis, an
major blow, stemming partly from rumors in one coun- inflammation of the membrane around the brain and
try about the alleged side effects of the vaccine.1 spinal cord,5 that was caused by West Nile virus. Th s
Getachew
© Jones & Bartlett is a 20-year-old
Learning, LLC Ethiopian with HIV.©HeJones virus originatedLearning,
& Bartlett in Egypt in the
LLC1930s and is transmit-
was recently placed on antiretroviral therapy for his ted by mosquitoes. Today, the virus can be found in
infection. He is already gaining weight and feeling much much of the world.6
3
4 Chapter 1 The Principles and Goals of Global Health
Jim Smith is a high school student in London, Islands have diabetes,8 which is highest rate for any
© Jones & Bartlett © Jones & Bartlett 9Learning, LLC
England. EarlyLearning, LLC
in the school year, he had a fever country in the world.
and cough that would not go away. He did not feel NOT FOR SALE OR DISTRIBUTION
like eating. He slept badly and woke up every morn-
ing in a sweat. Jim had tuberculosis (TB). Although
▸▸ Why Study Global Health?
many people think that TB has been eliminated from Over the last 50 years, the world has made signifi ant
high-income countries,© it has not. & Bartlett Learning,progress
Jones LLC in improving human © health.
JonesSome& Bartlett
of this Learning, LLC
Nirupama is a 50-year-old
NOT FOR woman
SALEwhoORlives in progress is refl cted in TABLE 1-1.
DISTRIBUTION NOT FOR SALE OR DISTRIBUTION
Chennai, India. Niru, as her friends call her, has dia- As shown in Table 1-1, never before have so many
betes. She is dependent on a regular supply of insulin, people lived for so long. Never before have so few
which she picks up monthly at a government clinic. young children died each year, or so few women died
Although she is only 50, she has already suffered from each year of maternal causes. There has also been enor-
some of the circulatory complications of diabetes.
mous progress against vaccine-preventable diseases
There is a common perception that diabetes is a dis- NOT FOR
and against neglected SALE
tropical OR DISTRIBUTION
diseases, such as many
ease that affects only people in high-income countries. parasitic infections. In addition, the consumption of
Th s, however, is not the case. Rather, the prevalence tobacco, a major risk factor for noncommunicable dis-
of diabetes is growing rapidly in low- and middle- eases, has decreased in many countries. One reason to
© Jonesincome countries.
& Bartlett India now
Learning, LLChas the largest num- © Jones
study global health is to
& Bartlett gain a better
Learning, LLCunderstanding of
NOT FOR ber SALE
of people
ORwith diabetes among such countries.7 NOT
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progress madeOR
SALE so far in addressing global health
DISTRIBUTION
Large proportions of populations in other low- and problems.
middle-income countries also suffer from this disease. Another reason to study global health, however,
More than one-third of the adults in the Marshall is to better understand the most important global
NOT FOR
TABLE 1-1 Selected Progress SALE
in Global HealthOR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION
■■ Global life expectancy increased 37% from 1960 to 2016.1
■■ The
© rate of child
Jones & mortality
Bartlettfell 62% from 1990
Learning, LLC to 2016.2 © Jones & Bartlett Learning, LLC
■■ Nearly 3 billion children have been vaccinated against polio, with only 22 cases of wild poliovirus cases reported
in 2017.3
■■ There were 44% fewer maternal deaths in 2015 than in 1990.4

■■ Fifty-three million tuberculosis deaths were averted from 2000 to 2016 through successful diagnosis and
NOT FOR SALE OR5 DISTRIBUTION NOT FOR SALE OR DISTRIBUTION
treatment.
■■ There were 900,000 fewer deaths due to HIV/AIDS in 2016 compared to 2005.6
■■ © Jones
The number of Guinea & Bartlett
worm cases Learning,
has decreased LLC
over 99.9%, from 3.5 million in 1986 to ©
30 Jones
in 2017.7 & Bartlett Learning, LLC
■■ The global prevalence of tobacco smoking decreased from 24% in 2007 to 21% in 2015, despite population growth.8
Modified f om The World Bank. (n.d.). Life expectancy at birth, total (years). Retrieved from https://data.worldbank.org/indicator/SP.DYN.LE00.IN
1
UNICEF, World Health Organization, World Bank Group, & United Nations. (2017). Levels and trends in child mortality: Report 2017. Retrieved from http://data.unicef.org/resources
2

/levels-trends-child-mortality/ © Jones & Bartlett Learning, LLC
3
Gardner, T. J., Diop, O. M., Jorba, J., Chavan, S., Ahmed, J., & Anand, A. (2018). Surveillance to track progress toward polio eradication—Worldwide, 2016–2017. MMWR, 67, 418–423. doi: http://
NOT FOR
dx.doi.org/10.15585/mmwr.mm6714a3 SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION
4
World Health Organization, UNICEF, UNFPA, World Bank Group, & the United Nations Population Division. (2015). Trends in maternal mortality: 1990 to 2015. Geneva, Switzerland: World Health
Organization. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/194254/9789241565141_eng.pdf?sequence=1
5
World Health Organization. (2017). Global tuberculosis report 2017. Geneva, Switzerland: World Health OrganizationAuthor. Retrieved from http://apps.who.int/iris/bitstream/han
dle/10665/259366/9789241565516-eng.pdf?sequence=1
6
UNAIDS. (2017). Ending AIDS: Progress toward the 90-90-90 targets. Geneva, Switzerland: Author. Retrieved from http://www.unaids.org/en/resources
© Jones /documents/2017/20170720_Global_AIDS_update_2017
& Bartlett Learning, LLC © Jones & Bartlett Learning, LLC
NOT FOR7TheSALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION
Carter Center. (2018, May 3). Guinea Worm case totals. Retrieved from https://www.cartercenter.org/health/guinea_worm/case-totals.html
8
World Health Organization. (2017). WHO report on the global tobacco epidemic, 2017: Monitoring tobacco use and prevention policies. Geneva, Switzerland: Author. Retrieved from http://apps.who
.int/iris/bitstream/handle/10665/255874/9789241512824-eng.pdf?sequence=1
Why Study Global Health? 5
of neonatal, maternal, and nutritional causes and of

