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Global Health Care, Essay Example

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Introduction

Global health care is a challenging phenomenon that supports the development of new perspectives and approaches to solving global health concerns, including nutrition, infectious disease, cancer, and chronic illness. It is important to address global health as a driving force in international healthcare expenditures because it represents an opportunity for clinicians throughout the world to collaborate and to address global health concerns to achieve favorable outcomes. Global healthcare in the modern era includes the utilization of technology to support different population groups and to address different challenges as related to global health problems that impact millions of people in different ways. These challenges demonstrate the importance of large-scale efforts to eradicate disease, to prevent illness, and to manage disease effectively through comprehensive strategies that encourage communication and collaboration across boundaries.

Global health care incorporates a number of critical factors into play so that people throughout the world are given a chance to live and to lead a higher quality of life. The World Health Organization (WHO) is of particular relevance because this organization supports global health initiatives and large-scale impact projects throughout the world (Sundewall et.al, 2009). The WHO recognizes the importance of developing strategies to address global health concerns by pooling resources in order to ensure that many population groups are positively impacted by these initiatives (Sundewall et.al, 2009). The WHO also collaborates with government bodies throughout the world to address specific concerns that are relevant to different population groups, such as infectious diseases, many of which ravage populations in a significant manner (Fineberg and Hunter, 2013). In this context, it is observed that global health has a significant impact on populations and their ability to thrive, given the high mortality rates of some diseases in less developed nations (Fineberg and Hunter, 2013). Therefore, it is expected that there will be additional frameworks in place to accommodate the needs of populations and the resources that are required to achieve favorable outcomes (Fineberg and Hunter, 2013).

In addition to the WHO, there are many other international organizations that support global health and disease in different ways. For example, The United Nations Children’s Fund (UNICEF) supports large-scale global health efforts to support the world’s children (imva.org, 2013). UNICEF works in conjunction with many governments and other sources of funding in order to accomplish its objectives related to child health and wellbeing (imva.org, 2013). UNICEF spends significant funds on many focus areas, including the preservation of child health, nutrition, emergency support, and sanitation in conjunction with local water supplies (imva.org, 2013). In addition, the United States Agency for International Development (USAID) provides support in many areas, including a primary focus on healthcare in developing nations (imva.org, 2013).

Leininger’s Culture Care Theory is essential in satisfying the objectives of global health because it supports an understanding of the issues related to cultural diversity and how they impact healthcare practices throughout the world (Current Nursing, 2012). This theory embodies many of the differences that exist in modern healthcare practices and supports a greater understanding of the issues that are most relevant on a global scale (Current Nursing, 2012). This theory is applicable because it represents a call to action to consider cultural differences when providing care and treatment to different population groups, but not at the expense of the quality of care that is provided (Current Nursing, 2012). In many countries, the provision of care is largely dependent on cultural diversity and customs, which is essential to a thriving healthcare system; however, diversity must also incorporate the concept of providing maximum care for an individual in need of treatment (Current Nursing, 2012).

Professional nursing is highly relevant to global health because nurses address some of the most critical challenges in providing care and expanding access to treatment for millions of people throughout the world. However, it is also important for nurses working with global health initiatives to recognize the importance of these directives and to consider ways to improve quality of care without compromising principles or other factors in the process. These efforts will ensure that nurses maximize their knowledge and understanding of global health and its scope in order to achieve positive outcomes for people in desperate need of healthcare services throughout the world. Nurses must collaborate with small and large-scale organizations regarding global health issues so that population needs are targeted and are specific. These efforts will ensure that patients are treated in areas where healthcare access is severely limited.

Global health represents a significant set of challenges for clinicians throughout the world. It is important to recognize these concerns and to take the steps that are necessary to provide patients with the best possible outcomes to achieve optimal health. The scope of global health concerns is significant; therefore, it is important to address these concerns and to take the steps that are necessary to collaborate and promote initiatives to fight global health problems. When these objectives are achieved using the knowledge and expertise of nurses, it is likely that there will be many opportunities to treat patients and to educate them regarding positive health. With the assistance of large global organizations, nurses play an important role in shaping outcomes for women throughout the world.

Current Nursing (2012). Transcultural nursing. Retrieved from http://currentnursing.com/nursing_theory/transcultural_nursing.html

Fineberg, H.V., and Hunter, D. J. (2013). A global view of health – an unfolding series. T he New England Journal of Medicine, 368(1), 78-79.

Imva.org (2013). Bilateral agencies. Retrieved from http://www.imva.org/Pages/orgfrm.htm

Sundewall, J., Chansa, C., Tomson, G., Forsberg, B.C., and Mudenda, D. (2009). Global health initiatives and country health systems. The Lancet, 374, 1237.

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• Open access
• Published: 07 April 2020

What is global health? Key concepts and clarification of misperceptions

Report of the 2019 GHRP editorial meeting

• Xinguang Chen 1 , 2 ,
• Hao Li 1 , 3 ,
• Don Eliseo Lucero-Prisno III 4 ,
• Abu S. Abdullah 5 , 6 ,
• Jiayan Huang 7 ,
• Charlotte Laurence 8 ,
• Xiaohui Liang 1 , 3 ,
• Zhenyu Ma 9 ,
• Zongfu Mao 1 , 3 ,
• Ran Ren 10 ,
• Shaolong Wu 11 ,
• Nan Wang 1 , 3 ,
• Peigang Wang 1 , 3 ,
• Tingting Wang 1 , 3 ,
• Hong Yan 3 &
• Yuliang Zou 3  

Global Health Research and Policy volume  5 , Article number:  14 ( 2020 ) Cite this article

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The call for “W orking Together to Build a Community of Shared Future for Mankind” requires us to improve people’s health across the globe, while global health development entails a satisfactory answer to a fundamental question: “What is global health?” To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, in-depth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word “global” in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multi-country and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of “international health” by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of the Belt and Road Initiative proposed by China.

“Promoting Health For All” can be considered as the mission of global health for collective efforts to build “a Community of Shared Future for Mankind” first proposed by President Xi Jinping of China in 2013. The concept of global health continues to evolve along with the rapid development in global health research, education, policymaking, and practice. It has been promoted on various platforms for exchange, including conferences, workshops and academic journals. Within the Editorial Board of Global Health Research and Policy (GHRP), many members expressed their own points of view and often disagreed with each other with regard to the concept of global health. Substantial discrepancies in the definition of global health will not only affect the daily work of the Editorial Board of GHRP, but also impede the development of global health sciences.

To promote a better understanding of the term “ global health” , we convened a special session in the 2019 GHRP Editorial Board Meeting on the 7th of July at Wuhan University, China. The session started with a review of previous work on the concept of global health by researchers from different institutions across the globe, followed by free brainstorms, questions-answers and open discussion. Individual participants raised many questions and generously shared their thoughts and understanding of the term global health. The session was ended with a summary co-led by Dr. Xinguang Chen and Dr. Hao Li. Post-meeting efforts were thus organized to further synthesize the opinions and comments gathered during the meeting and post-meeting development through emails, telephone calls and in-person communications. With all these efforts together, concensus have been met on several key concepts and a number of confusions have been clarified regarding global health. In this editorial, we report the main results and conclusions.

A brief history

Our current understanding of the concept of global health is based on information in the literature in the past seven to eight decades. Global health as a scientific term first appeared in the literature in the 1940s [ 1 ]. It was subsequently used by the World Health Organization (WHO) as guidance and theoretical foundation [ 2 , 3 , 4 ]. Few scholars discussed the concept of global health until the 1990s, and the number of papers on this topic has risen rapidly in the subsequent decade [ 5 ] when global health was promoted under the Global Health Initiative - a global health plan signed by the U.S. President Barack Obama [ 6 ]. As a key part of the national strategy in economic globalization, security and international policies, global health in the United States has promoted collaborations across countries to deal with challenging medical and health issues through federal funding, development aids, capacity building, education, scientific research, policymaking and implementation.

