Global Health
Global health addresses health challenges that transcend national boundaries, focusing on achieving health equity worldwide through tackling infectious diseases, non-communicable diseases, maternal and child health, and the social and commercial determinants of health.
Key Facts
Sustainable Development Goals (SDGs): 17 goals adopted by UN in 2015; SDG 3 = ensure healthy lives and promote well-being for all at all ages Global disease burden: non-communicable diseases (NCDs) now cause 74% of all deaths worldwide; infectious diseases remain dominant in low-income countries Leading causes of death globally: ischaemic heart disease, stroke, COPD, lower respiratory infections, neonatal conditions Maternal mortality: approximately 287,000 maternal deaths/year globally; 94% in low and lower-middle income countries Under-5 mortality: approximately 5 million deaths/year; leading causes are pneumonia, diarrhoea, malaria, neonatal complications Universal Health Coverage (UHC): ensuring all people have access to needed health services without financial hardship WHO is the lead UN agency for global health; coordinates International Health Regulations (IHR) Climate change, antimicrobial resistance, and pandemic preparedness are the three greatest global health threats of the 21st century
Overview
Key Facts
Global health is concerned with improving health and achieving health equity for all people worldwide. It addresses issues that transcend national borders and require international cooperation.
Global Disease Burden
- DALYs (Disability-Adjusted Life Years): composite measure of years of life lost + years lived with disability
- Top 5 DALY causes globally: neonatal conditions, ischaemic heart disease, stroke, lower respiratory infections, diarrhoeal diseases
- Epidemiological transition: shift from infectious disease to NCD dominance as countries develop
- Double burden of disease: many LMIC face both infectious diseases and rising NCDs simultaneously
Sustainable Development Goals (SDGs) Health Targets (SDG 3)
- Reduce maternal mortality to <70 per 100,000 live births by 2030
- End preventable deaths of newborns and children under 5
- End epidemics of AIDS, TB, malaria, and neglected tropical diseases
- Reduce premature NCD mortality by one-third
- Achieve universal health coverage
- Ensure access to sexual and reproductive healthcare
- Strengthen capacity for health risk warning and management
Key Global Health Organisations
- WHO: coordination, standard-setting, technical support, IHR
- World Bank: health financing, development loans
- GAVI: vaccine alliance; immunisation in LMICs
- Global Fund: financing for HIV, TB, malaria
- MSF (Doctors Without Borders): medical humanitarian organisation
- DFID/FCDO: UK international development
Clinical Presentation
Major Global Health Challenges
Infectious diseases:
- HIV/AIDS: 38 million living with HIV; 650,000 deaths/year; UNAIDS 95-95-95 targets
- Tuberculosis: 10 million new cases/year; 1.5 million deaths; MDR-TB growing threat
- Malaria: 240 million cases/year; 620,000 deaths; mostly children <5 in sub-Saharan Africa
- Neglected tropical diseases (NTDs): affect >1 billion people
Non-communicable diseases:
- CVD, cancer, diabetes, chronic respiratory disease — rising rapidly in LMICs
- Tobacco: 8 million deaths/year globally
- Alcohol: 3 million deaths/year globally
- Obesity: tripled since 1975; 1.9 billion overweight adults
Maternal and child health:
- Maternal mortality ratio: 223 per 100,000 globally (vs 10 per 100,000 in UK)
- Neonatal mortality: 2.3 million deaths/year in first 28 days
- Child malnutrition: underlying cause in 45% of under-5 deaths
Emerging threats:
- Pandemic preparedness (COVID-19 highlighted weaknesses)
- Antimicrobial resistance (predicted 10 million deaths/year by 2050 without action)
- Climate change (heat stress, vector-borne disease, food insecurity, displacement)
Differential Diagnosis
| Health Indicator | High-Income Countries | Low-Income Countries |
|---|---|---|
| Life expectancy | ~80 years | ~63 years |
| Maternal mortality ratio | <15/100,000 | >400/100,000 |
| Under-5 mortality | <6/1,000 | >60/1,000 |
| Leading cause of death | CVD, cancer | Infectious disease, neonatal |
| Health spending per capita | >$3,000 | <$50 |
| Physicians per 1,000 | >3.0 | <0.1 |
Diagnosis / Investigation
Measuring Global Health
- DALYs: years of healthy life lost (YLL + YLD)
- QALY (Quality-Adjusted Life Year): measure of health gain for economic evaluation
- Maternal mortality ratio: maternal deaths per 100,000 live births
- Under-5 mortality rate: deaths per 1,000 live births
- Healthy life expectancy (HALE): years lived in full health
- Global Burden of Disease Study (IHME): comprehensive data on disease burden by country
Key Data Sources
- WHO Global Health Observatory
- IHME Global Burden of Disease
- UNICEF State of the World's Children
- World Bank development indicators
- Lancet commissions and series
Management
Global Health Strategies
Infectious disease control:
- GAVI vaccination programmes (>1 billion children vaccinated since 2000)
- Global Fund programmes for HIV (antiretroviral scale-up), TB (DOTS strategy), malaria (bed nets, ACTs)
- WHO elimination targets for NTDs
NCD prevention:
- WHO Framework Convention on Tobacco Control (FCTC)
- WHO 'Best Buys': cost-effective NCD interventions (tobacco taxation, salt reduction, alcohol pricing, HPV vaccination)
- HEARTS package for CVD management in primary care
Health systems strengthening:
- Universal Health Coverage (UHC) as overarching goal
- Primary healthcare as foundation (Astana Declaration 2018)
- Health workforce development
- Essential medicines list (WHO EML)
- Health financing reform
UK contributions:
- FCDO global health programmes
- UK participation in WHO, GAVI, Global Fund
- NHS Global Health Exchange Programme
- Research: major UK contribution to global health research (LSHTM, Oxford, Edinburgh)
GP Relevance
- Understanding migrant and refugee health needs
- Recognising tropical diseases in returning travellers
- Cultural competence in diverse UK populations
- Awareness of global health determinants affecting local communities
- Ethical considerations in global health partnerships
Prognosis
- Global under-5 mortality has decreased by 60% since 1990 (12.7 million to 5 million deaths/year)
- Maternal mortality has decreased by 34% since 2000
- HIV-related deaths have decreased by 68% since peak in 2004
- Malaria mortality has decreased by 60% since 2000
- However, progress is uneven; COVID-19 reversed gains in many areas
- AMR threatens to undo progress in infectious disease control
- Climate change will increasingly impact health systems globally
- SDG health targets are unlikely to be fully met by 2030 at current trajectory
Other Relevant Information
Millennium Development Goals vs Sustainable Development Goals
| Feature | MDGs (2000-2015) | SDGs (2015-2030) |
|---|---|---|
| Number | 8 goals | 17 goals |
| Focus | Developing countries | Universal (all countries) |
| Health goals | Child mortality, maternal health, HIV/TB/malaria | Broader: NCDs, UHC, mental health |
| Scope | Poverty and basic needs | Broader: inequality, climate, institutions |
WHO Essential Medicines List
| Category | Examples |
|---|---|
| Analgesics | Paracetamol, morphine, ibuprofen |
| Antibiotics | Amoxicillin, metronidazole, ciprofloxacin |
| Antimalarials | Artemisinin-based combinations (ACTs) |
| Antiretrovirals | Tenofovir, lamivudine, dolutegravir |
| Cardiovascular | Enalapril, amlodipine, atorvastatin |
| Insulin | Short and intermediate acting |