Notes on Overview of International Health and Development Definition and Context of International Health International health is a field with

a public health emphasis across regional or national boundaries. It seeks to (a) understand health problems in a global context; (b) compare factors that affect the health of people in resource-poor and transitional economies around the world; and (c) develop means of disease reduction and health protection and promotion in these populations.1 This is the context that serves as a framework for this course. International health is often referred to as global health. Many resource materials use the terms interchangeably while others are careful and technical about the terms. Gulis et al (2009) differentiate international health from transnational and global health:2 International Health emphasizes: public health issues across national boundaries; dwelling on population health and its main determinants. policy actors and policy issues: governments and intergovernmental organizations and relations among them. Transnational health emphasis: issues related to population health and its determinants within country blocs and among these country blocs. policy actors and policy issues: member of the bloc, non-governmental actors, including corporations, and their mutual relations and relations to governments and international governmental actors. Global health deals with impacts of globalization on population health and its determinants, surpassing the perspectives and consensus of individual nations and country blocs. As to policy actors and issues, the course is concerned with and includes intergovernmental as well as nonintergovernmental actors that may operate on all levels and be concerned with all cross border issues.

Birn, A; Pillay, Y and Holtz, T. (2009). Textbook of International Health: Global health in a dynamic world, 3rd ed. USA: Oxford University Press.
1

Gabriel, G; Jens-Jorgen, J; Peter, M. International, transnational, and global health: do they differ? Journal of Public Health Policy; 30, 2; ProQuest Health & Medical Complete. p. 253.
2

There are several key considerations in the practice of international health. Global health issues, taking into consideration the impact of climate and geography, economics, culture and politics are the focus of the discipline. However, the concern is beyond the distribution and control of the identified global health issues. This extends to the study of health systems, stakeholders and key players that support, influence and govern the health systems - at the level of health promotion, disease prevention and control, and delivery of services that address the treatment of the health issues.

The following are key considerations in international health include the following: 3 Global Health Problems Main groups of problems confronted by international health workers: 1) those related to the control of illnesses, injuries, and other threats to individual health; 2) 2) those related to the provision of medical care services to individuals, and public health services to communities and nations. The major diseases include: Communicable diseases like respiratory and intestinal infections, particularly in the very young; AIDS (acquired immunodeficiency syndrome) and other sexually transmitted diseases; malaria, schistosomiasis,and others caused by parasites prevalent in tropical regions; Non-communicable and chronic conditions such as diabetes; mental illnesses; disabilities resulting from occupational and environmental hazards; and diseases of the circulatory system, malignancies, dementias, and other conditions that are found mainly in the elderly. Global health concerns also include conditions resulting from demographic transitions of the different countries such as patterns of high fertility and high mortality rates have been or are being replaced by low fertility and low mortality rates. As economic conditions improve and people are living longer, the median age of populations increases and the global burden of ill health shifs slowly from infectious to chronic diseases. This change in the proportional causes of illness and death is known as the "epidemiologic transition." Climate and geography In addition to the direct effects of altitude, sun exposure, frostbite, drought, flood, and so on, climate and geography affect human health in many ways. Soils and waters may contain an excess or deficiency of iodine, iron, fluoride, arsenic, selenium, or other beneficial or harmful chemical elements. Temperature, humidity, and soil type have direct effects on many disease causing organisms, such as the larvae of hookworms and the eggs of other parasites. Temperature and humidity are also critical for transmission of diseases carried by vectors such as insects, mites, or ticks. For example, malaria parasites develop best in mosquitoes when the temperature is between 20 and 30 centigrade and the relative humidity is above 60 percent. Oceanic currents and temperatures are related to blooms of plankton that may harbor and disseminate the causative agent of cholera, leading to outbreaks on adjacent shores. The range of food crops and animals that can be grown and raised locally has a great influence on nutrition and well-being. In poor areas where people depend entirely on locally grown food, malnutrition and weight loss may occur on a seasonal basis. Economics, Culture and Politics The most important determinant of the level of health in any population is not the absence or existence of formal health services but the degree of economic development that allows for the availability, access and affordability of health services, health education included.
3

Basch, Paul F. (1999). Textbook of International Health, 2nd edition. New York: Oxford University Press.