Based on his experience working with Professor Zongfu Mao, the lead Editors-in-Chief, who established the Global Health Institute at Wuhan University in 2011 and launched the GHRP in 2016, Dr. Chen presented his own thoughts surrounding the definition of global health to the 2019 GHRP Editorial Board Meeting. Briefly, Dr. Chen defined global health with a three-dimensional perspective.

First, global health can be considered as a guiding principle, a branch of health sciences, and a specialized discipline within the broader arena of public health and medicine [ 5 ]. As many researchers posit, global health first serves as a guiding principle for people who would like to contribute to the health of all people across the globe [ 5 , 7 , 8 ].

Second, Dr. Chen’s conceptualization of global health is consistent with the opinions of many other scholars. Global health as a branch of sciences focuses primarily on the medical and health issues with global impact or can be effectively addressed through global solutions [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Therefore, the goal of global health science is to understand global medical and health issues and develop global solutions and implications [ 7 , 9 , 15 , 17 , 18 , 19 ].

Third, according to Dr. Chen, to develop global health as a branch of science in the fields of public health and medicine, a specialized discipline must be established, including educational institutions, research entities, and academic societies. Only with such infrastructure, can the professionals and students in the global health field receive academic training, conduct global health research, exchange and disseminate research findings, and promote global health practices [ 5 , 15 , 20 , 21 , 22 , 23 ].

Developmentally and historically, we have learned and will continue to learn global health from the WHO [ 1 , 4 , 24 , 25 ]. WHO’s projects are often ambitious, involving multiple countries, or even global in scope. Through research and action projects, the WHO has established a solid knowledge base, relevant theories, models, methodologies, valuable data, and lots of experiences that can be directly used in developing global health [ 26 , 27 , 28 , 29 ]. Typical examples include WHO’s efforts for global HIV/AIDS control [ 13 , 30 , 31 , 32 ], and the Primary Healthcare Programs to promote Health For All [ 33 , 34 ].

The definition of Global Health

From published studies in the international literature and our experiences in research, training, teaching and practice, our meeting reached a consensus-global health is a newly established branch of health sciences, growing out from medicine, public health and international health, with much input from the WHO. What makes global health different from them is that (1) global health deals with only medical and health issues with global impact [ 35 , 5 , 36 , 10 , 14 , 2 ] the main task of global health is to seek for global solutions to the issues with global health impact [ 7 , 18 , 37 ]; and (3) the ultimate goal is to use the power of academic research and science to promote health for all, and to improve health equity and reduce health disparities [ 7 , 14 , 15 , 18 , 38 ]. Therefore, global health targets populations in all countries and involves all sectors beyond medical and health systems, although global health research and practice can be conducted locally [ 39 ].

As a branch of medical and health sciences, global health has three fundamental tasks: (1) to master the spatio-temporal patterns of a medical and/or health issue across the globe to gain a better understanding of the issue and to assess its global impact [ 40 , 41 , 42 , 43 ]; (2) to investigate the determinants and influential factors associated with medical and health issues that are known to have global impact [ 15 , 40 , 41 , 42 , 43 ]; and (3) to establish evidence-based global solutions, including strategies, frameworks, governances, policies, regulations and laws [ 14 , 15 , 28 , 38 , 44 , 45 , 46 , 47 ].

Like public health, medicine, and other branches of sciences, global health should have three basic functions : The first function is to generate new knowledge and theories about global health issues, influential factors, and develop global solutions. The second function is to distribute the knowledge through education, training, publication and other forms of knowledge sharing. The last function is to apply the global health knowledge, theories, and intervention strategies in practice to solve global health problems.

Understanding the word “global”

Confusion in understanding the term ‘global health’ has largely resulted from our understanding of the word “global”. There are few discrepancies when the word ‘global’ is used in other settings such as in geography. In there, the world global physically pertains to the Earth we live on, including all people and all countries in the world. However, discrepancies appear when the word “global” is combined with the word “health” to form the term “global health”. Following the word “global” literately, an institution, a research project, or an article can be considered as global only if it encompasses all people and all countries in the world. If we follow this understanding, few of the work we are doing now belong to global health; even the work by WHO are for member countries only, not for all people and all countries in the world. But most studies published in various global health journals, including those in our GHRP, are conducted at a local or international level. How could this global health happen?

The argument presented above leads to another conceptualization: Global health means health for a very large group of people in a very large geographic area such as the Western Pacific, Africa, Asia, Europe, and Latin America. Along with this line of understanding, an institution, a research project or an article involving multi-countries and places can be considered as global, including those conducted in countries involved in China’s Belt and Road Initiative (BRI) [ 26 , 48 , 49 , 50 , 51 ]. They are considered as global because they meet our definitions of global health which focus on medical and health issues with global impact or look for global solutions to a medical or health issue [ 5 , 7 , 22 ].

One step further, the word ‘global’ can be considered as a concept of goal-setting in global health. Typical examples of this understanding are the goals established for a global health institution, for faculty specialized in global health, and for students who major or minor in global health. Although few of the global health institutions, scholars and students have conducted or are going to conduct research studies with a global sample or delivered interventions to all people in all countries, all of them share a common goal: Preventing diseases and promoting health for all people in the world. For example, preventing HIV transmission within Wuhan would not necessarily be a global health project; but the same project can be considered as global if it is guided by a global perspective, analyzed with methods with global link such as phylogenetic analysis [ 52 , 53 ], and the goal is to contribute to global implications to end HIV/AIDS epidemic.

The concept of global impact

Global impact is a key concept for global health. Different from other public health and medical disciplines, global health can address any issue that has a global impact on the health of human kind, including health system problems that have already affected or will affect a large number of people or countries across the globe. Three illustrative examples are (1) the SARS epidemic that occurred in several areas in Hong Kong could spread globally in a short period [ 11 ] to cause many medical and public health challenges [ 54 , 55 ]; (2) the global epidemic of HIV/AIDS [ 13 ]; and the novel coronavirus epidemic first broke out in December 2019 in Wuhan and quickly spread to many countries in the world [ 56 ].

Along with rapid and unevenly paced globalization, economic growth, and technological development, more and more medical and health issues with global impact emerge. Typical examples include growing health disparities, migration-related medical and health issues, issues related to internet abuse, the spread of sedentary lifestyles and lack of physical activity, obesity, increasing rates of substance abuse, depression, suicide and many other emerging mental health issues, and so on [ 10 , 23 , 36 , 42 , 57 , 58 , 59 , 60 ]. GHRP is expecting to receive and publish more studies targeting these issues guided by a global health perspective and supports more researchers to look for global solutions to these issues.

The concept of global solution

Another concept parallel to global impact is global solution . What do we mean by global solutions? Different from the conventional understanding in public health and medicine, global health selectively targets issues with global impact. Such issues often can only be effectively solved at the macro level through cross-cultural, international, and/or even global collaboration and cooperation among different entities and stakeholders. Furthermore, as long as the problem is solved, it will benefit a large number of population. We term this type of interventions as a global solution. For example, the 90–90-90 strategy promoted by the WHO is a global solution to end the HIV/AIDS epidemic [ 61 , 62 ]; the measures used to end the SARS epidemic is a global solution [ 11 ]; and the ongoing measures to control influenza [ 63 , 64 ] and malaria [ 45 , 65 ], and the measures taken by China, WHO and many countries in the world to control the new coronaviral epidemic started in China are also great examples of global solutions [ 66 ].

Global solutions are also needed for many emerging health problems, including cardiovascular diseases, sedentary lifestyle, obesity, internet abuse, drug abuse, tobacco smoking, suicide, and other problems [ 29 , 44 ]. As described earlier, global solutions are not often a medical intervention or a procedure for individual patients but frameworks, policies, strategies, laws and regulations. Using social media to deliver interventions represents a promising approach in establishment of global solutions, given its power to penetrate physical barriers and can reach a large body of audience quickly.

