The Role of International Organizations in Shaping Global Health Policies; A Comparative Study of the Cases of Who and Global Fund
CHAPTER ONE
INTRODUCTION
Background to the Study
Global Health is becoming more and more well-known and important worldwide. First and foremost, the growth of international infectious diseases sparks a great lot of media and public interest, and it also influences faculty and academic programme research goals (Bozorgmehr, 2018). Global health has also grown to be a significant focus of charitable activity. Despite the prominence it has gained over the past 20 years, there is still no agreed-upon definition for the complicated collective phrase “Global Health” in use today. Development is dependent on global health. The unequal allocation of research resources and finances to the people facing the most serious health issues in the globe is a significant problem. Due to this disparity, significant efforts are being made to refocus research on health issues in low- and middle-income nations (Bozorgmehr, 2018).
The international community has made tremendous progress in creating global health goals over the past 20 years. International and regional organisations, primarily the United Nations and the Organization of American States (OAS), have taken steps to clearly outline the most urgent health-related needs in the developing world, global health standards, and a variety of policies intended to encourage countries to strive to reach basic health thresholds. Additionally, a wide range of public and private non-governmental organisations (NGOs) have stepped up to offer funding for a variety of health programmes, primarily in developing countries (Dry, 2020).
Today, humanity must overcome planetary-scale, unprecedented social, economic, and environmental issues. New infectious diseases are emerging and spreading, chronic, degenerative, and socio-behavioural pathologies are becoming more common, the right to health is frequently contested or denied, utilitarian approaches view human health as a factor of economic growth rather than a right in and of itself, and access to care is frequently restricted as part of macroeconomic interventions, including public spending (WHO, 2020). Inequities between the North and the South of the world are getting worse overall, and the terms “North” and “South” no longer have any geographic meaning. Instead, it symbolises the gap between the few in the many Norths, where riches and possibilities are concentrated, and the masses in the many Souths, where modernity has not been welcomed and where poverty and marginalisation are the norms. Also, these injustices increase health risks and dangers, which has serious consequences for sustainable development (WHO, 2020).
Health is now widely acknowledged as a crucial component of human rights advocacy, global security, efficient governance, and sustainable economic growth (Min, Zhao & Slivka, 2018). The fact that three of the eight Millennium Development Goals (MDGs) outlined in the year 2000 by the United Nations Millennium Declaration – “the blueprint agreed to by all the world’s countries and all the world’s leading development institutions” – were related to health targets (MDG 4: Reduce child mortality; MDG 5: Improve maternal health; MDG 6: Combat HIV) demonstrates the increased relevance of health in global development policies since the late 1990s.
The Agenda 2030 and its universal and indivisible 17 SDGs, which set forward a far bigger agenda for global development, were confirmed by the Sustainable Development Goals (SDGs) approved in 2015. (Vandemoortele, 2020). In addition, this shift in focus to health has led to an unprecedented increase in financial resources at the worldwide level earmarked for the growth of the health industry. This trend has somewhat reversed since 2013, with 2017 levels being comparable to those of 2012, however (UNDP, 2019).
The number of global health projects and public and commercial entities engaging in global health governance have both grown significantly over the past few decades, creating an extremely complicated situation. Even the World Health Organization’s (WHO) role as the “directing and coordinating authority” in worldwide health has been questioned by this. The actors who have traditionally played a role in the health sector are changing in terms of relative importance. Economic factors have a significant impact on national and international public policies, favouring the improvement of economic investment-friendly environments over the promotion of health and management of the factors that have a detrimental effect on population health and living conditions(Labonté & Gagnon, 2020). However, the discussion on the need to protect and promote health in global governance processes outside of the global health system has been sparked by a parallel increased focus on the importance of the social, economic, political, and environmental determinants of health that are influenced by decisions made in other global policy-making arenas (such as those governing international trade, the environment, and migration). The term “global governance for health” has been used to describe this strategy (Labonté & Gagnon, 2020).
