Global health issues can be divided up in a number of ways. Communicable vs Non-Communicable Disease (NCDs) is perhaps the most commonly used division as it allows important differences in terms of aetiology, epidemiological spread and options and scale of interventions to be thought through. Non-communicable disease is sometimes referred to as chronic disease.
Another way to divide up the many aspects of global health is to think of it in terms of the variety of disciplines which concern themselves with health at a global level including epidemiology, political science, demography economics, social science and the clinical disciplines.
And finally, one may think about global health in terms of the actors and stakeholders involved with global health, directly or quite commonly, indirectly. Politicians, aid workers, the private sector and civil society are all involved with the issues that determine population level health.
Common to all facets of global health however is the idea that the social and physical environment ranging from political freedoms to access to clean water are reasons for the difference between life and death for millions of people every year.
Communicable and non-communicable disease.
Communicable disease is responsible for about half of the global burden of disease. TB, HIV and Malaria have been the targets of important global health initiatives of late. With about 33 million people living with HIV, 14 million with Tuberculosis and 410 million cases of Malaria, it is clear that these three diseases are the issue of our time.
Non communicable diseases are on the rise. Presently cancer, heart disease, diabetes and obesity together form about half of the global burden of disease. Low income countries that have traditionally fallen victim to communicable disease are now also seeing diabetes and obesity epidemics giving rise to the ‘double epidemiological burden’, that is to say, poor countries are having to plan for both communicable and non-communicable disease epidemics.
Global health disciplines
Epidemiology, economics, demography, ethicists and political economists study global health issues.
A primary perspective emphasizes the cost-effectiveness and cost benefit approaches for both individual and population health allocation. Aggregate analysis from the perspective of governments, NGOs and Foundations for global health allocation focuses on the use of cost-effectiveness and cost-benefit analysis for the health sector. Cost-effectiveness analysis compares the costs and health effects of an intervention to assess whether health investments are worthwhile from economic perspective. It is necessary to distinguish between independent interventions and mutually exclusive interventions. For independent interventions, average cost-effectiveness ratios suffice, but for mutually exclusive interventions it is essential to use incremental cost-effectiveness ratios if the objective – to maximise healthcare effects given the resources available – is to be achieved. Individual health analysis from this perspective focuses on the demand and supply of health. The demand for health care is a derived demand from the demand for health, more generally. Health care is demanded as a means for consumers to achieve a larger stock of "health capital." The demand for health is unique, because individuals allocate resources in order to both consume and produce health.The optimal level of investment in health occurs where the marginal cost of health capital is equal to the marginal benefit resulting from it (MC=MB). With the passing of time, health depreciates at some rate δ. The general interest rate in the economy is denoted by r. Supply of health focuses on provider incentives, market creation, market organization, issues related to information assymetries, the role of NGOs and governments in health provision.
Another approach, embraced by ethicists and bioethicists, emphasizes distributional considerations. For example, the Rule of Rescue is a rule coined by A.R. Jonsen in 1986 that is currently used in a variety of bioethics contexts. The rule of rescue rule specifies that it is 'a perceived duty to save endangered life where possible' (Bochner et al, 1994, pp901) Recent bioethics research examines what kinds of international obligations of justice exist broadly clustered in three areas: (1) When Are International Inequalities in Health Unjust?; (2) Where Do International Health Inequalities Come From?; (3) How do we meet health needs justly if we can't meet them all?
A third approach emphasizes political economy considerations applied to global health. Political economy originally was the term for studying production, buying and selling, and their relations with law, custom, and government. Originating in moral philosophy (e.g. Adam Smith was Professor of Moral Philosophy at the University of Glasgow), political economy of health is the study of how economies of states — polities, hence political economy - influence aggregate population health outcomes.
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