communicable diseases. It also speaks to the growing
NOT FOR SALE OR DISTRIBUTION NOT FOR SALE
burden OR DISTRIBUTION
of noncommunicable diseases and an earlier
onset of these conditions in low- and middle-income
countries than in high-income countries. In addition,
many countries continue to face a substantial burden
© Jones & Bartlett Learning, LLCof injuries, especially from road traffic
© Jones accid ts.Learning, LLC
& Bartlett
NOT FOR SALE OR DISTRIBUTION As the world becomes NOTmore
FORglobalized,
SALEthe ORhealth
DISTRIBUTION
of people everywhere must be of concern to all of us.
Th s is particularly important because many d iseases—
such as TB, HIV/AIDS, and polio—are not limited by
political boundaries. Prior to 1960, dengue fever was
concentrated largely in Southeast Asia and the coast
NOT FOR SALE OR DISTRIBUTION of SouthNOT FORHowever,
America. SALE OR casesDISTRIBUTION
are now seen in five
continents, as shown in FIGURE 1-1.10,11
PHOTO 1-1 A child is shown here receiving polio vaccine. The “avian flu” fi st appeared in East Asia, but
Although challenges to polio eradication remain, the it, too, is spreading to other regions. As described in
world has
© Jones & Bartlett made an enormous
Learning, LLC amount of progress in © Jones
the&vignette
Bartlett at Learning,
the beginning
LLCof this chapter, no one
reducing the burden of polio. What have been some of in Laurie’s neighborhood ever thought of getting West
the reasons for the success of this effort? What can be
Nile virus 20 years ago. Recently, the Chikungunya
done to address the remaining challenges to eradication?
© Ranplett/E+/Getty Images.
and Zika viruses have also been spreading globally.
There are also exceptional disparities in the health
of some groups compared to the health of others. Life
health challenges© that Jones & Bartlett
remain Learning,
and learn how to LLCexpectancy in Japan, for © example,
Jones &is Bartlett Learning, LLC
84 years, but it
address them rapidly, effectively, effici tly, and fairly. NOT FOR 12 SALE OR DISTRIBUTION
is only 52 years in Sierra Leone. In addition, there
TABLE 1-2 describes some of the “unfin shed agenda” are a number of lifesaving technologies, such as the
©TABLE
Jones1-2 &Some of the Learning,
Bartlett Unfinished genda
LLCin Global Health © Jones & Bartlett Learning, LLC
■■ There were 5.6 million under-5 child deaths in 2016.
1
■■ Almost half of all under-5 child deaths are related to malnutrition.1
■■ There
© Jones & Bartlett were 435,000
Learning, malaria deaths in 2017.2
LLC © Jones & Bartlett Learning, LLC
■■ 1.3 million HIV-negative people died from tuberculosis in 2017, in addition to 300,000 people with HIV.3
■■ 1.8 million people became infected with HIV in 2017.4
■■ In 2017, there©were
Jones & Bartlett
940,000 Learning,
deaths caused by AIDS.4 LLC © Jones & Bartlett Learning, LLC
■■ There were 303,000 maternal deaths in 2015.5
■■ Approximately 1 billion people are infected with roundworm.6
©■■Jones & Bartlett