Types of Global Health researches

One challenge to GHRP editors (and authors alike) is how to judge whether a research study is global? Based on the new definition of global health we proposed as described above, two types of studies are considered as global and will receive further reviews for publication consideration. Type I includes projects or studies that involve multiple countries with diverse backgrounds or cover a large diverse populations residing in a broad geographical area. Type II includes projects or studies guided by a global perspective, although they may use data from a local population or a local territory. Relative to Type I, we anticipate more Type II project and studies in the field of global health. Type I study is easy to assess, but caution is needed to assess if a project or a study is Type II. Therefore, we propose the following three points for consideration: (1) if the targeted issues are of global health impact, (2) if the research is attempted to understand an issue with a global perspective, and (3) if the research purpose is to seek for a global solution.

An illustrative example of Type I studies is the epidemic and control of SARS in Hong Kong [ 11 , 67 ]. Although started locally, SARS presents a global threat; while controlling the epidemic requires international and global collaboration, including measures to confine the infected and measures to block the transmission paths and measures to protect vulnerable populations, not simply the provisions of vaccines and medicines. HIV/AIDS presents another example of Type I project. The impact of HIV/AIDS is global. Any HIV/AIDS studies regardless of their scope will be global as long as it contributes to the global efforts to end the HIV/AIDS epidemic by 2030 [ 61 , 62 ]. Lastly, an investigation of cardiovascular diseases (CVD) in a country, in Nepal for example, can be considered as global if the study is framed from a global perspective [ 44 ].

The discussion presented above suggests that in addition to scope, the purpose of a project or study can determine if it is global. A pharmaceutical company can target all people in the world to develop a new drug. The research would be considered as global if the purpose is to improve the medical and health conditions of the global population. However, it would not be considered as global if the purpose is purely to pursue profit. A research study on a medical or health problem among rural-to-urban migrants in China [ 57 , 58 , 60 ] can be considered as global if the researchers frame the study with a global perspective and include an objective to inform other countries in the world to deal with the same or similar issues.

Think globally and act locally

The catchphrase “think globally and act locally” presents another guiding principle for global health and can be used to help determine whether a medical or public health research project or a study is global. First, thinking globally and acting locally means to learn from each other in understanding and solving local health problems with the broadest perspective possible. Taking traffic accidents as an example, traffic accidents increase rapidly in many countries undergoing rapid economic growth [ 68 , 69 ]. There are two approaches to the problem: (1) locally focused approach: conducting research studies locally to identify influential factors and to seek for solutions based on local research findings; or (2) a globally focused approach: conducting the same research with a global perspective by learning from other countries with successful solutions to issues related traffic accidents [ 70 ].

Second, thinking globally and acting locally means adopting solutions that haven been proven effective in other comparable settings. It may greatly increase the efficiency to solve many global health issues if we approach these issues with a globally focused perspective. For example, vector-borne diseases are very prevalent among people living in many countries in Africa and Latin America, such as malaria, dengue, and chikungunya [ 45 , 71 , 72 ]. We would be able to control these epidemics by directly adopting the successful strategy of massive use of bed nets that has been proven to be effective and cost-saving [ 73 ]. Unfortunately, this strategy is included only as “simple alternative measures” in the so-called global vector-borne disease control in these countries, while most resources are channeled towards more advanced technologies and vaccinations [ 16 , 19 , 74 ].

Third, thinking globally and acting locally means learning from each other at different levels. At the individual level, people in high income countries can learn from those in low- and mid-income countries (LMICs) to be physically more active, such as playing Taiji, Yoga, etc.; while people in LMICs can learn from those in high income countries to improve their hygiene, life styles, personal health management, etc. At the population level, communities, organizations, governments, and countries can learn from each other in understanding their own medical and health problems and healthcare systems, and to seek solutions for these problems. For example, China can learn from the United States to deal with health issues of rural to urban migrants [ 75 ]; and the United States can learn from China to build three-tier health care systems to deliver primary care and prevention measures to improve health equality.

Lastly, thinking globally and acting locally means opportunities to conduct global health research and to be able to exchange research findings and experiences across the globe; even without traveling to another country. For example, international immigrants and international students present a unique opportunity for global health research in a local city [ 5 , 76 ]. To be global, literature search and review remains the most important approach for us to learn from each other besides conducting collaborative work with the like-minded researchers across countries; rapid development in big data and machine learning provide another powerful approach for global health research. Institutions and programs for global health provides a formal venue for such learning and exchange opportunities.

Reframing a local research study as global

The purpose of this article is to promote global health through research and publication. Anyone who reads this paper up to this point might already be able to have a clear idea on how to reframe his/her own research project or article to be of global nature. There is no doubt that a research project is global if it involves multiple countries with investigators of diverse backgrounds from different countries. However, if a research project targets a local population with investigators from only one or two local institutions, can such project be considered as global?

Our answer to this question is “yes” even if a research study is conducted locally, if the researcher (1) can demonstrate that the issue to be studied or being studied has a global impact, or (2) eventually looks for a global solution although supported with local data. For example, the study of increased traffic accidents in a city in Pakistan can be considered as global if the researchers frame the problem from a global perspective and/or adopt global solutions by learning from other countries. On the other hand, a statistical report of traffic accidents or an epidemiological investigation of factors related to the traffic accidents at the local level will not be considered as global. Studies conducted in a local hospital on drug resistance to antibiotics and associated cost are global if expected findings can inform other countries to prevent abuse of antibiotics [ 77 ]. Lastly, studies supported by international health programs can be packaged as global simply by broadening the vision from international to global.

Is Global Health a new bottle with old wine?

Another challenge question many scholars often ask is: “What new things can global health bring to public health and medicine?” The essence of this question is whether global health is simply a collection of existing medical and health problems packaged with a new title? From our previous discussion, many readers may already have their own answer to this question that this is not true. However, we would like to emphasize a few points. First, global health is not equal to public health, medicine or both, but a newly emerged sub-discipline within the public health-medicine arena. Global health is not for all medical and health problems but for the problems with global impact and with the purpose of seeking global solutions. In other words, global health focuses primarily on mega medical and health problems that transcend geographical, cultural, and national boundaries and seeks broad solutions, including frameworks, partnerships and cooperation, policies, laws and regulations that can be implemented through governments, social media, communities, and other large and broad reaching mechanisms.

Second, global health needs many visions, methods, strategies, approaches, and frameworks that are not conventionally used in public health and medicine [ 5 , 18 , 22 , 34 ]. They will enable global health researchers to locate and investigate those medical and health issues with global impact, gain new knowledge about them, develop new strategies to solve them, and train health workers to deliver the developed strategies. Consequently, geography, history, culture, sociology, governance, and laws that are optional for medicine and public health are essential for global health. Lastly, it is fundamental to have a global perspective for anyone in global health, but this could be optional for other medical and health scientists [ 40 , 41 ].

Global Health, international health, and public health

As previously discussed, global health has been linked to several other related disciplines, particularly public health, international health, and medicine [ 3 , 5 , 7 , 18 , 22 ]. To our understanding, global health can be considered as an application of medical and public health sciences together with other disciplines (1) in tackling those issues with global impact and (2) in the effort to seek global solutions. Thus, global health treats public health sciences and medicine as their foundations, and will selectively use theories, knowledge, techniques, therapeutics and prevention measures from public health, medicine, and other disciplines to understand and solve global health problems.

There are also clear boundaries between global health, public health and medicine with regard to the target population. Medicine targets patient populations, public health targets health populations in general, while global health targets the global population. We have to admit that there are obvious overlaps between global health, public health and medicine, particularly between global health and international health. It is worth noting that global health can be considered as an extension of international health with regard to the scope and purposes. International health focuses on the health of participating countries with intention to affect non-participating countries, while global health directly states that its goal is to promote health and prevent and treat diseases for all people in all countries across the globe. Thus, global health can be considered as developed from, and eventually replace international health.