Almost everything has been thrown into the “global” pot, often re-labelling as “global” issues and modalities defined by terms (such as international) that have previously proven to be more than adequate, based on the range of topics covered by the resources that are currently available on global health. This tendency has also been present in the health field, which has resulted in conceptual and empirical imprecision (Kickbusch, Silberschmidt & Buss, 2021).
Teaching “Global Health” also grew popular in line with this trend. Global health was emphasised in 2009 by The Lancet’s chief editor Richard Horton as a crucial component of universities’ educational, scientific, and moral missions (Yong et al.,2021). The concept of global health is being discussed more frequently in the media outside of the academic world. Institutions on the bilateral and international levels as well as private groups are placing more and more focus on it. New publications are devoted to this area of study, new generations of students and academics are drawn to the topic, and during the past ten or so years, the availability of courses in this emerging field has skyrocketed.
However, there is still much confusion about what global health entails and the topics covered in the courses that are offered there. For example, it has been suggested that the term “global health” is occasionally used to update previously existing courses in “international health,” “tropical medicine,” and other topics as a purely promotional measure (Stuckler & McKee, 2018). This is an intriguing conundrum since, as stated by Bozorgmehr (2018), “Social innovations are unlikely to evolve if ‘Global Health’ becomes or remains a cosmetic re-labelling of old patterns, objects, and interests”.
Health-financing reforms, universal health coverage, access to healthcare in rural areas, and other local or regional concerns are at the forefront of health policy in the majority of nations around the world as a result of the inherent difficulties that national health systems face. Yet, when a threat in the form of a potentially harmful infectious illness emerges, frequent public awareness of how global health has changed in the interim is raised (Davies, 2018). Cross-border, international, and increasingly global health issues get the attention of individuals in the Global North when lethal illnesses make the news. Although “killer viruses” and other epidemics have long been thought to be beaten or at least under control in high-income countries, a series of life-threatening situations brought on by them have grown more frequent in recent years.
With the emergence of dangerous infectious diseases like SARS (Severe Acute Respiratory Syndrome) in Southeast Asia in 2002, swine flu in the Northern Hemisphere winter of 2009–2010, MERS (Middle-East Respiratory Syndrome) in 2012, and avian influenza from 2013 onward, what started with the spread of the AIDS pandemic has further developed in an increasingly close time order. More than 11,000 people died as a result of the Ebola outbreak in Western Africa in 2014; the Eastern Democratic Republic of Congo outbreak five years later; the Zika virus in Brazil; and, most recently, the coronavirus pandemic that originated in the Chinese province of Wuhan and spread throughout the world (WHO, 2020).
This wave of continuously occurring epidemic outbreaks referred to as “health crises” frequently raises public awareness and makes headlines, especially in Europe and North America but also in South America and other developing countries of the world. Public interest in the health-related issues facing other nations and continents, however, is typically sporadic and fleeting. In the low- and middle-income nations of the Global South, particularly in Sub-Saharan Africa, where certain health risks still exist, that makes a significant difference. In low-income nations, particularly among the poorest populations, infectious diseases continue to be a serious health danger, and there is always a chance of developing endemic illnesses or even epidemics (Kickbusch, Cassar & Szabo, 2019).
But, today’s challenges for individuals and healthcare systems in underdeveloped nations go beyond infectious diseases. The disease spectrum is broadening as a result of the epidemiological change from infectious to chronic, non-communicable diseases. The majority of developing countries and countries in transition have been burdened by this previously dual burden of disease over the past few decades, which has been caused by bacterial, viral, or other pathogens on the one hand and health issues commonly referred to as chronic or civilisation diseases on the other (Schütte, 2018). The condition is made worse by the coexistence of dietary obesity, malnutrition, and undernourishment (Gouda et al., 2019).
