History Of Global Health Research Articles

The Pandemic Arc: Expanded Narratives in the History of Global Health.

Using the examples of plague, smallpox, and HIV/AIDS, the present essay argues for the benefits of incorporating the evolutionary histories of pathogens, beyond visible epidemic spikes within human populations, into our understanding of what pandemics actually are as epidemiological phenomena. The pandemic arc - which takes the pathogen as the defining "actor" in a pandemic, from emergence to local proliferation to globalization - offers a framework capable of bringing together disparate aspects not only of the manifestations of disease but also of human involvement in the pandemic process. Pathogens may differ, but there are common patterns in disease emergence and proliferation that distinguish those diseases that become pandemic, dispersed through human communities regionally or globally. The same methods of genomic analysis that allow tracking the evolutionary development of a modern pathogen such as SARS-CoV-2 also allow us to trace pandemics into the past. Reconstruction of these pandemic arcs brings new elements of these stories into view, recovering the experiences of regions and populations hitherto overlooked by Eurocentric narratives. This expanded global history of infectious diseases, in turn, lays a groundwork for reconceiving what ambitions a truly global health might aim for.

Examining Opportunities Offered Outside of Home Country in Physical Therapy Education: Considering the Colonial History of Global Health.

Increasingly, PT programs in the United States are providing educational experiences outside of the home country (OHC) where faculty and students engage in global health initiatives. It is important to consider that the field of global health has its historical roots in colonialism, which has led to inequities and injustice. Those who are engaged in this work must assist in reversing this colonial legacy. The purpose of this position paper is to present the colonial history of global health, to provide context, and to spark critical reflection among PT educators about how OHC experiences are developed and configured. As a profession, we must educate ourselves about the history of global health and critically reflect on OHC engagements to ensure that we support equity and justice. We must start by grounding our OHC experiences in health equity and justice. This should be done by considering the colonial history of global health and the privileges we hold as members of academic institutions in the United States. Why we offer OHC experiences in PT education should be investigated and clear to both faculty and students. Excluding this colonial history and its impacts risks perpetuating the historical harms to the health and well-being of the populations we claim to be serving.

Missing pieces: Integrating the socialist world in global health history

AbstractThis essay provides an overview of recent histories of medicine and global health from a socialist perspective, and maps out possible new directions of research. It focuses on key themes in the history of medicine in Eastern Europe, its global connections and Latin American, East Asian and African contexts. Through a discussion of international professional and diplomatic networks, health systems, medical technologies and aid and technical assistance, the essay argues that integrating missing actors, ideas and practices is crucial for a complete understanding of global health history.