Challenges and opportunities for China to contribute to Global Health

To pursue A Community with a Shared Future for Mankind , China’s BRI , currently involving more than 150 countries across the globe, creates a great opportunity for Chinese scholars to contribute to global health. China has a lot to learn from other countries in advancing its medical and health technologies and to optimize its own healthcare system, and to reduce health disparities among the 56 ethnic groups of its people. China can also gain knowledge from other countries to construct healthy lifestyles and avoid unhealthy behaviors as Chinese people become more affluent. Adequate materials and money may be able to promote physical health in China; but it will be challenging for Chinese people to avoid mental health problems currently highly prevalent in many rich and developed countries.

To develop global health, we cannot ignore the opportunities along with the BRI for Chinese scholars to share China’s lessons and successful experience with other countries. China has made a lot of achievements in public health and medicine before and after the Open Door Policy [ 49 , 78 ]. Typical examples include the ups and downs of the 3-Tier Healthcare Systems, the Policy of Prevention First, and the Policy of Putting Rural Health as the Priority, the Massive Patriotic Hygiene Movement with emphasis on simple technology and broad community participation, the Free Healthcare System for urban and the Cooperative Healthcare System for rural residents. There are many aspects of these initiatives that other countries can emulate including the implementation of public health programs covering a huge population base unprecedented in many other countries.

There are challenges for Chinese scholars to share China’s experiences with others as encountered in practice. First of all, China is politically very stable while many other countries have to change their national leadership periodically. Changes in leadership may result in changes in the delivery of evidence- based intervention programs/projects, although the changes may not be evidence-based but politically oriented. For example, the 3-Tier Healthcare System that worked in China [ 79 , 80 ] may not work in other countries and places without modifications to suit for the settings where there is a lack of local organizational systems. Culturally, promotion of common values among the public is unique in China, thus interventions that are effective among Chinese population may not work in countries and places where individualism dominates. For example, vaccination program as a global solution against infectious diseases showed great success in China, but not in the United States as indicated by the 2019 measles outbreak [ 81 ].

China can also learn from countries and international agencies such as the United Kingdom, the United States, the World Health Organization, and the United Nations to successfully and effectively provide assistance to LMICs. As China develops, it will increasingly take on the role of a donor country. Therefore, it is important for Chinese scholars to learn from all countries in the world and to work together for a Community of Shared Future for Mankind during the great course to develop global health.

Promotion of global health is an essential part of the Working Together  to Build a Community of Shared Future for Mankind. In this editorial, we summarized our discussions in the 2019 GHRP Editorial Board Meeting regarding the concept of global health. The goal is to enhance consensus among the board members as well as researchers, practitioners, educators and students in the global health community. We welcome comments, suggestions and critiques that may help further our understanding of the concept. We would like to keep the concept of global health open and let it evolve along with our research, teaching, policy and practice in global health.

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We would like to thank those who had provided their comments for the improvement of the manuscript.

The work is funded by the journal development funds of Wuhan University.

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Xinguang Chen, Hao Li, Xiaohui Liang, Zongfu Mao, Nan Wang, Peigang Wang & Tingting Wang

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Chen XG wrote the manuscript. LI H organized the meeting, collecting the comments and editing the manuscript. Lucero-Prisno DE integrated all the comments together. Abdullah AS, Huang JY, Laurence C, Liang XH, Ma ZY, Ren R, Wu SL, Wang N, Wang PG and Wang Tt all participated in the discussion and comments of this manuscript. Laurence C and Liang XH both provided language editing. The author(s) read and approved the final manuscript

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Chen, X., Li, H., Lucero-Prisno, D.E. et al. What is global health? Key concepts and clarification of misperceptions. glob health res policy 5 , 14 (2020). https://doi.org/10.1186/s41256-020-00142-7

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The COVID-19 pandemic: a global health crisis

Casey a. pollard.

1 Department of Surgery, The University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio

Michael P. Morran

2 The University of Toledo Advanced Microscopy and Imaging Center, The University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio

Andrea L. Nestor-Kalinoski

The novel coronavirus SARS-CoV-2 was identified as the causative agent for a series of atypical respiratory diseases in the Hubei Province of Wuhan, China in December of 2019. The disease SARS-CoV-2, termed COVID-19, was officially declared a pandemic by the World Health Organization on March 11, 2020. SARS-CoV-2 contains a single-stranded, positive-sense RNA genome surrounded by an extracellular membrane containing a series of spike glycoproteins resembling a crown. COVID-19 infection results in diverse symptoms and morbidity depending on individual genetics, ethnicity, age, and geographic location. In severe cases, COVID-19 pathophysiology includes destruction of lung epithelial cells, thrombosis, hypercoagulation, and vascular leak leading to sepsis. These events lead to acute respiratory distress syndrome (ARDS) and subsequent pulmonary fibrosis in patients. COVID-19 risk factors include cardiovascular disease, hypertension, and diabetes, which are highly prevalent in the United States. This population has upregulation of the angiotensin converting enzyme-2 (ACE2) receptor, which is exploited by COVID-19 as the route of entry and infection. Viral envelope proteins bind to and degrade ACE2 receptors, thus preventing normal ACE2 function. COVID-19 infection causes imbalances in ACE2 and induces an inflammatory immune response, known as a cytokine storm, both of which amplify comorbidities within the host. Herein, we discuss the genetics, pathogenesis, and possible therapeutics of COVID-19 infection along with secondary complications associated with disease progression, including ARDS and pulmonary fibrosis. Understanding the mechanisms of COVID-19 infection will allow the development of vaccines or other novel therapeutic approaches to prevent transmission or reduce the severity of infection.

CORONAVIRUSES AND SARS-C o V-2 GENETICS

Coronaviruses are a well-studied group of viruses in the Coronaviridae family that are known for their ability to infect a variety of hosts due to their capacity to evolve in epidemiological situations, including crossing species barriers, mutagenesis, tissue tropism, and pathogenicity ( 10b , 14 , 83 ). Coronaviruses are round, enveloped virions roughly 80–220 nm in diameter that contain a single-stranded, positive-sense RNA genome of ∼26–32 kb surrounded by an extracellular membrane containing a casing of spike glycoproteins ( 32 , 80 ). The term corona in Latin translates to crown and was given to these viruses due to the presence of the spike casing that resembled a “crown-like structure” using electron microscopy ( 37 ).

Coronaviruses have been implicated in human disease as early as the late 1960s, where they were identified as the causative agents in respiratory illnesses that presented with mild symptoms associated with the common cold ( 32 ). Seven strains of human coronaviruses have been characterized, four of which are known to infect the upper respiratory tract and cause mild symptoms, while the three others are known for their severe disease-causing characteristics of the lower respiratory tract including the following: SARS-CoV (severe acute respiratory syndrome), MERS-CoV (Middle East respiratory syndrome), and SARS-CoV-2 (COVID-19) ( 42 ). Since the emergence of the COVID-19 pandemic, data-sharing initiatives have led to the much needed generation of SARS-CoV-2 data, including complete reference genomes in the National Center for Biotechnology Information database ( {"type":"entrez-nucleotide","attrs":{"text":"NC_045512","term_id":"1798174254","term_text":"NC_045512"}} NC_045512 .2), which contains the 29,903 bp genomic sequence ( 83 ).