The prevalence Learning,
of diabetes LLCsince 1980.7
has doubled © Jones & Bartlett Learning, LLC
Modified f om UNICEF, World Health Organization, World Bank Group, & United Nations. (2017). Levels and trends in child mortality: Report 2017. Retrieved from http://data.unicef.org/resources
1
/levels-trends-child-mortality/
2
World Health Organization. (2018). Malaria. Retrived from https://www.who.int/en/news-room/fact-sheets/detail/malaria.
3
World Health Organization. (2018). Tuberculosis. Global Tuberculosis Report 2018. Retrieved from https://www.who.int/tb/publications/factsheet_global.pdf?ua=1.
4
UNAIDS. (2018, July). Fact sheet—Latest statistics on the status of the AIDS epidemic. Retrieved from http://www.unaids.org/en/resources/fact-sheet
© Jones & Bartlett
5
Learning, LLC © Jones & Bartlett Learning, LLC
World Health Organization, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division. (2015). Trends in maternal mortality: 1990 to 2015. Geneva, Switzerland: World Health
Organization. http://apps.who.int/iris/bitstream/handle/10665/194254/9789241565141_eng.pdf?sequence=1
6
Centers for Disease Control and Prevention. (2018, February). Parasites–Ascariasis. Retrieved from https://www.cdc.gov/parasites/ascariasis/index.html
7
World Health Organization. (2016). Global report on diabetes. Geneva, Switzerland: Author. Retrieved from http://www.who.int/diabetes/global-report/en/
hepatitis B vaccine, that have been widely used in health of babies and the failure of children to reach
© Jones & Bartlettcountries
high-income Learning, LLC years that are not © Jones
for many
& Bartlett Learning, LLC
their full mental and physical potential. In addition,
NOT FOR as widely in low-income countries. NOT
SALE OR DISTRIBUTION
yet disseminated FOR of
ill health SALE ORcan
children DISTRIBUTION
delay their entry into school
These points raise important ethical and humanitar- and can affect their attendance, their academic per-
ian concerns about disparities in access to health ser- formance, and, therefore, their future economic pros-
vices and in health status. pects. Countries with major health problems, such as
The important link©betweenJoneshealth and develop-
& Bartlett Learning,high
LLC rates of malaria or HIV, have difficulty
© Jones attracting Learning, LLC
& Bartlett
ment is another reasonNOT to payFOR
particular
SALE attention to the investments needed to develop
OR DISTRIBUTION NOT FOR their economies.
global health. Poor health of mothers is linked to poor Moreover, having large numbers of undernourished,
unhealthy, and ill-educated people in any country
can be destabilizing and poses health, economic, and
security threats to all countries.
The intersectoral nature of many global health
NOT FOR SALE OR DISTRIBUTION concerns andNOT FORfor
the need SALE ORactors
different DISTRIBUTION
to work
together to address them are additional reasons why
we should be concerned with global health. Although
locally relevant solutions are needed to address most
© Jones & Bartlett Learning, LLC health problems,
© Jones & BartlettsomeLearning,
health issuesLLC
can be solved only
NOT FOR SALE OR DISTRIBUTION withFOR
NOT a global
SALE approach. In addition, some problems,
OR DISTRIBUTION
such as ensuring access to drugs to treat HIV/AIDS,
may require more fi ancial resources than some indi-
vidual countries can provide. Still other global health
issues require technical cooperation across countries
© Jones & Bartlett Learning,because
PHOTO 1-2 Despite very good progress against malaria,
LLC few countries have the © Jones & Bartlett Learning, LLC
technical capacity to
it is estimated that over 700,000 people died of malaria deal with them. Global cooperation might SALE
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be needed,
in 2016. Most of these deaths were among young for example, to establish standards for drug safety, to
children in Africa. What can be done to further reduce set protocols for the treatment of certain health prob-
the burden of malaria? lems, or to develop an HIV vaccine that could serve
© Himarkley/E+/Getty Images.
© Jones & Bartlett Learning, LLC the needs of low-income
© Jones & countries.
Bartlett Learning, LLC
Frequent or continuous
FIGURE 1-1 Countries with a Frequent or Continuous Risk of Transmission of Dengue Fever
Reproduced from Sharp, T. M., Perez-Padilla, J., & Waterman, S. H. (2017). Infectious diseases related to travel: Dengue. Retrieved from https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases
-related-to-travel/dengue
Health, Public Health, and Global Health 7
The concepts and concerns of global health are and the health of populations. C.E.A. Winslow, con-
© Jones & Bartlett Learning, LLC prominent worldwide. © Jones & Bartlett Learning, LLC
also becoming increasingly sidered to be the founder of modern public health in
NOT FOR SALE OR DISTRIBUTION NOT
The spread of HIV, the SARS scare in the early 2000s, FOR
the SALE
United OR DISTRIBUTION
States, formulated a defin tion of public
the fear of the avian flu, and outbreaks of Ebola virus health in 1923 that is still commonly used today:
in West Africa and the Democratic Republic of the
Congo have all brought attention to global health. The science and the art of preventing disease,
The advocacy efforts
© Jonesof Doctors Without
& Bartlett Borders, LLC prolonging life, and ©
Learning, promoting
Jones & physical health
the establishmentNOTof theFOR
Millennium and mental health and effici cy through
SALE and
ORSustainable
Development Goals, and the philanthropy of the Bill organized community efforts toward a sani-
& Melinda Gates Foundation have also dramatically tary environment; the control of community
raised awareness about global health. The topic has infections; the education of the individual in
become so important that there is a push in many principles of personal hygiene; the organiza-
universities throughout the world to ensure that all tion©ofJones
medical & and
Bartlett Learning,
nursing service forLLC
the
students have a basic understanding of key global NOT FOR SALE OR DISTRIBUTION
early diagnosis and treatment of disease; and
health issues. the development of the social machinery to
ensure to every individual in the community
a standard of living adequate for the mainte-
© Jones &nance of health. 14
© Jones & Bartlett
▸▸ Health, Public Health, and
Learning, LLC
Bartlett
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Learning, LLC
ORtoDISTRIBUTION
According Winslow’s defin tion, some exam-
Global Health ples of public health activities would include the
development of a campaign to promote child immu-
Health nization in a particular country, an effort to get
Before starting our review of global health in greater
© Jones & Bartlett Learning, LLCpeople in a city to use©seat belts &when
Jones they drive,
detail, it will beNOT helpful to defi e health,
FOR SALE OR DISTRIBUTION public and actions to get people
NOT FOR SALE ORtoDISTRIBUTION
in a specific setting eat
health, and global health. Most of us think of healthier foods and to stop smoking tobacco. In
“health” from our individual perspective as “not being addition, most levels of government also carry out
sick.” The World Health Organization (WHO), how- certain public health functions. These include the
ever, set out a broader defin tion of health in 1948 that management of public health clinics, the operation
is©still
Joneswidely&used:
Bartlett Learning, LLC © health
of public Joneslaboratories,
& Bartlettthe Learning,
inspection LLC
of public
eating establishments, and the maintenance of dis-
Health is a state of complete physical, men- ease surveillance systems. Other examples are shown
tal and social well-being and not merely the in TABLE 1-3.
absence of disease or infi mity.13 There are a number of guiding principles to the
Th s is the
© Jones & Bartlett defin tion ofLLC
Learning, practice of public
health used in this text. © Jones & Bartlett health that LLC
Learning, have been articulated, for
example, by the American Public Health Association
NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION15
in its public health code of ethics. These principles
Public Health focus on prevention of disease, respect for the rights
Although the WHO concept of health refers fi st to of individuals, and a commitment to developing pub-
individuals, this book is mostly about public health lic health efforts in conjunction with communities.
TABLE 1-3 Selected Examples of Public Health Activities
The promotion of handwashing
■■
The promotion
■■
© Jones of bicycle
& Bartlett and motorcycle
Learning, LLC helmets © Jones & Bartlett Learning, LLC
■■ The promotion of knowledge about HIV/AIDS
■■ Large-scale screening for diabetes and hypertension
■■ Large-scale screening of the eyesight of schoolchildren
■■ Mass dosing of children against worms
■■ The operation of a supplementary feeding program for poorly nourished young children
■■ The taxation of tobacco and alcohol

■■ The regulation of industrial pollution
■■ The regulation of food labeling
© Jones & Bartlett Learning,people Global &Health

