Abstract
BackgroundCurrent definitions of 'global health' lack specificity about the term 'global'. This debate presents and discusses existing definitions of 'global health' and a common problem inherent therein. It aims to provide a way forward towards an understanding of 'global health' while avoiding redundancy. The attention is concentrated on the dialectics of different concepts of 'global' in their application to malnutrition; HIV, tuberculosis & malaria; and maternal mortality. Further attention is payed to normative objectives attached to 'global health' definitions and to paradoxes involved in attempts to define the field.DiscussionThe manuscript identifies denotations of 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic'. A fourth concept of 'global' as 'supraterritorial' is presented and defined as 'links between the social determinants of health anywhere in the world'. The rhetorical power of the denotations impacts considerably on the object of 'global health', exemplified in the context of malnutrition; HIV, tuberculosis & malaria; and maternal mortality. The 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic' house contradictions which can be overcome by the fourth concept of 'global' as 'supraterritorial'. The 'global-local-relationship' inherent in the proposed concept coheres with influential anthropological and sociological views despite the use of different terminology. At the same time, it may be assembled with other views on 'global' or amend apparently conflicting ones. The author argues for detaching normative objectives from 'global health' definitions to avoid so called 'entanglement-problems'. Instead, it is argued that the proposed concept constitutes an un-euphemistical approach to describe the inherently politicised field of 'global health'.SummaryWhile global-as-worldwide and global-as-transcending-national-boundaries are misleading and produce redundancy with public and international health, global-as-supraterritorial provides 'new' objects for research, education and practice while avoiding redundancy. Linked with 'health' as a human right, this concept preserves the rhetorical power of the term 'global health' for more innovative forms of study, research and practice. The dialectic approach reveals that the contradictions involved in the different notions of the term 'global' are only of apparent nature and not exclusive, but have to be seen as complementary to each other if expected to be useful in the final step.
Highlights
Dialectics: A Controversy-Oriented Approach to the Theory of Knowledge New York: State University of New York Press; 1977, xiii.5
Linked with ‘health’ as a human right, this concept preserves the rhetorical power of the term ‘global health’ for more innovative forms of study, research and practice
‘global health’ as ‘an area for study, research, and practice’ is blurred with ‘study, research and practice’ in the fields of international or public health. This conflict is reflected by the recent reaction of representatives of the ‘public health’ community, who promptly proclaimed in The Lancet that ‘global health is public health’, disagreeing with the attempt to distinguish between the fields
Summary
The ‘health’ in global health Since health is understood as physical, mental and social wellbeing and not merely as the absence of disease [5], it is clear that ‘global health’ does not mean ‘the absence of disease worldwide’. To apply the proposed terminology: decisions, made on Ginsburg and Rapp’s ‘small-scale arenas’, on ‘the local’ [41] or on the ‘territorial’ [20] must not necessarily, but can influence people’s social determinants of health anywhere in the world In this case, the decisions themselves, the particular processes, institutions, agencies, legal frameworks and channels through which they are translated, realised, established or imposed constitute the supraterritorial link and the ‘global’ in ‘global health’. The above-described social sphere of global-as-supraterritorial seems to be quite ‘distant’ at the first glance for health professionals (Figure 1), this is not the case after closer scrutiny: there is an international (read: interterritorial) spread of local (read: territorial) efforts and initiatives to increase ‘access to essential medicines’ across Asia, Africa, Australia and Europe, as, for example, reflected by the many chapters of the Universities Allied for Essential Medicines [46] Their actions can influence the ‘supraterritorial’ aspect of the determinant ‘access to essential medicines’ by framing ‘knowledge’ as a global (read: universal) public good.
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