While it is known that the RNA polymerase of viruses lack proofreading capacity, the ensuing result is a high mutation rate with low replicative fidelity. In contrast, the coronaviruses possess an exonuclease proofreading capability that has resulted in the expansion and maintenance of one of the largest known viral genomes at ∼30 kb ( 17 , 60 ). The large viral genome of SARS-CoV-2 codes for four structural proteins including the envelope, membrane, nucleocapsid, and spike glycoprotein, which play a role in both molecular characterization and host cell entry ( 23 , 35 ). The SARS-CoV-2 genome also includes 16 nonstructural proteins and 9 accessory proteins required for replication and pathogenesis ( 23 , 35 , 60 ). While SARS-CoV-2 and SARS-CoV are 75–80% identical ( 3 , 89 ), SARS-CoV-2 displays the highest sequence similarities with BatCoV at 96.2% ( 11 ). Global sequence comparison of SARS-CoV-2 isolates have expanded the literature and information known for this virus in a short period of time. Initial analysis of roughly 100 genomes of SARS-CoV-2 identified two major subtypes, designated L and S, which vary due to the presence of two linked single nucleotide polymorphisms ( 71 ). Interestingly, the L subtype is a derivative of the S type and was identified in ∼70% of the genomes compared with the S type in the remaining 30% ( 71 ). Phylogenic tree analysis of the L type suggests that the differences are related to a significantly higher mutation rate, which, consequently, results in higher transmission and/or replication rates ( 71 ). Furthermore, the SARS-CoV-2 virus has geographically diverse strains that seemingly vary in severity, mortality rate, and treatment options that were characterized using phylogenetic network analysis of 160 SARS-CoV-2 genomes ( 18 ). Three distinct viral clusters (A, B, and C) were identified with derivative subgroups, with cluster A sharing the closest similarity to the BatCoV genome. Clusters A and C are found predominantly in the Americas and Europe, while cluster C is found across East Asia ( 18 ).

INDIVIDUAL GENETIC PREDISPOSITION/SUSCEPTIBILITY

Throughout the progression of the COVID-19 pandemic, it is clear that not all infected patients are created equal. The diversity in symptoms, morbidity, genetics, age, and geographic location all play distinct roles in viral transmission. Understanding the genetic implications underlying severe COVID-19 infection requires complex biochemical and immunological studies. Previously identified immune-related genetic variants known to be associated with susceptibility to SARS-CoV ( 61 , 85 ), including mannose-binding lectin, basigin (CD147), C-C motif chemokine ligand 2 (CCL2), interleukin-12 and human leukocyte antigen (HLA) genes, might show promise due to the shared homology of the two viral genomes ( 41 , 69 , 73 , 78 ). Utilizing our current understanding of viral entry and pathophysiology in relation to viral infection has prompted research focused on host genetic factors that may help to mitigate differences in viral replication and the innate and adaptive immune responses triggered during viral infection ( 75 ). While angiotensin-converting enzyme-2 (ACE2) receptor expression seems promising as a genetic element that could relate to immunity, no polymorphisms or mutations in ACE2 related to spike protein binding resistance have been reported in populations ( 8 ). Although rare, ACE2 variants have been identified that alter the interaction between host cells and SARS-CoV-2 causing reduced affinity of SARS-CoV-2 binding ( 66 ). Along this same line of reasoning, the gene encoding the transmembrane serine protease 2 (TMPRSS2) protease responsible for spike protein priming for viral entry has received much attention. Cell lines expressing high amounts of TMPRSS2 are highly susceptible to SARS-CoV-2 infection ( 43 ). In addition, it is known that TMPRSS2 has 2 isoforms 1 with and 1 without a 37 amino acid long cytoplasmic tail, which is thought to interact with viral spike proteins and promote viral spreading within the host ( 90 ).

Monoclonal antibodies against the spike protein of COVID-19 could play a pivotal role in blocking the virus attachment, fusion, and entry into host cells ( 67 , 72 ). Antibodies against the receptor-binding domain (RBD) of the spike protein or antibodies that bind to the ACE2 receptor have been discussed as potential therapeutics ( 67 , 72 ). Furthermore, recombinant RBD proteins have been shown to strongly bind to the ACE2 receptor in human and bat cells ( 67 ). There are also studies targeting glycocalyx loss as a therapeutic target of the spike protein. Importantly, blocking these initial steps in viral entry and replication could block the downstream cascade of COVID-19 pathophysiology. This would effectively decrease the morality rate of the current pandemic as it reduces the viral load in patients. Additionally, these antibodies could be potential candidates for COVID-19 antiviral and vaccine development ( 67 ). However, this therapeutic method would have very little impact on the case rate or the infectious propensity of the virus.

In addition, genetic alterations in immune response elements will be important in identifying possible gene candidates that could control host inflammatory responses that elicit the cytokine storm to help reduce secondary complications of infection by altering expression and activity of cytokines like IL-1, IL-6, interferons, and others ( 10 ). HLA is known to be one of the most polymorphic antigen systems in the body. In silico studies point out that all known HLA genotypes A, B, and C have affinity to bind SARS-CoV-2 peptides ( 50 ). Furthermore, predictive alleles have been found to have a binding capability that can infer susceptibility or possibly impart some T-cell-based immune response ( 50 ). Further studies have reviewed the genetic association of COVID-19 infection based on blood type ( 47 ) and sex, with the number of X chromosomes having an effect on susceptibility and progression of infection ( 20 ).

COVID-19 PATHOPHYSIOLOGY

The novel coronavirus SARS-CoV-2 was originally identified as the causative agent for a series of atypical respiratory diseases in the Hubei Province of Wuhan, China in December of 2019. The disease SARS-CoV-2, which will be termed COVID-19 from herein, was officially declared a pandemic by the World Health Organization (WHO) on March 11, 2020 ( 82b ). According to the WHO, there are 28,637,952 positive COVID-19 cases and 917,417 deaths worldwide as of September 14th, 2020 ( 82a ). As shown in Table 1 , the United States had 6,571,867 total cases resulting in 195,053 deaths, as of September 16th, 2020 according to the Centers of Disease Control and Prevention ( 10b ). Highly populated states like California, Texas, Florida, and New York have the highest total number of cases exceeding 400,000, while less populated rural states such as Vermont, Wyoming, and Maine have total case numbers below 5,000 ( 10b ). This reflects the predilection of the virus for more densely populated areas, allowing for higher rates of transmission in crowded areas compared with rural communities that are less densely populated. This can be seen in New York wherein the number of total deaths was 32,765 out numbering both California’s and Texas’s total deaths at 28,794 ( Table 1 ).

United States SARS-CoV-2 Statistics

The epidemiology of COVID-19 to date has been found to have disproportionate impacts on populations depending on sex and ethnicity. Table 1 highlights the differences in total cases and mortality by ethnicity, sex, and age. For example, in the United States ∼51.7% of total COVID-19 cases are female and 48.3% are male ( 10a ). In contrast, 54% of the total deaths in the United States are male compared with 46% female ( 10a ). The most significant predictor of poor outcome and mortality associated with COVID-19 is age. The mortality data in Table 1 include available data in nine different age brackets spanning 0–85 yr and above. Most notably, patients 50 yr and above in the United States have the highest mortality rates accounting for >94% of the total deaths due to COVID-19 ( Table 1 ; 10b , 10c ). In contrast, individuals 18–29 yr old have the highest percentage of total cases at 23.3% but only have a mortality rate of ∼0.5% ( 10b , 10c ). Older adults have higher rates of chronic health conditions that have been associated with poorer COVID-19 outcomes including hypertension, diabetes, coronary artery disease, and chronic kidney disease ( 62 ). These conditions place adults over 60 yr old at the highest risk of developing a complicated COVID-19 infection and mortality compared with younger cohorts without these conditions ( 62 ). Many patients with these conditions also take daily medications that interfere with the renin-angiotensin-aldosterone system (RAAS) such as angiotensin-converting enzyme (ACE) inhibitors for hypertension. This system has been implicated in COVID-19 infection and the virus’s ability to attach to host cells, causing dysregulated host cell responses, which subsequently results in worse outcomes ( 20 , 25 , 66 ).