Over the past 15 years, global health has grown to be one of the most crucial areas of foreign, development, and security policy, despite having minimal impact on national health policy debates within nations ( Sentes & Kipp, 2017). Political health and foreign policy texts typically use security as a contextual framework, and the securitization of health is regarded as a crucial aspect of public health governance (Alatas et al., 2020). The quick succession of endemic and epidemic outbreaks regarded as health emergencies has helped to create the securitization of global health, which is supported by several actors at the national and international levels who collaborate to target cross-border health concerns (Blakely et al., 2019). While global health tends to neglect and conceal long-term diseases like tuberculosis, the structural reasons for poor health and health inequities, acute epidemic breakouts are frequently perceived as a manifestation of globalisation (Gates, 2018). The growing international and political importance of global health necessitates more comprehensive governance strategies for national and regional institutions and mechanisms that are established to contribute to the governance of global health, as well as for institutions and processes of global governance that have a direct and indirect impact on health (global governance for health) (WHO, 2019).
Regardless of these ancillary topics, the concept of “Global Health” itself covers a wide range of topics like political perspectives, research, teaching, and clinical practice, and it aims to improve access to health care, the quality of the care provided, and the general health of people all over the world. In the sense of public health, global health includes both individual clinical care and prevention at the level of populations or individuals. The notion also entails looking at international contexts as well as the social, political, and economic determinants of health and coming up with solutions to current health issues, notwithstanding the complexity and heterogeneity of the definitions and parties involved. The understanding of Global Health ranges from health as an instrument of internal security and foreign policy to charitable philanthropies, public-private partnerships, general human rights and solidarity(Alvarado et al., 2020).
International health and global health have always been intimately connected to both the defence of national populations and business interests and goals. For instance, the US Institute of Medicine stressed the protection of citizens in the USA; they bluntly stated that four of the top ten pharmaceutical manufacturers worldwide control 40% of the global market and that the introduction of new drugs and vaccines in developing countries provides the pharmaceutical and vaccine industry in industrialised countries with good sales opportunities (Pickett & Wilkinson, 2020). Â The Federal Republic of Germany’s population protection and the nation’s export-oriented economy was given top priority by the German government in its first global health strategy (Hussain et al., 2020). Prioritizing neglected and poverty-driven diseases, the German Ministry of Education and Research is only slowly broadening the scope of issues in the context of Global Health Sciences (Cueto, 2018).
Statement of the Research Problem
The conditions and outcomes of globalisation, particularly the global dispersion of both infectious and non-infectious public health threats, have an increasing impact on the global burden of disease. In Sub-Saharan Africa, Asia, and South America, rural areas are where infectious diseases are most prevalent. Due to their disproportionate impact on the poorest populations and their contribution to a cycle of poverty due to lower productivity, these diseases are distributed differently in different regions (Adams et al., 2019). Although infectious diseases like malaria, tuberculosis, and HIV still account for the majority of diseases in the poorest parts of the Global South, these nations are also going through a rapid epidemiological transition that is marked by a change from disease-burden profiles that are dominated by communicable diseases and childhood illnesses to profiles that are increasingly dominated by chronic, non-communicable diseases and accidents (Aggleton & Parker, 2019).
Globalization’s frequently abrupt changes in daily living have had noticeable and palpable effects on health in almost every nation on the planet. For instance, the accelerated pace of daily life puts more individuals under pressure to succeed, causes stress, and exposes many people who are gainfully employed to significant direct and indirect risks. Urbanization and changing lifestyles, especially air pollution, bad nutrition, physical inactivity, smoking, and excessive alcohol use, are strongly linked to today’s rising health hazards in the Global South (Biruk, 2019).
The harmonisation of the disease spectrum on a global scale, which in many developing and emerging countries is associated with a double burden of disease due to the concurrent occurrence of infectious and non-communicable diseases, is a result of changes in working and living habits and their effects on physical, mental, and social health (Narayan et al., 2021). In contrast to middle- and low-income countries, the Global North is likely to experience different repercussions of globalisation. Despite this, a wealth of data indicates that social inequalities both within and between cultures have a significant impact on a population’s or demographic group’s level of health (Rabkin & El-Sadr, 2021). Moreover, there are regional and temporal variations in the relationship between socioeconomic status and health risk variables. Nonetheless, there are significant links between absolute economic poverty and important health factors such as child malnutrition, a lack of access to clean water and adequate sanitation, and exposure to indoor air pollution (Rabkin et al., 2020).
