Global Health

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

Migration is a reality of today’s world, with over 1 billion migrants worldwide. While many choose to move voluntarily, others are forced to migrate due to economic reasons or to flee war, conflict, or persecution. Such migrants often find themselves in precarious and marginalized situations. This is especially true of asylum seekers, refugees, and undocumented or irregular migrants. While often viewed as a single population, the legal status and entitlements of these three groups are distinct. Differences between these peoples affect access to health care with rights and entitlements varying across the 28 countries of the European Union as well as across different parts of national health systems. The lack of entitlement to receive care, including primary and secondary care, is a significant barrier for many asylum seekers and refugees and an even greater barrier for undocumented migrants. Other barriers include different health profiles and awareness of chronic disease risk among migrants, awareness of the organization of health systems in host countries, and language and communication. The use of professional interpreters can help to overcome communication barriers, but entitlement to free interpreting services is inconsistent. Host countries need to consider how to ensure that their health systems are “migrant-friendly.” Solutions include provision of professional interpreters; ensuring that health care staff are aware of migrants’ rights to health care access; increasing knowledge of migrants in relation to the organization of the health care system in their host country; and how to access care, for example, through the use of patient navigators. Perhaps the greatest facilitator for migrants’ improved health care access would be a reduction of the stigma that demonizes those who are forced to migrate due to political situations outside of their control.

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

The region of Latin America and the Caribbean (LAC) consists of 26 countries or territories that occupy a territory of 7,412,000 square miles, almost 13% of the Earth's land surface area, which extends from Mexico to Patagonia, where about 621 million people live (2015), distributed among different ethnic groups. Geographically, it is divided into Mexico and Central America, Caribbean and South America, but presents sub-regions with populations and cultures a little more homogenous, like the sub-regions of the Andes and the English Caribbean, for example. By its characteristics, LAC has acquired increasing global political and economic importance.

In the 1960s, integration processes began in the region, including UNASUR, Mercosur, the Andean Community, Caricom, the Central American System, ALBA, ACTO, SELA, ALADI, and finally, since 2010, the most comprehensive integrative organization, CELAC (Community of Latin American and Caribbean States).

While starting as a mechanism for political and economic integration, health is now an important component of all the integration processes mentioned, with growing social, political, and economic importance in each country and in the region, currently integrating the most important regional and global negotiations.

Joint protection against endemic diseases and epidemics, as well as non-communicable diseases, coordination of border health care, joint action on the international scene—particularly in multilateral organizations such as the United Nations and its main agencies—and the sectoral economic importance of health are among the main situations and initiatives related to “health diplomacy” in the aforementioned integration processes.

The greater or lesser effectiveness of integration actions—and health within those actions—varies according to the political orientations of the national governments in each conjuncture, amplifying or reducing the spectrum of activities performed. The complexity of both the present and future of this rich political process of regional health diplomacy is also quite important for global health governance.

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

There is one common health objective by all nations, as stated in the constitution of the World Health Organization of 1947: the progress toward the best feasible level of health for all people. This goal captures the concept of health equity: fair distribution of unequal health. However, 70 years later, this common global objective has never been measured. Most of the available literature focuses on measuring health inequalities, not inequities, and tends to concentrate on comparisons among population subgroups, specific health risks, diseases, or health services, thereby indirectly contributing to the high fragmentation of health policies, actions, and even constituencies and resulting in competition for funds and/or priority.

A method to identify standards for the best feasible levels of health through criteria of healthy, replicable, and sustainable (HRS) models is needed. The avoidable death toll has not improved significantly since the 1970s. Younger age groups (though gradually shifting toward older age groups) and women are most affected. Data analysis of smaller sample units (such as provinces, states, counties, or municipalities) increases the sensitivity of measurement and detects higher levels of health inequity.

Most of the burden of health inequity takes place in countries with levels of income per capita below the average of the HRS countries, which is called the “dignity threshold” (the economic condition threshold necessary to enjoy the best feasible levels of health). Based on this threshold, it is possible to estimate the necessary distribution of the world’s resources compatible with the universal right to health—“the equity curve.” Income above the upper thresholds, and hence wealth accumulation, prevents others from living in conditions of dignity compatible with the universal right to health, is correlated with a carbon footprint above the ethical sustainable threshold, and does not translate into better health nor well-being. The international redistribution of wealth required to enable all nations to have at least an average per capita income above the dignity threshold would be around 8%, much higher than the present, nonbinding, and volatile levels of international cooperation, which currently lack an equity approach.

At subnational levels, the burden of health inequity can be the most sensitive barometer of socioeconomic justice among territories and the population, informing and directing fiscal and territorial equity schemes to enable all people within and between nations to enjoy the universal right to health. HRS models can also inspire lifestyles, political, and economic frameworks that increase efficiency, replicability, and sustainability of ethical well-being without undermining the rights of others in present and future generations.

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

There is a broad consensus that the health of an individual or population is not influenced solely by the efforts of the formal health sector. Rather, it is also defined by the conditions of daily life as well as the inputs, intentional or not, of various stakeholders and policies. The recognition that health outcomes and inequity in health extend beyond the health sector across many social and governmental sectors has led to the emergence of a comprehensive policy perspective known as Health in All Policies (HiAP). Building on the key principles outlined in the Alma Ata Declaration (1978), the Ottawa Charter for Health (1986), the Final Report of the Commission on the Social Determinants of Health (2008), and the Rio Political Declaration on the Social Determinants of Health (2011), Health in All Policies is a collaborative approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. Given the breadth and ambition of the Health in All Policies approach, it has great potential to serve as a powerful mechanism for linking the goals, means, and priorities associated with health in numerous global agendas such as Universal Health, the Social Determinants of Health, and the Sustainable Development Goals (SDGs) of the 2030 Agenda.

Violence is a problem that accompanies the trajectory of humanity, but it presents itself in different ways in each society and throughout its historical development. Despite having different meanings according to the field of knowledge from which it is addressed and the institutions that tackle it, there are some common elements in the definition of this phenomenon. It is acknowledged as the intentional use of force and power by individuals, groups, classes, or countries to impose themselves on others, causing harm and limiting or denying rights. Its most frequent and visible forms include homicides, suicides, war, and terrorism, but violence is also articulated and manifested in less visible forms, such as gender violence, domestic violence, and enforced disappearances.

Although attention to the consequences of different forms of violence has always been part of health services, its formal and global inclusion in health sector policies and guidelines is very recent. It was only in 1996 that the World Health Organization acknowledged it as a priority in the health programs of all countries. Violence affects individual and collective health; causes deaths, injuries, and physical and mental trauma; decreases the quality of life; and impairs the well-being of people, communities, and nations. At the same time, violence poses problems for health researchers trying to understand the complexity of its causes, its dynamics, and the different ways of dealing with it. It also poses serious challenges to health systems and services for the care of victims and perpetrators and the formulation of interdisciplinary, multi-professional, inter-sectoral, and socially articulated confrontation and prevention policies and programs.