They also highlight the need to pay particular atten-
LLC and communities © Jones Bartlett Learning, LLC
tion to disenfranchised
What exactly is global health? The U.S. Institute of Med-
NOT FOR
andSALE of evidence-based public health NOT FOR SALE OR DISTRIBUTION
OR DISTRIBUTION
the importance
icine defi ed global health as “health problems, issues,
interventions. In addition, they note the importance
and concerns that transcend national boundaries and
of taking account of a wide range of disciplines and
may best be addressed by cooperative actions.”18
appreciation for the values, beliefs, and cultures of
Another group defi ed what we would now call
diverse groups. Finally, ©they put considerable
Jones & Bartlettempha-
Learning, LLC © Jones & Bartlett Learning, LLC
global health as “the application of the principles of
sis on engaging in public health
NOT FORpractice
SALE in aOR
way DISTRIBUTION
that NOTand FOR SALEthatOR DISTRIBUTION
public health to health problems challenges
“enhances the physical and social environment” and
transcend national boundaries and to the complex
that builds on collaborations across public health sec-
array of global and local forces that affect them.”19
tors and actors.15
The discussion of the defin tion of global health
Many people confuse “public health” and “medi-
© Jones & Bartlett Learning, LLC has continued. Two groups
© Jones of distinguished
& Bartlett Learning, public
LLC
cine,” although they have quite different approaches.
NOT FOR SALE OR DISTRIBUTION health scholars
NOT and practitioners
FOR SALE offered
OR additional
DISTRIBUTION
TABLE 1-4 outlines these differences.16 To a large extent,
commentaries on this matter. One group suggested
the biggest difference between the medical approach
that we should defi e global health as follows:
and the public health approach is the focus in pub-
lic health on the health of populations rather than on An area for study, research, and practice
© Jonesthe&health of individuals.
Bartlett Learning,Exaggerating
LLC somewhat for © Jones that &places
Bartlett Learning,
a priority LLC health
on improving
NOT FOReffect,
SALEwe could
ORsay, for example, that a physician cares NOT FOR
DISTRIBUTION SALE OR DISTRIBUTION
and achieving equity in health for all people
for an individual patient whom he or she immunizes worldwide. Global health emphasizes trans-
against a particular disease, whereas a public health national health issues, determinants, and
specialist is likely to focus on how one ensures that solutions; involves many disciplines within
the whole community gets vaccinated. A physician and beyond the health sciences and promotes
will counsel an individual patient on the need to exer-
NOT FOR SALE OR interdisciplinary
DISTRIBUTION collaboration;
NOT and is SALE
FOR a syn- OR DISTRIBUTION
cise and avoid obesity; a public health specialist will thesis of population based prevention with
work with a program meant to help a community stay individual-level clinical care.20
suffici tly active to avoid obesity. In addition, there
are branches of public health, such as epidemiology, In response to this suggestion, however, another
that focus on studying patterns and
© Jones & Bartlett Learning, LLCcauses of disease panel suggested that one
© Jones should not
& Bartlett distinguish
Learning, LLC
in specific
NOTpopulations
FOR SALE andORtheDISTRIBUTION
application of this between globalNOThealth
FORand SALE
public health more broadly.
OR DISTRIBUTION
information to controlling health problems.17 Finally, They also suggested that the key principles of both
we should note the exceptional attention that public are the same: a focus on the public good, belief in a
health approaches pay to the prevention of health global perspective, a scientific and interdisciplin-
problems. ary approach, the need for multilevel approaches to
TABLE 1-4 Approaches of Public Health and Medicine
Differentiating Factors © Jones

Public Health
& Bartlett Learning, LLC Medicine © Jones & Bartlett Learning, LLC
Focus Population Individual
Ethical basis Public service Personal service
© Jones
Emphasis & Bartlett Learning,
Disease LLC
prevention and health promotion for © Jones & Bartlett
Disease diagnosis, Learning, LLC
treatment, and
NOT FOR SALE communities
OR DISTRIBUTION NOT FOR
care forSALE OR DISTRIBUTION
individuals
Interventions Broad spectrum that may target the environment, Emphasis on medical care
human behavior, lifestyle, and medical care
© Jones Modified
& Bartlett Learning,
with permission f om Harvard School LLC © Jones
of Public Health. (n.d.). About HSPH: Distinctions between public health & Bartlett
and medicine. RetrievedLearning, LLC
from http://www.hsph.harvard.edu/about
NOT FOR/public-health-medicine/
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Critical Global Health Concepts 9
interventions, and the need for comprehensive frame- the health of different communities. Some additional
© Jones & Bartlett © Jones & Bartlett Learning, LLC
works forLearning, LLC
health policies and fi ancing.21 global health issues are shown in TABLE 1-5.
NOT FOR SALEThe ORstudy
DISTRIBUTION NOT
and practice of global health today FOR SALE OR DISTRIBUTION
refl cts many of the above comments. Global health
implies a global perspective on public health problems. ▸▸ One Health and Planetary
It suggests issues that people face in common, such as
the impact of a growing
© Jones and &aging worldwide
Bartlett popula- LLC
Learning, Health © Jones & Bartlett Learning, LLC
tion on health or NOT
the potential
FOR SALErisks ofOR
climate change
DISTRIBUTION While this text focusesNOT FORhealth,
on global SALEit ORwill DISTRIBUTION
also
to health. The topic also relates in important ways to deal in a number of sections with the concept of “One
problems that require cooperative action. An import- Health.” The American Veterinary Medical Founda-
ant part of global health also covers the growing prob- tion defi ed One Health as follows:
lem everywhere of noncommunicable diseases, as well
as the “unfin shed agenda” of the health needs of the The©integrative
Jones &effortBartlett Learning,
of multiple LLC
disciplines
poor in low-income countries. In practical terms, as a NOT FOR SALE OR DISTRIBUTION
working locally, nationally, and globally to
new student to global health, it may be best not to worry attain optimal health for people, animals, and
much about the defin tion of global health, but rather the environment.22
to see the topic as an important part of public health,
Learners should note that the One Health
which itself
© Jones & Bartlett has many areas
Learning, LLC of critical importance. © Jones & Bartlett Learning, LLC
approach is getting increasing attention among those
NOT FOR SALESome examples of important global health con-
OR DISTRIBUTION NOT FOR SALE
working OR DISTRIBUTION
in global health.
cerns include the factors that contribute to women
A related concept is referred to as Planetary
dying of pregnancy-related causes in so many coun-
Health. A report of a commission of the Rockefeller
tries; the exceptional amount of undernutrition
Foundation and Th Lancet noted the following:
among young children, especially in South Asia and
Africa; and the burden of different communicable
Planetary health is the achievement of the high-
NOT FOR SALE OR
and noncommunicable diseases worldwide and whatDISTRIBUTION NOT FOR SALE OR DISTRIBUTION
est attainable standard of health, wellbeing, and
can be done to control those diseases. The impact of equity worldwide through judicious attention
the environment on health globally and the effects of to the human systems—political, economic,
natural disasters and confli ts are also important to and social—that shape the future of humanity
global
© Joneshealth.& The impactLearning,
Bartlett of climate change
LLC on health and©theJones
Earth’s&natural
Bartlett Learning,
systems that defi LLC
e the
isNOT
also FOR
becoming
SALE an OR
important global health con-
DISTRIBUTION safeNOT FOR SALE
environmental limitsOR DISTRIBUTION
within which human-
cern. Other signifi ant global health issues include ity can fl urish. Put simply, planetary health is
how countries can organize and manage their health the health of human civilisation and the state of
systems to enable the healthiest population possible the natural systems on which it depends.23
given the resources available, the search for new tech-
© Jones & Bartlett
nologies Learning, LLC global health problems,
to address important © Jones &ItBartlett Learning,
may be helpful to thinkLLC
of One Health as focus-
NOT FOR SALE
and howOR different
DISTRIBUTION NOT FOR
actors can work together to solve ing SALE OR DISTRIBUTION
on the interconnectedness of animal, human, and
health problems that no country or actor can solve environmental health; whereas Planetary Health has
on their own. Another global health matter of impor- a greater focus on the health of the environment and
tance is the relationship between globalization and the connections between that and human and animal
© Jones & Bartlett Learning, LLCwell-being. © Jones & Bartlett Learning, LLC
TABLE 1-5 Selected Additional Examples
of Global Health Issues
▸▸ Critical Global Health
Concepts
■■ Emerging and re-emerging infectious diseases
©■■Jones & Bartlett
Antimicrobial Learning, LLC
resistance © to
In order Jones & Bartlett
understand Learning,
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The determinants and social determinants of health
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■■ Environmental health focus on the “health–development link.” Thus, data
■■ Nutrition are organized wherever possible by the seven World
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■■ Reproductive & Bartlett Learning, LLC Bank regions:© Jones & Bartlett Learning, LLC
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■■ Communicable diseases ■■ Europe and Central Asia
■■ Noncommunicable diseases ■■ Latin America and the Caribbean
■■ Injuries ■■ Middle East and North Africa
■■ North America
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tion. Some of these concern confli ts, natural disasters,
and humanitarian emergencies. Others relate to the The World Bank regions are shown in FIGURE 1-2.
mechanisms by which different actors in global health As you consider data by World Bank region, it is
activities work together to solve global health prob-
© Jones & Bartlett Learning, LLC to remember that ©
important theJones
region &
that encom- Learning, LLC
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lems. Harnessing the power of science and technol- passes Europe contains a number of countries that
ogy for global health also requires cooperation. Many are not high-income, whereas the region of North
health issues require the action of agencies beyond America includes only high-income countries.
The World by Region

