User:LGreg/sandbox/Approaches to Knowledge (LG seminar 2020/21)/Seminar 18/History/History of Global Health

Defining global health
Global health lies at the convergence of many fields such as medicine, epidemiology, economics, demography, and international relations. As cited by Beaglehole et al., it is defined by Macfarlane et al. as the ‘worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders'.

Origins
Formal international health cooperation, whilst not yet termed 'global health', first began in the mid-nineteenth century, in the form of the fourteen International Sanitary Conferences, which took place between 1851 and 1938, with the objective of regulating the length of quarantine periods for diseases across different countries.

However, whilst in practice what might now be regarded a constituent of global health was prevalent beforehand, conceptually, global health only emerged when the term first began to be used in scientific literature in the late 1940s, during the immediate aftermath of the Second World War (which had drastically affected the health of citizens around the world). This was a period characterised by the onset of a changing socio-political landscape, whereby scientific developments flourished, and states adopted a more internationalist and multilateral outlook. This, furthered by increasing globalisation and the easier proliferation of knowledge worldwide, led to nations being more invested in developing solutions to scientific issues collaboratively.

Development as a discipline
The consolidation of global health as a discipline occurred following the inception of the World Health Organisation in 1948 - the first international governing body to institutionalise and specialise on the growing movement (whilst the OIHP and the health organisation of the League of Nations, formed in 1914, also dealt with improving the control of diseases, they were not formed in response to the emergence of global health as a discipline). The year 1995 also denotes a pivotal moment in the history of global health, as it signifies the start of the dramatic increase in searches on PubMed using the term. Subsequently, other organisational frameworks have also arisen to further formalise the area, and provide a network for contributors to engage with each other and advance the field, including academic journals such as The Lancet Global Health, founded in 2013, and now many universities, such as University College London, the University of Oxford, and Harvard University offer professional certifications on the field.

Whilst often still conflated with the two, global health distinguishes itself from both public and international health given its specialised object of research, which focuses on health related issues that can only be solved by the implementation of strategies on a global scale (as implied by its name). Public health, on the other hand, solely works at a national level, whilst international health focuses on binational partnerships to aid low and middle-income countries. Indeed, it has even been contested by Jose Miguel DeAngulo and Luz Stella Losada that global health is gradually replacing international health all together and thus signalling a paradigm shift in health governance and management. Moreover, global health is further distinct in that one of its primary objectives is to achieve health equity for all citizens around the world.

Global health research
A crucial component of global health's methodology is that, in order to be considered part of the discipline, studies must be either one of two types of global health research (GHR). Type 1 GHR includes studies collating data from a broad range of locations and ethnic populations, whilst Type 2 GHR involves studies with a global framework and consideration, but with data limited to only one small region.

Contributors to the field, notably Craig Stephen, have now also suggested the identification of four key competencies required by global health researchers. These entail: collaborative skills, systems-based thinking (as opposed to a linear approach), the ability to lead and manage a project, and 'ethical and personal perspectives'. Stephen further highlights six common themes prevalent in the GHR practices of the fourteen teams he studied - to include: excellence in research, an emphasis on long-term research goals, a priority on implementing strategies, the formation of partnerships between different agencies around the world, an 'ethical foundation', and the presence of skilled researchers - which he presents as being integral to the discipline as a whole.

Future of the discipline
Despite its relative brevity as a discipline, conflicts have already arisen in global health regarding the extent to which it reflects neocolonialist attitudes. The current paradigm of global health, argued by Rafael Pérez-Escamilla, is inherently racist given its assumption that low-income countries are unable to implement solutions without the assistance of Western powers. On a similar vein, Büyüm et al. contest that historical ideas, such as slavery and racism, perpetuate modern-day inequalities and silences within the discipline (evidenced by the 10/90 gap and the fact that most global health networks are based in the Northern Hemisphere), and that without addressing these factors and other underlying social determinants of health, health equity cannot truly be achieved. These sentiments have led to players in the discipline calling for a paradigmatic shift from the so-called 'charity model of global health' to one based upon principles of justice.

Furthermore, whilst historically to date global health has always incorporated aspects of foreign policy and international affairs, in terms of aid distribution and multinational agreements, a new (sub-)discipline of global health diplomacy is currently evolving, which has the potential to break free and distinguish itself as a separate entity in its own right. Thus, the future of global health as a discipline remains open to significant change.