Global Medicine in China: A Diasporic History by Wayne Soon

Reviewed by: Global Medicine in China: A Diasporic History by Wayne Soon Rachel Core Wayne Soon. Global Medicine in China: A Diasporic History. Stanford, Calif.: Stanford University Press, 2020. ix + 312 pp. Ill. $30.00 (978-1-5036-1400-0). Before the outbreak of the COVID-19 pandemic fixated the attention of armchair epidemiologists on China’s contributions to global health, scholars had begun to recenter China’s importance within global health histories.1 Wayne Soon’s recent volume contributes to this literature by highlighting the role of overseas Chinese—both within Asia and globally—in building biomedical care, education, [End Page 167] and institutions in Mainland China and Taiwan, especially during the 1937–45 war and postwar years. In particular, the book weaves together the contributions of three ethnic Chinese from Singapore and Malaysia. First, Wu Lien-teh, a Cambridge-educated physician from Penang, became a central figure in controlling the 1910–11 Manchurian Plague outbreak. Following the outbreak, Wu established the North Manchurian Plague Prevention Service and convened an International Plague Conference, which brought foreign financial support for disease control. Second, the book examines the unsuccessful attempts of Lim Boon Keng to create a medical school at Xiamen University. Finally, most of the book focuses on Lim Boon Keng’s son, Robert Lim, who like his father, was born in Singapore and educated in Edinburgh. Robert Lim took lessons from his father’s experience, helped to diversify the Peking Union Medical College, and built successful biomedical institutions including: the Chinese Red Cross Medical Relief Corps (CRCMRC), blood banks, an Emergency Medical Services Training School (EMSTS), and the National Defense Medical Center (NDMC). While elites championed urban biomedical institutions in prewar China, Chapter 2 details how with financial and voluntary support from overseas Chinese, the CRCMRC adapted to local conditions in 1937–45 China. Specifically, Robert Lim led efforts to develop mobile medical units, which prioritized preventive medical interventions. Because “most soldiers suffered from diseases, rather than wounds,” the CRCMRC emphasized immunization, delousing to reduce scabies and relapsing fever, and improved nutrition (p. 63). As described in Chapter 3, Robert Lim used the priority of improved nutrition to incentivize donations to blood banks. Originally, few Chinese supported blood donation, believing it “would deplete their vitality”; however, Lim’s team offer of eggs and soymilk changed the calculus for would-be donors in wartime China (p. 96). In May 1938, Lim founded the EMSTS, which responded to the urgent need for medical providers by training military personnel in a three-month course. As Chapter 4 argues, the Chinese Communist Party would build upon the precedent of providing practical medical education after 1949; however, Robert Lim hoped the schools where the medics received basic training would evolve “to become comprehensive medical centers,” providing a six-year training course (p. 132). On this point, the leader of the United China Relief (UCR), a United States–based organization that funded the EMSTS, lambasted Lim, claiming that this aspiration was impractical. The exchange between Lim and URC illustrated the precariousness of relying on overseas donors, yet Lim was eventually able to build a more comprehensive medical training program. The final chapter illustrates how the NDMC—which had both vocational and academic tracks—was built in Shanghai after the war, and moved to Taiwan in 1948. This meticulous study is based upon research in more than twenty archives and libraries on three continents. In addition to re-centering the role of the Chinese diaspora in global health history, Soon follows both monetary donations and disagreements about how to best develop biomedicine across boundaries, both geopolitical and temporal. The book crosses the Taiwan Strait to examine Taiwan’s successful blood donation program and universal health care system as [End Page 168] legacies Robert Lim’s vision. The account also spans the 1949-divide in Mainland China, contributing to the growing body of scholarship highlighting continuities in medical care provision in the 1950s and beyond.2 Soon’s claim that the Chinese Communist Party “fostered a sense of wartime urgency,” allowing for biomedical expansion deserves explication in future scholarship, but his own contribution on the importance of wartime institutions to the development of biomedicine in China is...

War Against Smallpox: Edward Jenner and the Global Spread of Vaccination by Michael Bennett