Classified according to World Bank analytical grouping
East Asia and Pacific Europe and Central Asia
Latin America and Caribbean Middle East and North Africa
North America South Asia

© Jones & Bartlett Learning, LLC Africa
Sub-Saharan © Jones & Bartlett Learning, LLC
FIGURE 1-2 World Bank Regions
Data from The World Bank. (n.d.). World Bank country and lending groups. Retrieved from https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
The Organization of Data in This Text 11
Some critical data are organized only by the ■■ Upper middle-income economies: GNI per cap-
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regions ofLearning,
WHO. WHO LLCregions cover all countries. ita between $3,896 and $12,055
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High-income economies: GNI per capita of
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Africa
■■
■■ The Americas TABLE 1-6 shows a representative sample of countries
■■ Southeast Asia organized by World Bank country income group.
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■■ Western Pacifi Th s information is drawn largely from the Global
Burden of Diseases, Injuries, and Risk Factors Study,
FIGURE 1-3 shows the WHO regions. 2016 (GBD 2016), which was prepared by the Institute
Th s text presents considerable
© Jones & Bartlett Learning, LLC data in terms of the of Health Metrics and
© Jones Evaluation
& Bartlett (IHME).25 LLC
Learning, Much of
income level of different countries. The World Bank clas- the data from that study is presented on the extensive
sifies countries into four income groups, based on esti- burden of disease website of the IHME.26 Findings of
mates of their gross national income (GNI) per capita: the study have also been published in a series of arti-
■■ Low-income economies cles in Th Lancet.27 Th s text will refer to the study and
■■ Lower middle-income economies all of its related parts as The Global Burden of Disease
© Jones & Bartlett Learning, LLC © Jones & Bartlett
Study 2016, GBD Learning, LLC
2016, or GBD.
■■ Upper middle-income economies
■■ High-income economies
The burden of disease data from the IHME study
are complemented as needed by data published by
For the World Bank’s 2019 fiscal year, country other organizations such as UNICEF, WHO, and the
income groups are defi ed as follows: World Bank. The data are also supplemented when
■■ Low-income © economies: GNI per capita of $995
Jones & Bartlett Learning, LLCnecessary by data from earlier © Jones burden of disease Learning,
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Africa Region Region of the Americas South-East Asia Region
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LLC Region Eastern Mediterranean
Region
Western Pacific Region
FIGURE 1-3 WHO Regions
Data from World Health Organization. (n.d.). WHO regional offices. Retrieved from http://www.who.int/about/regions/en/
© Jones TABLE
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1-6 World © Jones
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Bank Country & Bartlett Learning,
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Low-Income Lower Middle-Income Upper Middle-Income High-Income
Afghanistan Bangladesh Botswana Argentina

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▸▸ The Sustainable Development

© Jones & Bartlett Learning, LLC 1
No poverty
2
Zero hunger© JonesGood
&3health
and well-being
Goals
Th s text makes frequent reference to the 17 Sustain-
able Development Goals (SDGs). These were formu- 4
Quality education
5
Gender equality
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Clean water
lated by©the global&community
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2030 Agenda
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7 8 9
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Decent work
and economic
Industry,
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lennium Declaration.31 There were 8 MDGs and 15 core growth infrastructure
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Some of the SDGs have a very direct link with Reduced
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Sustainable cities
and communities
Responsible
consumption
and production
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Others have Learning,
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Climate action
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Life below water
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Life on land
■■ Goal 1: No poverty
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Partnerships
In addition, it is easy to see how all of the goals and strong
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the achievement of good health and well-being.
Most of the goals also have an associated set of spe-
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well-being for all at all ages—are shown in TABLE 1-7.