Patients with COVID-19 often present with an array of symptoms that are similar to influenza that can make it difficult to diagnose. An epidemiological study of the first 41 patients infected with COVID-19 in Wuhan, China found that fatigue, cough, and fever were the most commonly reported symptoms ( 28 , 31 ). As a result, the general symptoms of COVID-19 are challenging to diagnose without reliable testing. Positive COVID-19 classifications include the following: asymptomatic, mild, moderate, severe, and critical. Asymptomatic patients test positive and exhibit no clinical symptoms while mild cases present with acute symptoms of respiratory tract infection and digestive complications. Moderate patients experience pneumonia, without noticeable hypoxemia, with lesions on chest computerized tomography (CT) scan. Severe patients experience pneumonia with detectable hypoxemia and CT lesions while critical patients experience acute respiratory distress syndrome (ARDS) along with possible shock, encephalopathy, myocardial injury, coagulation dysfunction, heart failure, and acute kidney injury ( 86 ). In a study of 80 patients hospitalized for COVID-19, over 90% had detectable ground glass opacities present on CT scan ( 31 , 84 ). A correlation was also found with the degree of inflammation seen on chest CT and lymphopenia (low white blood cell count), days of symptoms, and fever ( 84 ). Although these symptoms are often informative in diagnosis, COVID-19 has an unpredictable clinical course. As a result, 13.8% of positive patients had severe cases that required an in-patient hospital stay, with 4.7% requiring intensive care unit hospitalization and 2.3% of cases resulting in death ( 31 ). Taken together, these factors make COVID-19 difficult to manage and hard for clinicians to diagnose and predict clinical outcomes. Furthermore, real-time generation of data using artificial intelligence is an absolute priority to combat the spread, diagnosis, treatment, and categorized susceptibility to COVID-19 ( 1 ).

Understanding the pathophysiology of COVID-19 is critical to improving patient outcomes and determining how we can overcome the current pandemic. A key component to the virus being able to enter host cells and replicate is the ACE2 receptor, which is highly expressed in alveolar epithelial cells of the lung as confirmed by RNA-seq ( 91 ). The viral glycoprotein spike casing found on the exterior of a virus particle is responsible for eliciting viral entry into susceptible host cells ( 27 ). The process of viral entry requires priming of the spike protein by host expressed TMPRSS2, which interacts with the spike protein and cleaves it into two functional subunits known as S1 and S2 ( 27 , 43 , 66 ). The S1 subunit directly interacts with the ACE2 receptor, leaving the S2 subunit to facilitate viral fusion with the host cell membrane ( Fig. 1 ; 25 , 27 , 41a ). Internalization and replication of virus subsequently cause degradation of membrane-bound ACE2 receptors ( 27 ), which in turn causes an increase in angiotensin II (ANG II) and the angiotensin type 1 receptor (AT 1 R) ( Fig. 1 ). Angiotensinogen is cleaved by renin to angiotensin I (ANG I). ANG I is cleaved via ACE to ANG II, wherein it can freely interact with AT 1 R and angiotensin type 2 receptor (AT 2 R). Excess ANG I and II are hydrolyzed by ACE2 to become the heptapeptides ANG-(1-9)/ANG-(1-7) ( Fig. 1 ). Reduced or bound ACE2 is unable to hydrolyze ANG I/II, which results in an inability of the counterbalancing effects of the Mas receptor (Mas-R) to protect against detrimental disease/immune complications. As a result of COVID-19 infection, decreases in ACE2 cause elevated activity in the ANG II/AT 1 R axis, resulting in an inflammatory immune response ( 76 ). This deficiency leads to many adverse outcomes for patients including interstitial fibrosis, myocardial hypertrophy, endothelial fibrosis, and increased inflammation ( 76 ). Additionally, thrombosis and hypercoagulation secondary to platelet activation after lung epithelial damage are seen in patients with severe infections ( 39 , 86 ). Further consequences of hypercoagulation include disseminated intravascular coagulation, pulmonary embolisms, cardiac complications, and an increased risk of death ( 39 , 70 ). Coagulation is induced as a protective physiological control in response to vascular leak but in turn elicits dangerous consequences in COVID-19 patients. Often the physiologic response mechanisms to vascular leak and permeability fail, which allows for enhanced viral invasion, thus amplifying the problem in host cells on two separate fronts ( 86 ).

Biological effects of COVID-19 infection on angiotensin-converting enzyme 2 (ACE2) receptor and GTPase signaling pathways. The COVID-19 virus can bind and interact with both shed ACE2 and the cell membrane-bound ACE2 receptor. COVID-19 particles utilize and degrade membrane bound ACE2 receptors to gain entry into host cells. Virus particles also bind shed ACE2 causing a reduction in free ACE2 thus preventing the hydrolysis of ANG I/II into ANG-(1-9)/ANG-(1-7), which results in an imbalanced renin-angiotensin system that becomes skewed toward the ANG II/angiotensin type 1 receptor (AT 1 R) axis. COVID-19 produces an inflammatory response, i.e., the cytokine storm, which triggers cellular activation through cytokine receptors (CRs). Upon infection, these interactions favor detrimental complications such as acute respiratory distress syndrome (ARDS)/pulmonary fibrosis, vasoconstriction and alters cytoskeletal dynamics including cell proliferation, migration, and cytoskeletal composition. Intracellular elements such as Abelson murine leukemia viral oncogene homolog 1 kinase and Rho GTPase-associated proteins play a significant role in controlling polymerization of F-actin, maintaining the density of the extracellular matrix (ECM), and modulating myofibroblast proliferation, and the development of pulmonary fibrosis.

CARDIOVASCULAR DISEASE AND COVID-19

The highest risk factors for severe COVID-19 infection, including ARDS, is diabetes, hypertension, and a history of heart disease ( 76 ). Although the primary target of COVID-19 is the lungs, it can also have detrimental effects on the cardiovascular system. These comorbidities result in an upregulation of ACE2 on the cell surface of perivascular pericytes and cardiomyocytes, which is exploited by COVID-19 as the route of entry and infection ( 25 ). The leading cause of death in the United States is cardiovascular disease (CVD) causing more than 800,000 deaths in 2016 ( 20a ). A meta-analysis study in China found that COVID-19 causes acute cardiac injury in roughly 8.0% of patients, which poses concern for those that have a preexisting cardiac or metabolic condition ( 40 ). Cardiac injury may present as common arrhythmias, myocarditis, cardiogenic shock, and/or heart failure ( 24 , 49 ). Patients with prior cardiac history, including acute coronary syndrome and angina or myocardial infraction, have a higher risk for developing pneumonia and a decreased cardiac reserve that poses significant risks if they contract COVID-19 ( 40 , 88 ). The middle east respiratory syndrome coronavirus (MERS-CoV) is in the same corona virus family as COVID-19, has similar clinical outcomes, and has been extensively studied in patients with these comorbid conditions ( 5 ). In an analysis of 637 MERS-CoV patient cases, 30% had cardiac diseases and 50% had hypertension or diabetes ( 5 , 88 ). These cardiovascular disorders are highly prevalent in the United States, placing this vulnerable population in a higher risk category for acquiring severe infection with COVID-19. Patients with CVD may not have the ability to maintain cardiovascular function upon COVID-19 infection, leading to an increase in metabolic demand, exacerbating cardiovascular conditions thus increasing their risk for severe outcomes ( 68 ).