Reviewed by: War Against Smallpox: Edward Jenner and the Global Spread of Vaccination by Michael Bennett Niels Brimnes Michael Bennett. War Against Smallpox: Edward Jenner and the Global Spread of Vaccination. Cambridge: Cambridge University Press, 2020. xii + 424 pp. Ill. $39.99 (978-0-521-14788-0). Scholars writing global health history today tend to be careful to avoid narratives that are either triumphalist, Eurocentric or both. If Michael Bennett shares these concerns—and I believe he does— he has given himself a significant challenge: writing a much-needed and comprehensive account of the global spread of vaccination against smallpox. This episode in the history of global health obviously invites the employment of both these “vices.” The vaccination-based eradication of smallpox represents, after all, a much-celebrated triumph of medical knowledge, and the practice undeniably began in Gloucestershire before it spread to the wider world. It seems impossible to write about vaccination without reference to at least elements of heroic benevolence and allusions to the blessings of “Western” medical science. The challenge is augmented by Bennett’s decision to end his narrative in 1815, which he understands as the end of the “heroic phase in the history of vaccination” (p. 352). Had he ventured further into the nineteenth century, it would have been easier to emphasize the setbacks and complexities that characterized the nineteenth-century career of vaccination. As it stands, Bennett’s book describes an effort deeply entangled with both the Napoleonic Wars and structures of colonialism. Bennett suggests that benevolent science triumphed over strife and war and often overcame racialized [End Page 269] barriers through a willingness to share the vaccine between bodies of different skin color. The account also contains outright heroic episodes, such as Jose Salvany’s “gruelling journey across the high Andes . . . [s]pitting blood from a raging tubercular infection” (p. 312). While Bennett identifies vaccination campaigns as imperial projects—in Napoleonic Europe as well as in British India—he also warns against making simplistic connections between vaccination and empire. In India, he asserts, its introduction “was driven by the same sorts of impulses, hopes and fears, visions of improvement and humanitarian concern evident in Britain and elsewhere” (p. 245). These elements are complemented by numerous references to failures, as well as widespread hesitancy and opposition toward new prophylaxis from both medical men and the wider population. On balance, Bennett’s account is not triumphalist, but he remains loyal to the notion that the spread of vaccination was “a humanitarian endeavour” (p. 6). The inherent Eurocentrism in the smallpox prevention narrative is countered by a genuine attempt to cover as much of the globe as possible and by insisting on the importance of indigenous and creole agency in India and Latin America. Bennett not only reminds us of the “need to challenge and reverse assumptions of colonial backwardness and dependency” (p. 319), he also points to the extent to which the spread of vaccination depended on the institution of slavery. I do, however, find a reminiscence of Eurocentrism in Bennett’s treatment of variolation. Given that this was predominantly an Asian practice and that it was “more routinely deployed in the Caribbean than in any other parts of the world” (p. 298), it appears unfortunate that Bennett overwhelmingly treats it in it British incarnation(s) as a practice that both rivaled and paved the way for vaccination. While this is a valid point, the global perspective seems to be lost. Bennett’s book is empirically dense, but not an easy read. While it is a gold mine of information on an impressive range of regions throughout the world, the reader looking for the bigger picture is often lost in detail. It tends to become a truism that in any particular region, significant numbers took the vaccine, while it also struggled to find acceptance among certain groups. The final chapter goes some way to lift the perspective toward significant global patterns of similarity and difference, but I would have welcomed more in that direction. War on Smallpox is the kind of book I will definitely order for the library, but rarely ask students to read cover to cover. The bulk of Bennett’s text was...