Case Study: Smallpox Eradication—The Most Famous Success Story 13
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TABLE Learning,
1-7 Targets forLLC © 3Jones & Bartlett Learning, LLC
Sustainable Development Goal
■■ By 2030, end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, and combat
hepatitis, waterborne diseases, and other communicable diseases.
■■ By 2030, reduce by one-third premature mortality from noncommunicable diseases through prevention and
treatment and promote mental health and well-being.
■■ Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use
of alcohol.
By 2020,&halve
©■■ Jones the number
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©traffic
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■■ By 2030, ensure universal access to sexual and reproductive healthcare services, including for family planning,
information and education, and the integration of reproductive health into national strategies and programs.
■■Achieve universal health coverage, including financial isk protection, access to quality essential healthcare
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■■ By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and
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■■ Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control
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workforce in developing countries, especially in least developed countries and small island developing states.
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▸▸ Case Study: Smallpox known to everyone who works in public health, and
it provides many lessons that can be applied to other
Eradication—The
© Jones Most
& Bartlett Learning, LLC public health
© Jonesefforts.
NOTFamous Success Story
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Background
It is fitting to end the main part of this introductory In 1966, smallpox ravaged over 50 countries, affect-
chapter with a summary of the most famous public ing 10 million to 15 million people, of whom almost
health success story of all: the case of smallpox eradica- 2 million died each year.32 At the time, smallpox killed
tion. Th s effort was not only a great triumph of public as many as 30 percent of those infected. Those who
NOT FOR SALE
healthOR but DISTRIBUTION
also a great accomplishment for humanity.NOT FOR SALEcould
survived OR DISTRIBUTION
suffer from deep-pitted scars and
In addition, the history of smallpox eradication is well blindness as a result of their illness.33
The
© Jones Intervention
& Bartlett Learning, LLC Costs and
© Jones BenefitLearning, LLC
& Bartlett
Although
NOT FOR SALEaORvaccine against smallpox was created NOT
DISTRIBUTION TheFOR
annual cost ofOR
SALE the DISTRIBUTION
eradication campaign between
by Edward Jenner in 1798, eradication of smallpox 1967 and 1979 was $23 million U.S. dollars (from here
became a practical goal only in the 1950s, when the on, the dollar sign will refer to U.S. dollars unless oth-
vaccine could be mass produced and stored without erwise stated). For the whole campaign, international
refrigeration. A later breakthrough came in the form donors provided $98 million, and $200 million came
of the bifurcated needle, a marvel of simple technol- from the endemic countries.31 The United States saves
NOT FOR SALE OR
ogy that dramatically reduced costs by allowing nee- the total of all its contributionsNOT
DISTRIBUTION every FOR
26 daysSALE
becauseOR it DISTRIBUTION
dles to be reused endlessly after sterilization and by no longer needs to spend money on vaccination or treat-
requiring a far smaller amount of vaccine per patient ment, making smallpox eradication one of the best-value
than had previously been the case. The needle also health accomplishments ever achieved.35 Estimates for
made vaccination
© Jones easy, thereby Learning,
& Bartlett reducing the LLC
time and © Jones & Bartlett Learning, LLC
effort required
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SALEvillagers
ORinDISTRIBUTION
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In 1959, WHO adopted a proposal to eradicate
smallpox through compulsory vaccination, but the
program languished until 1965, when the United
States stepped in with technical and fi ancial support.
A Smallpox Eradication Unit was established at WHO,
NOT FORheaded by Dr. D. A. Henderson of the Centers for Dis- NOT FOR SALE OR DISTRIBUTION
ease Control and Prevention (CDC) in the United
States. As part of the smallpox eradication program,
all WHO member countries were required to man-
age program funds effectively,
© Jones report smallpox Learning,
& Bartlett cases, LLC © Jones & Bartlett Learning, LLC
encourage research on NOT smallpox,
FOR and maintain
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bility in the implementation of the smallpox program
to suit local conditions.
The Smallpox Eradication Unit proved to be a
small but committed team, supplying vaccines and
specimen kits to those countries that still had small-
pox. Although wars and civil unrest caused disrup- NOT FOR SALE OR DISTRIBUTION
tions in the program’s progress, momentum was always
regained with new methods and extra resources that
focused on containing outbreaks by speedily seeking
© Jonesout& new cases Learning,
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new cases.
Th s military-style approach proved effective even
in the most difficult circumstances. It also took prac-
tical account of the facts that (1) it would have been
extraordinarily difficult© to Jones
immunize& the
whole world © Jones & Bartlett Learning, LLC
against smallpox, and NOT FOR
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the NOT FOR SALE OR DISTRIBUTION
smallpox virus could be stopped by focusing vaccina-
PHOTO 1-3 This photo shows the last person in the world
tion efforts around new cases. to have suffered from the natural transmission of variola
major, a 3-year-old girl in Bangladesh named Rahima
The Impact
© Jones & Bartlett Learning, LLC © Jones
Banu. This occurred in late&1975.
Bartlett
In 1977,Learning,
Ali Maow LLC
NOT FOR SALE OR DISTRIBUTION Maalin, a Somali,
NOT wasFOR
the last personOR
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DISTRIBUTION
In 1977, the last endemic case of smallpox in the world acquired smallpox caused by variola minor. Why was
was recorded in Somalia. In 1980, after additional sur- smallpox chosen for eradication? What factors were
veillance and searching, WHO declared smallpox the behind the success of the eradication effort? Are there
fi st disease in history to have been eradicated. Small- diseases today that are good candidates for eradication?
© Jonespox& had previously
Bartlett been eliminated
Learning, LLC in Latin America © JonesStanley O. Foster & Bartlett
M.D., M.P.H.,World Learning,
Health Organization/CDC. LLC
Centers for Disease
of smallpox. Retrieved from https://www.cdc.gov/smallpox/history/history.html
Control and Prevention. (2016). History
NOT FORin 1971