COVID-19 AND ACUTE RESPIRATORY DISTRESS SYNDROME

The host immune response to COVID-19 is similar to ARDS and therefore treatment modalities may be beneficial in treating COVID-19 patients. ARDS is defined clinically as bilateral neutrophilic infiltrates seen on imaging, acute hypoxia, and pulmonary edema ( 19 , 30 ). ARDS is caused by a dysregulated immune response with a fibroproliferative component due to excessive levels of cytokines, chemokines, and reactive oxygen species ( 30 ). ARDS-positive patients exhibit elevated levels of proinflammatory cytokines including IFN-y, IL-6, IL-12, and IL-1 compared with patients with uncomplicated COVID-19 infections ( 12 ). A study in ARDS positive mice confirmed these findings, wherein bronchoalveolar lavage fluid from ARDS positive mice strains had higher levels of TNF-α, IL-6, and vascular endothelial growth factor (VEGF) with reduced levels of IL-10 in comparison with controls ( 57 ). Similarly, patients hospitalized with severe COVID-19 infections have elevated cytokine profiles that are reflective of what defines a “cytokine storm.” The cytokine storm is a result of an uncontrolled immune response due to systemic inflammation and hemodynamic instability due to the abundance of proinflammatory cytokines that include IL-1, IL-6, IL-18, IFN-γ, and TNF-α ( Fig. 1 ) ( 65 ). As a result, new therapies are needed to thwart the immune response including nonconventional immunomodulation ( 22 ) to control the increase in proinflammatory cytokines that results in an accumulation of macrophages, neutrophils, and T cells from the circulation to the lung destroying the cell-cell interactions resulting in severe cases of ARDS. These findings suggest that patients suffering from ARDS and severe COVID-19 have a failed anti-inflammatory response that contributes to the excessive inflammatory damage caused by a host of proinflammatory cytokines wreaking havoc on lung tissue ( 58 ). Extensive damage to epithelial and endothelial cells of the lung triggers apoptotic destruction ( 12 ) leading to changes in the cellular junctions in alveolar tissue, thus increasing vascular permeability and ultimately alveolar fluid leak ( 30 ). Consequently, these cellular changes result in the pulmonary edema classically seen in ARDS patients ( 30 ), which is further complicated by an increase in dysregulated epithelial cell remodeling contributing to pulmonary fibrosis ( 12 ), a common cause of mortality in ARDS patients ( 30 ).

ABL1 AND VASCULAR PERMEABILITY

Abelson murine leukemia viral oncogene homolog 1 (Abl1) is a widely expressed nonreceptor tyrosine kinase that has been implicated in controlling cell morphology, growth, and survival ( 79 , 82 ). Abl1 is activated through a variety of receptor interactions and factors including cytokines, DNA damage, and oxidative stress ( 77 ). Abl1 plays a major role in modulating cytoskeletal dynamics influencing cell proliferation, cell survival, endocytosis, membrane trafficking, and cell-cell junctions and is also implicated in solid tumor proliferation and survival ( 34 ). Abl1 signals proteins that are critical to extracellular matrix (ECM) function and composition including the formation of actin stress fibers. These fibers interact with F-actin, inducing filopodia, which can alter cell-cell junctions ( 59 , 79 , 82 ).

Inhibition of Abl1 leads to increased Rho-Rock signaling, actomyosin contractility, and destabilization of cell-cell adhesions leading to an increase in barrier disruption ( 16 , 59 , 87 ). There is a direct implication of Abl1 as a therapeutic target to regulate GTPases in an effort to control ARDS and fibrosis as a result of disrupted endothelial barrier function and vascular leak in the lungs of ARDS patients ( 45 , 82 , 87 ). This critical association can be detrimental in ARDS, pulmonary fibrosis, and in severe cases of COVID-19 infection when vascular leak becomes uncontrolled and leads to sepsis ( 30 ). Multiple studies have investigated therapies to preserve endothelial barrier function. This includes the therapeutic use of low molecular weight heparin to combat the degradation of heparin sulfate by heparinase, thus protecting the endothelial barrier ( 7 ). Furthermore, the drug imatinib, an Abl1 inhibitor, has been investigated for possible repurposing and use for lung injury patients ( 36 , 82 ). One study found that pretreatment with imatinib protected against acute lung injury in mice ( 36 ) and may have potential to be repurposed in patients suffering from ARDS and/or COVID-19. Case studies report that imatinib resolved pneumonitis and pulmonary fibrosis secondary to antibiotics ( 9 , 59 ). Selective targeting of Abl1-based therapeutics needs further investigation to avoid potential negative side effects. For example, studies have shown that inhibiting Abl1 leads to increased endothelial permeability because of F-actin alternations and is amplified in cells undergoing cyclic stretch secondary to mechanical ventilation ( 38 , 59 ). As a result, increased vascular permeability will lead to an acceleration in vascular leak, exacerbating outcomes in ARDS patients.

PULMONARY FIBROSIS AND GTPase SIGNALING

While much is known about the progression of COVID-19 and ARDS, the mechanism of pathophysiology and associated treatment strategies are still under investigation. One such area includes GTPase signaling and its role in the development of ARDS and subsequent pulmonary fibrosis. Pulmonary fibrosis is caused by excessive fibroblasts and ECM protein deposits in the lungs, referred to as scarring of the lungs ( 4 ). Myofibroblasts are derived from resident fibroblasts and mesenchymal cells in the lung that express high amounts of smooth muscle actin ( 29 ) and are major players in the production of excess collagen leading to progressive fibrosis in patients ( 6 ). The overall ECM composition and stiffness have a direct impact on the degree of fibroblast migration, proliferation, and differentiation ( 4 ). Studies have shown that denser ECM substrates in later stages of disease show higher fibroblast migration levels compared with decreased fibroblasts migration in less stiff substrates as seen in earlier stages ( 6 ). One pathway with therapeutic implications in these physiological processes is the Rho GTPase signaling cascade ( 6 , 82 ).

Rho GTPase signaling has vast cellular implications in the control of actin and myosin stress fiber formation, regulation of cell adhesion molecules, cell migration, and common cellular functions ( 81 ). In addition, Rho GTPases play significant roles in cytoskeletal actin remodeling by polymerization and de-polymerization of monomeric G-actin leading to the conversion of F-actin ( 29 ). Increases in F-actin fibers causes stiffening of the ECM in patients suffering from ARDS leading to decreased vascular compliance ( 33 ). ARDS patients often require some form of oxygen supplementation due to severe hypoxemia. These measures often lead to hyperoxia and cause acute lung injury compounding damage to the lungs ( 30 , 44 ). Interestingly, hyperoxia in mice was found to activate the Rho/ROCK GTPase pathway and led to an increase in cell stiffness secondary to F-actin increase. However, when these mice were treated with Y-27632, a Rho inhibitor, the cytoskeletal changes in stiffness were prevented ( 81 ). These results suggest a possible connection in the control of GTPase signaling and ARDS and/or fibrosis complications seen in patients who require supplemental oxygen. Therefore, therapeutically modulating the increased activity of the GTPase cascade could decrease the adverse effects of ARDS pathogenesis secondary to ECM remodeling events.

As previously discussed, the Rho GTPase pathway regulates ECM density ( 81 , 82 ). This leads to the conclusion that higher activation levels of Rho and associated downstream targets lead to a higher levels of fibroblast proliferation. The ACE2 cascade is protective against lung fibrosis through activation of Rho GTPase pathways, while ACE is damaging and stimulates fibrosis in lung endothelial cells ( 46 ). These findings correlate to the virus’s predilection for patients with a history of obesity, hypertension, and CVD as these chronic conditions have been found to have lower levels of ACE2 at baseline ( 76 ). Therefore, the interplay between the ACE2/ACE and the Rho GTPase pathway may be an important association that could be a target for therapeutics to block lung fibrosis that results in ARDS and a majority of the mortality in COVID-19 patients. A study performed by Haung et al. proved this association by showing blockade of the Rho GTPase pathway inhibits matrix stiffness and alters stress fiber formation in fibroblasts ( 29 ). Therefore, Rho is actively involved in the underlying mechanism of pulmonary fibrosis by controlling proteins critical to modulating the ECM. A few significant trials have tested this theory for idiopathic pulmonary fibrosis by using nintedanib, a multikinase inhibitor, and pirfenidone, a small molecule antifibrotic, both of which were shown to reduce loss of lung functioning in pulmonary fibrosis patients ( 6 ).

STRATEGIES FOR SARS-C o V-2 THERAPEUTICS

Controlling the extensive spread and progression of SARS-CoV-2 has proven very difficult and will require a multidisciplinary approach with global collaboration. While certain areas of interest in SARS-CoV-2 remain unknown, past coronavirus knowledge provides scientists with the foundation for the development and/or repurposing of therapeutic interventions and vaccine development. Since the spike protein of each individual type of coronavirus is unique, this protein is currently being targeted in vaccine development as an approach to block initial entry of the virus ( 2 , 63 ). Multiple vaccines have entered clinical trials, the first of which is an RNA-based vaccine, mRNA-1273 ( 26 ). This vaccine entered phase I clinical trials on March 16, 2020 in collaboration with the National Institutes of Health (NIH), utilizing 45 healthy participants ranging in ages from 18 to 55 yr old ( 2 ). Although science has provided the foundational studies on vaccine development, the time needed to assess the safety and efficacy of vaccine candidates is a major bottleneck in the overall process.