Commodities of Care: The Business of HIV Testing in China by Elsa L. Fan

Reviewed by: Commodities of Care: The Business of HIV Testing in China by Elsa L. Fan Aaron Su Elsa L. Fan. Commodities of Care: The Business of HIV Testing in China. Minneapolis: University of Minnesota Press, 2021. 216 pp. When strategies to streamline global health resources result in narrow, magic-bullet testing solutions, what meaningful interventions and social relations are enacted or foreclosed? Resonating with contemporary debates around the limits of technical solutions for COVID-19, Elsa L. Fan's Commodities of Care explores the scaling up of HIV testing in China stimulated by global health donors through programs of performance-driven financing. From the production of the category "men who have sex with men" (MSM) to the retraction of programs that offer lasting support beyond the positive test itself, Commodities of Care deftly illustrates how new trends in global health financing simultaneously usher in new subject positions, experiences of disease, and definitions of care. In so doing, the book offers a lucid glimpse into the stories and meanings of HIV for MSM in China while never losing sight of the political economy that makes these experiences possible. Commodities of Care is the result of Fan's comparative ethnographic work across several HIV organizations in a southern Chinese city. These community-based local centers, such as Bright Love, administer sexual health services as well as events and outreach programs, yet their funding structures are ambivalently tied to heterogeneous global health donors. Some, like the Health Fund and the Global Fund, have recently pushed for performance-based financing schemes that determine payments based on quantitative measures of HIV tests administered, positive test outcomes, and other related outputs, thereby reducing care to the transactional process of "selling blood (mai xue)" (3), as one of Fan's interlocutors [End Page 715] describes it. Analyzing the consequences of this shift—e.g., the purposeful proliferation of repeated and fraudulent tests for financial gain (40), the reduction of the HIV-positive population to solely MSM (17), and the "instrumentalization of community-based organizations as technical service delivery agents rather than stewards of social change" (116)—the author illuminates the transformative effects that "audit cultures" (Strathern 2000) can wield in the making of local and global health. Having worked in the development and philanthropy industries during these "ideological shifts" (19), Fan is uniquely positioned to tell the history of global health's financial streamlining at the turn of the millennium alongside the emergence of new players like the Gates Foundation. In the introduction and Chapter 1, she ethnographically analyzes how the world of HIV testing as a singular global health solution par excellence comes together in the Chinese context. Intricately describing the promotion of performance-based financing over peer-to-peer education (26) as well as the rise of statistics like the quality-adjusted life year and disability-adjusted life year in global health discourses (36), Fan traces how these shifts appear in the narrations and material practices of her interlocutors. For example, she digs into rumors of organizations splitting performance incentives with non-MSM migrant laborers, whom they recruit to get tested for the sake of their tally. She thus reveals the concrete, local consequences of approaches like evidence-based medicine (EBM) and their dominance in public health. In Chapter 2, Fan draws on Ian Hacking's (1986) concept of "making up people"–the production of new subject positions through categories and counting practices–to show how global health's enumeration strategies led to the "making up" of MSM in China. She charts the varied negotiations over the concept of MSM in China to understand organizations' concerns about recruiting testers, noting that many MSM were perhaps in publicly heterosexual relationships. Addressing this problem of a "hidden population" and insisting that Chinese MSM could not merely be drawn out and defined in the conventional terms of identity politics, Fan illuminates how practices of self-affirmation (ziworentong) "instill in these men an acceptance of their same-sex desires and a recognition of their HIV risk as part and parcel of desires" (77). The result of this affirmation, Fan reminds us, is not just the production of new personhoods but also the manufacturing of "commodities of care" in...

Out of the East (or North or South): A Response to Philip Slavin

Abstract This article responds to Philip Slavin’s ‘Out of the West: Formation of a Permanent Plague Reservoir in South-Central Germany (1349–1356) and Its Implications’. Genetics has transformed the study of plague, one of the most lethal diseases in human history. But this technically demanding science raises questions of what constitutes valid evidence and supportable argument when examining historical phenomena at a microscopic level. Slavin argues that two new lineages of Yersinia pestis, the causative organism of plague, were seeded in central Germany following the Black Death; appearing sequentially, one lineage caused plague outbreaks in the 1350s and early 1360s, only to retreat and be replaced by a second lineage. Here, evidence is adduced to support the early central European proliferation of one lineage of Y. pestis, but also to suggest that the second lineage arose simultaneously in a different locale, outside Europe and within different epidemiological parameters. Because of the inherent rarity of biological evidence, the reconstruction of epidemiological phenomena will always require consilience with archaeological and documentary sources. Establishing ‘best practices’ of analysis and verification in this emerging multidisciplinary field has implications not only for Europe’s four hundred-year experience with plague, but for all fields of global health history.

The Ethical Implications of Student Participation in Short-Term Experiences in Global Health

Student interest in short-term experiences in global health (STEGHs) has grown in recent years. Typically, students travel from high-income countries (HIC), standing to benefit from varied clinical exposure and participation beyond what is allowed in their home jurisdictions. Whether STEGHs benefit the hosting low- and middle-income countries (LMICs) are less clear. We seek to mitigate the ethical implications of student participation in STEGHs by examining three domains: (a) the medical scope of practice for students; (b) cultural competency; and (c) reciprocal partnerships. These domains permit further elucidation of key issues relating to ethics, and public policy, to clarify how STEGH initiatives can be evaluated. Our analysis implicates that STEGHs can be described as post-colonial enterprises that perpetuate structural violence in LMICs and may cultivate hubris and savior complexes in learners. Examination of these domains necessitates two points for further analysis and evaluation with respect to STEGHs: (1) a stronger idea of justice and distributive justice that includes considerations of structural violence and reciprocity; and (2) realignment of student global health priorities towards the communities being cared for as opposed to the benefits of high income countries and volunteers. To improve global health knowledge transfer worldwide, we advocate for reciprocity between HIC and LMIC institutions and training in the colonial history of global health. We hope these changes will reduce eurocentrism within student global healthand any potential harms.