The primary cause of ill health is poverty, which produces immense suffering and injustice, frustrates individual potential, and denies the benefits of poverty-stricken individuals' contributions to everyone else. Poorer people, on average, would be less healthy and do not live as long as wealthier people. Nonetheless there are also health hazards associated with high incomes include obesity, diseases of the elderly, and those resulting from environmental pollution and degradation. However, economic development permits advances in transportation and communication, water supply, electrification, refrigeration, and similar factors that have powerful effects on the level of well-being. Adequate economic and social conditions enable people to make choices about their profession, place of residence, and number of children. Education, particularly of girls and women, is of primary importance to understanding the principles of sanitation and nutrition and recognizing the role of preventive measures such as immunization. Tropical public health The concerns of international health workers are often centered on conditions more common in the warmer and economically disadvantaged regions sometimes known as the "third world", developing countries or resource-poor countries. The branch of public health that focuses on these issues is often known as tropical public health. Tropical countries typically have agriculturally based economies, relatively low employment and literacy rates, large numbers of children and youths, few elderly people, and lower life expectancies when compared to the industrialized countries. Because illnesses and deaths in these regions are more commonly caused by viruses, bacteria, and parasites (like pneumonias, tuberculosis and diarrheas), much of tropical public health is concerned with the control of these infectious agents, with maternal and child health, and similar topics. In addition, health concerns is these settings include nutritional problems like vitamin deficiency , protein energy malnutrition and deficiencies in micronutrients. Health and medical care systems The health sector in any country embraces two kinds of functions. First are the public health activities such as assuring safe water and food, vector control, reduction of environmental hazards, and collection of statistics. Second is the provision of preventive, curative, and rehabilitative medical services to individuals (i.e., medical care). Within the structure of every government is a health agency, usually a Ministry of Department of Health. The various levels of government (national, provincial, district, municipal) may each provide different kinds of services and operate health facilities. In spite of government efforts, the role of the private sector can not be overlooked. In many areas government-run health services are perceived to have lower quality that those provided by the private sector. Thus, many consult pharmacists, healers, or fee-forservice private practitioners, or alternative healers in the community. The provision of public welfare services also include medical insurance or other medical care benefits arising from workers compensation or retirement systems. Countries with poorer economies would have poor or no institutionalization of such services and benefits.

Reform of the Health Sector Dissatisfaction with the health sector is a common feature in all countries, whether wealthy or poor, centrally planned or free market. There is a widespread feeling that conventional health expenditures are not cost-effective, and alternative opinions about the public and private sectors are actively debated in many countries. Increasingly complex technology and greater prosperity have led to rising expectations for prevention and treatment of illnesses. Expanding and aging populations place greater demands on health establishments and may outstrip the capacity of local systems. Within a growing awareness of the importance of nongovernment health care providers, health insurance programs of various kinds are promoted to relieve government budgets while protecting households from large financial losses. Governments are encouraged to redefine their role as public sector institutions, trimming down the direct provision of medical care services in favor of setting goals, controlling finances, and managing growth and change in the entire health sector. These goals may be accomplished through regulation, licensing, and monitoring, as well as imposing fees, taxes, subsidies, and incentives. Another widely promoted feature of health sector reform is the decentralization of existing bureaucratic authority for planning, budgeting, and providing governmentsponsored health services. Many reform strategies allow for contracting of certain services to enhance the role of private providers in national health systems. Health and International Development Development involves a series of directed changes in many aspects of individual, community, and national life. Development is progressive; it is not development if regressive. Development refers not only to increasing financial and material resources, but also to aspects of modernization. These include the expansion of technologies that make everyday life more comfortable, productive, less hazardous, and the attitudes that are associated with them. Incorporating these changes into everyday life generally leads to increased receptivity to further change. On a national scale, development includes investment in agriculture, industries, factories, and infrastructure such as roads, dams, water supplies, and electric generation and communications systems. Investment in human potential through adequate educational opportunities, housing, employment, and health care is also important. Development Aid Projects Development projects are often targeted toward the health sector in the poorer countries. Such projects are often aimed at strengthening the capacity of health providers to plan, budget, manage, supervise, and evaluate services. Many projects support primary health care systems and infrastructure at community, regional, or national levels. Other projects involve training of health workers of various kinds, providing maternal and child health services including immunization and family planning, the supply of essential drugs, prevention and control of major diseases, and health education. International Agencies Early official international health activities began in Venice in 1348, when quarantine, a forty-day detention period for entering vessels, was introduced in an attempt to stop the