It is true that when highly contagious, serious infectious illnesses tend to spread over the world and pose a threat to the Global North, the growing importance of health issues and difficulties becomes particularly clear. The latest coronavirus epidemic has once again brought attention to how people see global health in terms of health crises. The so-called non-communicable or chronic diseases, which are typically linked to permanent or lifelong use of health services and the corresponding costs for affected persons and systems, are significantly more significant from an epidemiological point of view despite the public worries and anxiety that are frequently sparked by outbreaks of “killer viruses” that arouse associations with threatening scenarios leading to the extinction of mankind (Koplan et al., 2020). However, non-communicable illness financing globally is rather low and poorly coordinated, and many international stakeholders are urging increased efforts against uncommon diseases rather than against chronic non-communicable diseases (Gupta & Bukhman, 2021).
The objective of the Study
The main objective of this study is to investigate the role of international organizations in shaping global health policies. a comparative study of the cases of who and global fund. Specific objectives include to:
- Assess the impact of globalization on health and global health-related problems.
- Examine the effect of poverty on global health problems.
- Explore the impact of urbanization and lifestyle on global health problems.
- Investigate the effect of lack of access to basic social amenities on global health problems.
- Review global policies aimed at mitigating health-related problems.
Research Questions
The following research questions are investigated in this study:
- What is the impact of globalization on health and global health-related problems?
- What is the effect of poverty on global health problems?
- What is the impact of urbanization and lifestyle on global health problems?
- What is the effect of a lack of access to basic social amenities on global health problems?
- What are the global policies aimed at mitigating health-related problems?
Significance of the Study
Members of every society in the world should take this study seriously. The literature evaluated in this study will broaden society’s general understanding as well as that of students and academics studying health-related courses. This is due to the detailed assessment of recent literature on global factors causing diseases everywhere in the world. The study’s conclusions and suggestions will work as a roadmap for the implementation of global health policies that aim to drastically reduce or eradicate the majority of the causes of diseases around the world. Stakeholders in the health sector will benefit greatly from the study as well.
Scope of the Study
This study focused on the role of international organizations in shaping global health policies. a comparative study of the cases of who and global fund. The impact of globalisation, poverty, urbanisation, lifestyle and a lack of access to fundamental social amenities on world health issues is also included in the study. In this study, worldwide policies for reducing health-related issues were also examined.
Limitations of the Study
Several variables place restrictions on this research. Its quality and quantity were largely governed by the time allotted for completion. The concepts discussed were also strongly impacted by the absence of prior literature that addressed the topic of this thesis. Online and offline, there were no publicly available publications, articles, or past research works that were precisely following the stated aims of this study. All of these significantly influenced how much of the study was covered.
Definition of Terms
Poverty:Â not having enough money for basic expenses like housing, clothing, and food. Yet poverty goes far beyond simply not having enough money.
Lifestyle: an individual, group, or culture’s interests, beliefs, actions, and behavioural inclinations.
Urbanization: the migration of individuals from rural to urban regions, the consequent decline in the number of people living in rural areas, and the methods by which communities adjust to these changes.
Disease: a specific aberrant condition that adversely affects an organism’s structure or function on the whole or in part but is not immediately caused by external harm.
Health policy: decisions, strategies, and initiatives implemented in society to meet particular healthcare objectives.
References
- Bozorgmehr K.(2018). Rethinking the ‘global’ in global health: a dialectic approach. Globalization Health.;6:19.
- Dry, S.(2020).  Epidemics for all? Governing Health in a Global Age. Brighton: University of Sussex. https://www.episouth.org/doc/r_documents/Epidemics.pdf. Accessed 14 Aug 2019.
- WHO. (2020).: Making a Difference. The World Health Report 1999. Geneva: World Health Organization;Â https://www.who.int/whr/1999/en/whr99_ch2_en.pdf. Accessed 10 Dec 2019.
- Min J, Zhao Y, & Slivka L,(2018). The double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases. Obes Rev. ;19(1):49–61. doi: 10.1111/obr.12605.
- Vandemoortele J.(2020). SDGs: the tyranny of an acronym? Impakter 13. https://impakter.com/sdgs-tyranny-acronym. Accessed 28 Aug 2019.
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