Safeguarding vaccine production and supply strategies for polio eradication endgame

The world is tantalizingly close to eradicate the second human disease in the history of global health. Compared to late 1980s when the Global Polio Eradication Initiative (GPEI) was launched, incidence of wild poliovirus (WPV) cases has been reduced by more than 99.9%, two of three serotypes of WPV have been certified eradicated and all but two countries – Pakistan and Afghanistan – have successfully interrupted endemic WPV transmission. However, an uptick of WPV type 1 cases in these two endemic countries in the recent past combined with a rise in circulating vaccine-derived poliovirus (cVDPV) spreading across more than twenty countries in Africa have proved to be issues of major concern in the final phase of the eradication battle [1].

Abstract IA02: The Compelling Imperative to Diversify Participation in Clinical Trials and Research

Abstract COVID 19 has brought race disparities to the forefront as part of a national dialogue and upset. Those of us that are people of color or do research in this space are not surprised. The reality is that despite the numerous reports and efforts that have so keenly highlighted race disparities and recommendations to address them, we have yet to truly move the needle to improve the health of black and brown people. Interestingly, COVID 19 has caused a national pivot among funding agencies to add research around COVID-19 to their current funding portfolios as enhancement awards or RFAs specific to the pandemic, quickly emerged requiring a rapid response. The value and need for this pivot given this monumental time in global health history is necessary. Yet to what extent are we thinking carefully and deliberately about the importance of diversity in our clinical research and trials to ensure our findings positively impact the populations who are hardest hit and carry the greatest burden of the disease, namely African Americans and other people of color. This a fundamental question and poses an opportunity for us to do something different than what has been our historical pattern. It is well documented that a lack of diverse participation in clinical research and trials is a national problem, where in most studies disproportionally engage white men and women more than any other race and ethnic group. For example, in a recent publication the authors found that 96% of prostate cancer research study participants are white men, in a disease in which black men have the highest incidence and mortality than any other race and ethnic group. National studies engage thousands of patients in clinical research, trials, registries and biobanks but on average have less than 20% of participants from underrepresented race and ethnic groups. This is a far cry from national representation of race and ethnic groups of color and has clear implications that in essence perpetuates the disparities we seek to reduce or eliminate. Lack of diversity in research participation limits our ability to accelerate research and improve population health more broadly. For example, it limits generalizability of findings from the development of effective therapeutics to dissemination and implementation of evidence-based methods to increase screening, treatment, and quality of care are critical, all critical points care points highlighted by COVID-19. It excludes or limits access to cutting edge and potentially life-saving therapies that may have the potential to ease the burden of disease and death for people of color. Essentially, access to clinical research and trials is a social justice and an equity issue and without deliberate and intentional diversity strategies being initiated as we develop and design studies, we are adding to the ongoing sickness and death or preventable diseases among people who are black and brown, this particularly true in the case of COVID 19, cancer and other chronic diseases. While diversity in clinical trials to improve population health and advance racial equity is critical, COVID 19 has presented added challenges and opportunities to address the lack of diversity in oncology clinical research, trials, and biobanking. The very nature of a pandemic requires rapid response, action with a heightened sense of urgency, and some would argue, fear of the unknown. Add these key factors to the well-known points that influence lack of diversity in clinical trials including race and ethnic minorities not being asked or informed about clinical trials, assumptions made by research teams that suggest implicit biases, lack of an overarching diversity strategy embedded in recruitment strategies, lack of accountability -despite the requirement to complete the minority enrollment table, and a paucity of authentic community and stakeholder partnerships that have the ability to build trust and bolster diversity in clinical research before, during and post the pandemic and across an array of diseases, the outcomes could seem dismal. However, addressing these key elements can yield invaluable outcomes, namely improved health and quality of life, preventing avoidable deaths, and equity. This presentation provides key recommendations to advance equity and move the needle in increasing diversity in oncology clinical research and trials, a national imperative. Citation Format: Nadine J. Barrett. The Compelling Imperative to Diversify Participation in Clinical Trials and Research [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA02.