SALE andOR
in Asia in 1975.34
Central Messages of This Text 15
economic loss due to smallpox being endemic in a low- coverage could therefore disrupt transmission entirely.
© Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC
LLCare available only for India.
or middle-income country Unfortunately, almost 30 years after eradication, funds
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Based on these, it has been estimated that low- and FOR
are SALE OR DISTRIBUTION
still allocated to precautionary measures against
middle-income countries as a whole suffered economic the disease because of the continuing threat of small-
losses related to smallpox of about $1 billion each year pox being used as an agent of bioterrorism.
at the start of the intensifi d campaign.36
Lessons Learned
NOT FOR SALE OR DISTRIBUTION ▸▸ Central Messages of This Text
The success of the smallpox eradication program can Because this is the introductory chapter of the text, it
be attributed to the political commitment and lead- does not end with a summary, as the other chapters
ership exemplifi d in the Learning,
partnership between do. Rather, it is more valuable to end this chapter by
© Jones & Bartlett LLC WHO © Jones
highlighting some & of Bartlett
the centralLearning,
messages ofLLCthe text
and
NOT theFOR
U.S. Centers
SALEfor ORDisease Control and Preven-
tion. Success in individual countries hinged on having as a whole. They are listed without citations or rec-
someone who was responsible, preferably solely, for itation of the evidence behind them. That evidence
the eradication effort. In addition, small WHO teams is provided and cited in the chapters that follow. It is
made frequent fi ld trips to review progress, and a very important to keep these messages in mind while
© Jones & Bartlett Learning,
small number LLC people working in ©
of committed theJonesreading the restLearning,
& Bartlett of the text. LLC
NOT FOR SALE
programORwere
DISTRIBUTION NOT FOR
able to motivate large numbers of staff. ■■ SALE OR DISTRIBUTION
Most countries regard health as a human right.
Moreover, in the days before the internet and email, Toward this aim, they seek to achieve a system
the program managers held a monthly meeting in of universal health coverage. Th s is a package of
which they exchanged information about the progress health services linked to mechanisms to protect
of the campaign and the lessons
© Jones learned from
& Bartlett working LLC people from the costs
Learning, © of healthcare
Jones services.Learning,
& Bartlett Uni- LLC
on it in different countries. versal health coverage is well developed in most
No two national campaigns were alike, and flex - high-income countries. Most low-income coun-
bility was an essential asset in the design of this pro- tries do not yet have well-developed systems of
gram. The plan for eradicating smallpox used existing universal health coverage.
healthcare systems and enabled many countries to ■■ There are strong links among health, human
© Jones
improve & Bartlett
their Learning,
health services. LLC immu-
Th s benefited © Jones labor
development, & Bartlett Learning,
productivity, LLC
and economic
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more DISTRIBUTION
and also off et the NOT FOR SALE OR DISTRIBUTION
development.
cost of the initial smallpox campaign. ■■ Health status is determined by a variety of fac-
Monitoring standards were established across the tors, including age, culture, income, education,
program to constantly evaluate progress against agreed knowledge of healthy behaviors, social status, sex,
benchmarks. Community participation provided stra- genetic makeup, and access to health services.
tegic lessons for later community-based projects. The
The economic and social conditions under which
NOT FOR SALE
value OR DISTRIBUTION
of publicity was highlighted when news aboutNOT the FOR SALE ORasDISTRIBUTION
people live, well as government policies, also
program’s progress triggered large donations in 1974 to have an important influence on people’s health.
complete eradication in five remaining countries. An ■■ Given the wide range in the determinants of
important discovery made during the campaign was health, it is fundamental to think and act broadly
that immunization © programs
Jones &could vaccinate
Bartlett people LLC in health policy—in©some
Learning, respects
Jones more likeLearning,
& Bartlett a LLC
against more thanNOT one disease at a time. Th s helped
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pave the way for routine immunization. than how a minister of health would act.
The eradication of smallpox continues to inspire ■■ There has been enormous progress in improving
efforts against other diseases, but it must be remem- health status over the last 50 years in many coun-
bered that the particular features of smallpox made tries. Th s is refl cted in the substantial increases
it a prime candidate for eradication. The disease was
these countries have witnessed in that period, for
passed directly between people, without an interven- NOT FOR
example, SALE ORand
in life expectancy DISTRIBUTION
the substantial
ing carrier, so there were no reservoirs; the distinctive reductions in the deaths of children under 5 years
rash of smallpox made diagnosis easy; survivors gained of age.
lifetime immunity; and the severity of symptoms, once ■■ Some of this progress has come about as a result
the disease
© Jones & Bartlett became infectious,
Learning, LLC made patients take©toJones &ofBartlett
overall economic
Learning, development
LLC and improve-
their OR
NOT FOR SALE bedsDISTRIBUTION
and infect few others. Good vaccination NOT FOR SALE ments inOR income. However, much of it is due to
DISTRIBUTION
improvements in public hygiene, better water sup- number of examples, such as China, Costa Rica,
© Jones &ply
Bartlett Learning,
and sanitation, LLCeducation. Increased © Jones
and better
Cuba, Kerala state in India, and Sri Lanka, that
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clear that DISTRIBUTION
low-income countries or low-
improvements in health status. Technical progress income areas within countries can help their peo-
in some areas, such as the development and dis- ple achieve good health, even in the absence of
semination of vaccines against childhood diseases extensive fi ancial resources to do so. However,
and antibiotics, has ©also improved
Jones human health.
& Bartlett this requires strong political
Learning, LLC will and &
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Bartlett
■■ There are proven packages
NOT FORof investments
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FOR SALE but high-
OR DISTRIBUTION
address a range of issues related to neonatal, mater- yield investments in nutrition and health.
nal, and child health and communicable diseases. ■■ In this light, when considering health policy, one
However, they have not yet been taken to suffici t must always seek value for money and ask: “If we
scale in many low- and middle-income countries. only had $100 to spend, how should we spend it to
■■ There is an increasing amount of evidence about
achieve the maximum health for our people, at least
measures that can be taken, on a large scale, to NOT
cost, and in FOR
doable, SALE OR
sustainable, DISTRIBUTION
and fair ways?”
reduce the risk of and address noncommunicable ■■ The burden of disease is evolving in light of eco-
diseases in cost-effective ways. However, many nomic and social changes, aging populations, and
low- and middle-income countries are only now scientific nd technical progress, among other
© Jones & beginning
Bartlett to take steps to
Learning, reduce the burden of
LLC things.
© Jones The burdenLearning,
& Bartlett of disease isLLC
predominantly
noncommunicable
NOT FOR SALE diseases. Many high-income
OR DISTRIBUTION communicable,
NOT FOR SALE OR maternal, neonatal, and nutritional
DISTRIBUTION
countries have also failed to address these issues only in sub-Saharan Africa. In all other regions,
effectively at scale. the burden of disease is predominantly noncom-
■■ The progress in improving health status has municable. In the absence of new communicable
been very uneven. Hundreds of millions of disease threats of major importance, the burden of
© Jones
people, especially poor & low-
people in Bartlett
and Learning, LLC © Jones & Bartlett Learning, LLC
disease is expected to shift un versally toward non-
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middle-income countries, continue to get sick, DISTRIBUTION
communicable disease. Climate NOTchange
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could also
be disabled by, or die from preventable causes of have an important impact on health.
disease. In many countries, the nutritional status ■■ Some global health issues can be solved only
and health status of lower-income people have through the cooperation of various actors in
improved only slowly. In addition,
© Jones & Bartlett Learning, LLC HIV/AIDS global health. Th s could
© Jones include, Learning,
& Bartlett for example, LLC
caused
NOTa decline
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ORnutritional status,
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NOT FORof polio.
and life expectancy in a number of countries in ■■ An important part of health status is determined
sub-Saharan Africa and the former Soviet Union. by an individual’s and family’s own knowledge
■■ There are enormous disparities in health sta- of health and hygiene. People and communities
tus and access to health services both within have tremendous abilities to enhance their own
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across Learning, LLC people in most © Jones
countries. Wealthier & status.
health Bartlett Learning, LLC
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countriesOR DISTRIBUTION
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Nonetheless, OR DISTRIBUTION
circumstances, the quality
access to health services than poorer people. In of governance, and the level of government com-
general, urban dwellers and ethnic majorities mitment to equity all have an important bearing
enjoy better health status than rural people and on the health of a people.
disadvantaged ethnic minorities. In addition, ■■ The world is increasingly becoming intercon-
women face a number of unique challenges to nected at a rapid pace. For both security and
their health, as do lesbian, gay, bisexual, and humanitarian reasons, each of us should be con-
transgender (LGBT) people, prisoners, and cerned about the health of everyone else.
other marginalized people. ■■ Taking account of these points, we could say, in
■■ There are exceptional gaps in the quality of health many respects, that low-income countries should
© Jones
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everywhere, Learning,
but especially LLC
in low- and focus on © Jonesold
“burying & people,
Bartlett Learning,
instead of youngLLC
middle-income countries. Poor-quality health NOT FOR SALE OR DISTRIBUTION
people, making the transition as fast as possible,
services not only fail to achieve their aims but and doing so at least cost and in fair ways.”
they are also dangerous to people’s health. Major ■■ Taking account of these points, we could also
attention needs to be paid to ensuring that health say, in many respects, that the health goals for
© Jones & servces
Bartlettare Learning,
of appropriate quality.
LLC all countries
© Jones & Bartlett are to enable the LLC
Learning, maximum health
■■ Countries do not need to be high-income to for their people, in fairly distributed ways, at
enjoy good health status. By contrast, there are a least cost.
References 17
Study Questions
1. What are some
NOT FOR SALE OR DISTRIBUTION examples of important progress
NOT FOR What OR
7. SALE are some of the most important chal-
DISTRIBUTION
in improving health worldwide over the last lenges to health globally?
50 years? 8. Why should everyone be concerned about crit-
2. What are some of the global health challenges ical global health issues?
that remain to be addressed? 9. What are the Sustainable Development Goals,
3. How might one defi e health, public health, and how do they relate to health?
and global health? 10. What were some of NOT FORtoSALE
the keys OR DISTRIBUTION
the eradication
4. What are some examples of public health of smallpox? What lessons does the smallpox
activities? eradication program suggest for other global
5. What are some examples of global health issues? health programs?
6. Jones
© What are the key differences
& Bartlett Learning, between
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lic health?
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cases confirmed in Guinea, Mali and the Sudan. Retrieved /gb/bd/PDF/bd47/EN/constitution-en.pdf
from http://www.who.int/mediacentre/news/releases/2004 14. Merson, M. H., Black, R. E., & Mills, A. (2001). International
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/meningococcal/ 18. Institute of Medicine. (1998). America’s vital interest in
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Retrieved from http://www.who.int/mediacentre/factsheets and advancing our international interests. Washington, DC:
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7. International Diabetes Federation. (2017). IDF Diabetes 19. Merson, M. H., Black, R. E., & Mills, A. (2001). International
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health: Diseases, programs, systems, and policies
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(p. xix). Gaithersburg, MD: Aspen Publishers.
8. WorldAtlas.com. (2018). Countries with the highest rates 20. Koplan, J. P., Bond, T. C., Merson, M. H., Reddy, K. S.,
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/articles/countries-with-the-highest-rates-of-diabetes.html (2009). Towards a common defin tion of global health. Th
9. Statista. (n.d.). Countries with the highest prevalence of Lancet, 373(9679), 1993–1995.
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2017. Retrieved fromLearning,
https://www LLC21. Fried, L. P., Bentley, M.© E.,Jones & Burke,
Buekens, P., BartlettD. S., Learning,
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-number-of-diabetics/ public health. Th Lancet, 375(9714), 535–537.
10. World Health Organization. (2014). Dengue, countries 22. American Veterinary Medical Foundation (AVMA). (n.d.).
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© Jones & Bartlett Learning LLC. An Ascend Learning Company.

NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC

and the Health–

© Jones & Bartlett Learning, LLC

The Principles and

NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Discuss some examples of global health activities

■■ Describe some of the guiding principles of public health work

© Jones & ■■ Briefly

▸▸ Vignettes stronger than before. Getachew is one of about 1.2 mil-

4 Chapter 1 The Principles and Goals of Global Health

■■ Global life expectancy increased 37% from 1960 to 2016.1

■■ There were 44% fewer maternal deaths in 2015 than in 1990.4

© Jones & Bartlett Learning, LLC

Why Study Global Health? 5

of neonatal, maternal, and nutritional causes and of

■■ Almost half of all under-5 child deaths are related to malnutrition.1

■■ 1.8 million people became infected with HIV in 2017.4

■■ Approximately 1 billion people are infected with roundworm.6

©■■Jones & Bartlett

6 Chapter 1 The Principles and Goals of Global Health

Health, Public Health, and Global Health 7

■■ Mass dosing of children against worms

■■ The taxation of tobacco and alcohol

8 Chapter 1 The Principles and Goals of Global Health

© Jones & Bartlett Learning,people Global &Health

TABLE 1-4 Approaches of Public Health and Medicine

Differentiating Factors © Jones

Ethical basis Public service Personal service

Critical Global Health Concepts 9

■■ The increasing prevalence of diabetes and heart

10 Chapter 1 The Principles and Goals of Global Health

The World by Region

Latin America and Caribbean Middle East and North Africa

North America South Asia

The Organization of Data in This Text 11

Africa Region Region of the Americas South-East Asia Region

© Jones & Bartlett Learning, European

12 Chapter 1 The Principles and Goals of Global Health

Afghanistan Bangladesh Botswana Argentina

Mozambique Egypt South Africa Denmark

▸▸ The Sustainable Development

well-being for all at all ages—are shown in TABLE 1-7.

Case Study: Smallpox Eradication—The Most Famous Success Story 13

© Jones & Bartlett

© Jones & Bartlett Learning,

14 Chapter 1 The Principles and Goals of Global Health

NOT FORin 1971

Central Messages of This Text 15

16 Chapter 1 The Principles and Goals of Global Health

18 Chapter 1 The Principles and Goals of Global Health

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