introduction of plague. With the growth of international commerce such blockades were increasingly viewed as obstacles to trade, an International Sanitary Conference was held in Paris in 1851, mainly to try to control the frequent epidemics of cholera in Europe. The first international nongovernmental agency, the International Red Cross, was founded in Switzerland in 1864 primarily to promote neutral humanitarian assistance to wounded combatants, has come to be known as the original Geneva Convention. Many conferences and congresses on health and other topics were held in the latter nineteenth century. In 1902 the First Pan American Sanitary Conference in Washington established the International Sanitary Bureau (later named the Pan American Sanitary Bureau) among the nations of the western hemisphere. In 1909 a formal international public health organization, L'Office Internationale d'Hygine Publique (OIHP) was established, called by English speakers the "Paris Office." The purpose of this office was to collect and disseminate information about public health with an emphasis on infectious diseases such as cholera, plague, and yellow fever. Outbreaks of diseases such as typhus during World War I and the great influenza epidemic of 1918 stimulated the formation of the Health Office of the League of Nations (LNHO). Several large international agencies established during and after World War II are important in international health. Discussed here are some components of the United Nations system, primarily the World Health Organization and the World Bank group. The charter of the United Nations (UN) was signed in San Francisco in 1945. The UN family includes many organizations that promote development and health. These include the UN Development Program, the UN Children's Fund (UNICEF), the UN Environment Program, the UN High Commission for Refugees, the World Food Program, the UN Centre for Human Settlements (Habitat), the International Labor Organization, the Food and Agriculture Organization, and the UN Educational, Scientific, and Cultural Organization (UNESCO). By far the most important UN agency for international health is the World Health Organization (WHO). World Health Organization The UN charter contained provision for a specialized health agency with wide powers. In 1946 the Constitution of the World Health Organization was written, and ratified by member states on April 7, 1948. The mission of the WHO is "the attainment by all peoples of the highest possible level of health." The work of the WHO is divided into two major categories. The first is central technical services such as information about the occurrence of diseases; international standardization of vaccines and pharmaceuticals; and the dissemination of knowledge through meetings and publications. The second is services to governments, at the request of member countries, usually in the form of specific projects for training, primary care, or specific disease control programs.

World Bank Group The great world depression of the 1930s followed by World War II caused many people to believe that increased international organization and regulation would be helpful in preventing monetary and military crises. In 1944 the U.S. government organized the United Nations Monetary and Financial Conference established the International Bank for Reconstruction and Development (IBRD), more commonly called the World Bank, the International Monetary Fund (IMF), and the World Trade Organization, which was not formally constituted until 1995. While not primarily health organizations, these agencies, particularly the World Bank, have had a profound influence on international health. The International Monetary Fund operates to stabilize monetary and fiscal policies and the liquidity and convertibility of currencies. Countries in financial difficulty may receive support from the IMF on the condition that they adopt certain policies to control inflation and assure international payments. Roles and functions of bilateral agencies and non-governmental organizations Bilateral agencies commonly provide two broad kinds of assistance: 1) for general economic development, including health projects such as control of malaria, services for mothers and children; or strengthening of health services; and 2) for humanitarian relief during periods of natural disaster or civil disturbance. In the United States this role is met by the U.S. Agency for International Development (USAID). Many development and humanitarian activities are also carried out by a very large number of nongovernmental or private voluntary organizations based in the wealthier countries and supported by religious or private groups, or donations from the public. Such nonprofit organizations often interact directly with local counterparts in the developing world. Some companies in the private sector provide services such as consulting, planning, implementing, or evaluating projects in the field, often funded by contracts from governmental bilateral agencies.