Historical epidemiology and global health history.

The subdiscipline of historical epidemiology holds the promise of creating a more robust and more nuanced foundation for global public health decision-making by deepening the empirical record from which we draw lessons about past interventions. This essay draws upon historical epidemiological research on three global public health campaigns to illustrate this promise: the Rockefeller Foundation's efforts to control hookworm disease (1909-c.1930), the World Health Organization's pilot projects for malaria eradication in tropical Africa (1950s-1960s), and the international efforts to shut down the transmission of Ebola virus disease during outbreaks in tropical Africa (1974-2019).

Viral Reflections: Placing China in Global Health Histories.

Public health in China has become a global concern as a consequence of the outbreak and worldwide spread of COVID-19. This article examines the historical place of China in international and global health. Contrary to prevalent narratives in the history of medicine, China and Chinese historical actors played key roles in this field throughout the twentieth century. Several episodes illustrate this argument: the Qing organization of the International Plague Conference in 1911; the role of China in the work of the interwar League of Nations Health Organization and postwar establishment of the World Health Organization; Cold War medical diplomacy; and Chinese models of primary health care during the 1970s. These case studies together show that Chinese physicians and administrators helped shape concepts and practices of "global health" even before that term rose to prominence in the 1990s, and current events are best understood in the context of this history.

Humanities, criticality and transparency: global health histories and the foundations of inter-sectoral partnerships for the democratisation of knowledge

Historians of medicine have been influential actors in a broader movement to highlight the social, institutional and administrative benefits of historical research, and its relevance for national and international policy intended to extend and improve contemporary healthcare. Historical perspectives are fundamentally useful to health policy actors because questions about what it is to be healthy, to suffer disease or disability, and the presentation and acceptance of solutions are interwoven in culturally and historically complex webs of meaning. Historians, as they have examined the social and cultural social determinants of health, have also used their work as public engagement, educational and policy resource tools, demonstrating that history is an effective way of making key issues in science, medicine and well-being more administratively responsive and accessible to lay audiences. This article explores such issues through the case study of the long-running World Health Organization (WHO) Global Health Histories project. Established in late 2004, the project’s enduring rationale has been that understanding the history of health helps the global public health community to respond to the challenges of today and help shape a healthier future. It has sought to do this by bringing together researchers and policy-makers into honest and democratic conversations and exchanges of ideas. The aim has been to stimulate a fusion between historical evidence and current policy approaches to many of the most urgent health issues. This article discusses the challenges and opportunities in bringing health history and policy together, and explores the importance of explaining historical method and the need to convince policy partners how history is evidence-based, that it can access and provide useful strategic information from archives of major institutions, and, therefore, a useful contributor to making policy initiatives adaptable and acceptable within complex polities and societies.

Marcos Cueto, Theodore M. Brown and Elizabeth Fee, The World Health Organization: A History, Global Health Histories

Marcos Cueto, Theodore M. Brown and Elizabeth Fee, The World Health Organization: A History, Global Health Histories

A History of Global Health: Interventions into the Lives of Other Peoples.

A History of Global Health: Interventions into the Lives of Other Peoples.

Polio Across the Iron Curtain: Hungary's Cold War with an Epidemic by Dóra Vargha

Reviewed by: Polio Across the Iron Curtain: Hungary's Cold War with an Epidemic by Dóra Vargha Donna Harsch Dóra Vargha. Polio Across the Iron Curtain: Hungary's Cold War with an Epidemic. Global Health Histories. Cambridge: Cambridge University Press, 2018. xii + 260 pp. Ill. $105.00 (978-1-108-42084-6). Dóra Vargha's well-documented and clearly argued monograph is a welcome addition to the historiography on polio outside the United States and, more generally, to the history of medicine and public health in Socialist Eastern Europe. The book draws on primary sources from thirteen archives and libraries, including Hungarian repositories, an Albert B. Sabin collection, World Health Organization records, and International Committee of the Red Cross documents. It incorporates eyewitness accounts from fifteen people interviewed by Vargha. It offers a very interesting analysis of the intense coverage of polio by the Hungarian press. Last but not least, it weaves in information and arguments from a multitude of secondary studies. From this material, Vargha reconstructs a many-sided story that covers the epidemiological, cultural, and political history of polio in Hungary after the Second World War, while also situating Hungarian events and discourse within a wider medical context of international and cooperative efforts to develop a cure, on the one hand, and within the global political framework of Cold War ideological hostility and all-round rivalry, on the other. [End Page 633] The history of the fight against polio in Hungary, Vargha demonstrates, actually challenges the view that Cold War antagonisms were ubiquitous and constant in the 1950s and 1960s. The search for a cure and the testing of vaccines, she argues convincingly, were characterized by transnational medical collaborations that crossed the Cold War divide. Polio researchers and public health officials from all over the world, not only the United States and Western Europe, shared medical data and information, presented research at international congresses, and participated in major vaccine trials. Interest in polio peaked at the same time around the world because in the 1950s so many countries experienced frequent and severe polio epidemics. Socialist health officials in Hungary (and the Soviet Union) were eager to learn from and work with research teams from the West in carrying out the decisive trials of the Sabin vaccine, while Western hospitals and medical personnel were happy to help supply equipment and vaccine to Hungary (and other Eastern European states). Transnational exchange and cooperation were actively promoted by the World Health Organization—which, she argues, gained respect and, gradually, participation from East Bloc countries in the 1960s. The book traces the course of multiple polio epidemics in Hungary from the late 1940s through 1961. It discusses the varieties, technology, accessibility, venues, medical personnel, and patients' experience of polio treatment. It tracks the opening and extension of treatment centers and examines the ways in which Hungarian public health officials, doctors, and nurses worked to overcome and/ or circumvent shortages of, most significantly, iron lungs. Beyond the facts of polio, Vargha evaluates change and continuity in public discourse and private opinion about polio in Hungary. She considers why polio elicited considerably more official and popular fear than infectious diseases that were more common and deadlier than polio. As have other scholars, she points, above all, to the dominant demographic of its victims, children, and to the relatively high incidence of paralysis and, from that, long-term disabilities among them. Polio's perverse association with children's beloved summer recreational activities, she suggests, also contributed to the broad and deep anxieties that polio epidemics sparked. Polio's disproportionate impact on innocent children, she argues, is another reason that researchers and, more importantly, governments were willingly to breach the Iron Curtain when solving this international problem. The cooperative and successful effort against polio both represented and encouraged rising global concern about children's welfare. Inside Hungary too, the book shows, anxiety about polio's threat to children crossed domestic political divides and tempered the Communist regime's ideological rigidity. Initially, the repression that followed the crushing of the Hungarian revolution of 1956 hurt the efforts of doctors to diagnose and of hospitals to treat polio patients. When a polio epidemic broke out...

The promise and peril of universal health care.

Universal health care (UHC) is garnering growing support throughout the world, a reflection of social and economic progress and of the recognition that population health is both an indicator and an instrument of national development. Substantial human and financial resources will be required to achieve UHC in any of the various ways it has been conceived and defined. Progress toward achieving UHC will be aided by new technologies, a willingness to shift medical tasks from highly trained to appropriately well-trained personnel, a judicious balance between the quantity and quality of health care services, and resource allocation decisions that acknowledge the important role of public health interventions and nonmedical influences on population health.BACKGROUNDThe September 1978 Alma- Ata Declaration is a landmark event in the history of global health. The declaration raised awareness of “health for all” as a universal human right,whose fulfillment reduces human misery and suffering, advances equality, and safeguards human dignity. It also recognized economic and social development and international security as not only causes, but also consequences, of better health. In addition, it highlighted the power of primary health care and international cooperation to advance the protection and promotion of health in resource-constrained settings.Building on the achievement of Alma-Ata and gaining further traction from the Millenium Development Goals and the Sustainable Development Goals set by the United Nations, universal health care (UHC) has emerged in recent years as a central imperative of the World Health Organization (WHO), the United Nations and most of its member states, and much of civil society. UHC characterizes national health systems in which all individuals can access quality health services without individual or familial financial hardship. More broadly, UHC covers social systems that provide medical and nonmedical services and infrastructure that are vital to promoting public health.ADVANCESAlthough there are numerous articulations of the UHC agenda, the WHO and World Bank offer a relatively simple UHC service-coverage index that is useful for intercountry comparison. This index focuses on four categories of health indicators: reproductive, maternal, and child health; infectious disease control; noncommunicable diseases; and service capacity and access. Comparison of UHC index values for 129 countries reveals that country index scores are positively correlated with income per capita, though there is considerable variation in scores among countries with similar incomes. These variations presumably reflect differentials in income inequality, commitment to public health infrastructure, and the quality and reach of human resources for health. The WHO and World Bank also offer multiple measures of health spending–related financial hardship in assessing UHC, which do not increase monotonically with increasing income, health spending per capita, or coverage of health services. Rather, catastrophic health expenditures tend to be lower in countries that channel health spending through public social security or insurance programs, rather than private insurance schemes.Bangkok, Thailand. A nurse keeps records of a blood donor at the Thai National Blood Centre on 14 June 2017.OUTLOOKThe financial cost of massively expanding access to health care globally is a formidable barrier to achieving UHC. For example, the Disease Control Priorities Network estimates that low- and lower-middle-income countries would, on average, need to raise their respective annual per capita health expenditures by U.S.$53 and U.S.$61 per person to achieve coveragewith the essential UHC package of 218 core interventions, a sizable burden in relation to average expenditure increases in recent years. Wealthy industrial countries are much further along the path to achieving UHC, though they also face challenges involving rising costs of new health care technologies and the growing share of their populations at the older (and more health care–intensive) ages.Technically and economically efficient approaches to the achievement of UHC may include the use of electronic medical records, telemedicine systems, digital monitors for drug adherence, and clinical decision–support applications; expansion of the quantity and quality of human resources for health at the physician, nurse, and community health worker levels; improvements in inventory systems and supply chains for the delivery of vaccines, drugs, diagnostics, and medical devices; screening for risk factors and early signs of disease; and focusing on the often neglected domains of surgical care, reproductive health, and mental health. Also key will be efforts to ensure universal access to proven public health interventions that address social and environmental determinants of health, such as health education campaigns; access to safe water; regulation of excessive sugar and salt in the food supply; control of tobacco and the unsafe consumption of alcohol; road traffic safety; walkable city designs; expanding enrollment in high-quality primary and secondary schools; and more equitable distributions of income and wealth.Achieving UHC is an ambitious aspiration and a powerful indicator of human progress. Fortunately, it may be expected to deliver myriad health, economic, and social welfare benefits along the way, helping to mobilize the substantial political and financial resources needed for its continued future expansion.

Randall M. Packard. A History of Global Health: Interventions into the Lives of Other Peoples.

Randall M. Packard. A History of Global Health: Interventions into the Lives of Other Peoples.

Taxes for health: evidence clears the air

Taxes for health: evidence clears the air

A History of Global Health: Interventions into the Lives of Other Peoples by Randall Packard

A History of Global Health: Interventions into the Lives of Other Peoples by Randall Packard