While vaccines are being tested and manufactured, novel therapeutic treatments for the control and clinical management of COVID-19 infection are needed. Numerous approaches for treatment have been anecdotally reviewed in mainstream media; however, there are currently no Food and Drug Administration-approved medications for the treatment of COVID-19 infections ( 13 ). Still, there are a number of medications under evaluation for their effectiveness as potential antivirals that are recommended for use in the National Institutes of Health COVID-19 treatment guidelines ( 13 ). A noteworthy example of a current therapeutic intervention includes the use of convalescent plasma therapy ( 15 , 64 ). In this process, plasma-containing-neutralizing antibodies, removed from a donor who has previously recovered from a SARS-CoV-2 infection, are administered to infected patients to impart protection. Another unique therapeutic method involves treatment with soluble recombinant human ACE2 to disrupt viral entry via the spike protein-ACE2 interaction. Initial testing with recombinant ACE2 in simian cell lines and engineered human tissues shows promise in reducing viral load in a dose-dependent fashion ( 48 ). Finally, due to the high sense of urgency in clinical treatment of COVID-19 infection, the repurposing of known antiviral drugs has been explored with extreme caution, and the rationale are outlined in the NIH COVID-19 Treatment Guidelines ( 13 ). The treatment guidelines have the current recommendations either for or against the use of known antiviral drugs and the existing clinical trial data from the National Institutes of Health ( 13 ). Furthermore, implications for the use of some drugs have been identified using in silico databases that predict protein-protein interactions ( 23 , 74 ). Antiviral therapies contained in these studies include remdesivir, ivermectin, favipiravir, kaletra, and chloroquine/hydroxychloroquine with or without azithromycin ( 13 , 23 , 74 ).

The COVID-19 pandemic continues to pose a serious public health threat to nations around the world, as effective antiviral therapeutics or vaccines are yet to be developed. The primary goal in the COVID-19 pandemic is to limit transmission and define clinical management that improves the cure rate and effectively reduces the overall mortality rate. To achieve this goal, a complete understanding of all aspects of coronaviruses is needed to prevent or lessen their threat to society in the future. A thorough understanding of the epidemiology, pathophysiology and pandemic response efforts to combat COVID-19 is an invaluable lesson to society providing a protocol to fight future pandemics should they occur. Most importantly, scientific insights gained in the fight against COVID-19 will provide the evidence needed to develop vaccines and antiviral therapeutics that target viral entry, immune response and activation, and clinical management of secondary complications associated with severe infections.

M.P.M. and A.L.N-K. acknowledge funding support from the University of Toledo University Research Funding Opportunities (URFO) Program - Interdisciplinary Research Initiation Award I-127366-01.

DISCLOSURES

No conflicts of interest, financial or otherwise, are declared by the authors.

AUTHOR CONTRIBUTIONS

C.A.P., M.P.M., and A.L.N-K. prepared figures; C.A.P., M.P.M., and A.L.N-K. drafted manuscript; C.A.P., M.P.M., and A.L.N-K. edited and revised manuscript; C.A.P., M.P.M., and A.L.N-K. approved final version of manuscript.

Global Health Humanities Essays

Humanities Futures at the Franklin Humanities Institute has published a series of Global Health Humanities Essays. You can read them here .

This set of essays from the Global Health Humanities Working Group includes two explorations, by Gregg Mitman and Alvan Ikoku, of the troubled imbrications of “Africa” in the historical development and visual imaginary of global health. Two fascinating and moving personal essays from the Breath | Body| Voice conference by Juan Obarrio and Alan Bleakley that jnspire a new, holistic way of thinking about health, illness, and memory. It also proposes new ways of thinking and new forms of publishing with comic illustrations (“The Health Humanities and the Future of Publishing” by Craig Klugman) and a think piece that is made up entirely of drawings (“Frames of Thought” by Nick Sousanis).

Theorizing the Emergence of Global Health Humanities is convened by Deborah Jenson (Romance Studies & Global Health / Franklin Humanities Institute) and Kearsley “Karrie” Stewart (Duke Global Health Humanities). * Image: Little Crippled Haiti (2006) by Edouard Duval Carrié.

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• Volume 5, Issue 5
• Global health beyond geographical boundaries: reflections from global health education
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• http://orcid.org/0000-0002-5270-1170 Sibylle Herzig van Wees 1 ,
• Hampus Holmer 2 , 3
• 1 UGHRIS - Uppsala Global Health Research on Implementation and Sustainability, Department of Women's and Children's Health , Uppsala Universitet , Uppsala , Sweden
• 2 Department of Global Public Health , Karolinska Institute , Stockholm , Sweden
• 3 Center for Policy Impact in Global Health, Duke Global Health Institute , Duke University , Durham , North Carolina , USA
• Correspondence to Dr Sibylle Herzig van Wees; sibylle.herzigvanwees{at}kbh.uu.se

https://doi.org/10.1136/bmjgh-2020-002583

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Our experience suggests that global health is often taught as ‘public health somewhere else’.

However, the experience and demands of global health students and pressing global health issues in all settings require a different approach.

We, therefore, suggest that a more useful definition of global health is to move beyond the notion of geographical boundaries, with ‘global’ instead referring to a holistic, multidisciplinary perspective of health.

We suggest that current global health educational practices include a broader disciplinary scope and focus on educational examples from throughout the world, including one’s own local context.

Introduction

As global health educators and researchers from Sweden, we read King and Koski’s 1 argument that global health should be defined as ‘public health somewhere else’ with interest and recognition. Often, global health has been and still is being taught and practised precisely in this way, too often without critical reflection about expertise, accountability and inefficiency, as pointed out by the authors. From our experience of teaching global health, two themes both confirm and challenge the notion of global health as public health somewhere else: the experience and demands of global health students, and the existence of global health problems in our local setting. In this commentary, drawing on examples from global health education, we call for an urgent revision of current teaching practices. In order to do so, we propose a reframing of the global health definition with a move away from a focus on geographical boundaries and instead focus on the global scope of the discipline.

Experiences from global health education

Pressing health issues exist in all countries, and in the best of worlds, global health education can provide both tools and curiosity to explore these issues in any setting, including high-income settings. Meanwhile, global health courses particularly in undergraduate medical education including medical schools frequently include field visits to low-income countries. These courses are very popular, but not entirely unproblematic. On the one hand, experiencing a context different from one’s own can be a transformative experience, hard to come by without travelling, but on the other hand they may reinforce the idea that global health is about health somewhere else, decreasing interest in health issues at home while carrying a huge carbon footprint and perpetuating colonial or neocolonial practices. The latter is particularly true when such experiential learning is not sufficiently narrated by teachers. 3 4 In a similar vein, we have observed that medical students often appear to lack interest in traditional public health and social medicine courses within the medical curriculum, but ‘global health’, which covers much the same subjects, is seen as interesting, perhaps due to the perception that it is somehow exotic and involves international travel.

There are several reasons that can explain why we teach global health as public health somewhere else. Global health emerged from tropical medicine and international health, 5 and there are remnants of that in many departments, reflected in a lingering resistance to changing the name of departments, curricula or teaching practices. Moreover, because global health has its history in tropical medicine, many global health teaching programmes are located in schools or faculties of medicine, rendering it challenging to shift towards a curriculum highlighting the social sciences.

Beyond geographical boundaries: towards a new definition

If global health is not about health somewhere else, what does it constitute? We suggest that teaching global health should prioritise the development skills and perspectives necessary to understand health and how it can be improved, which can be applied to any setting or context, and less about learning about health issues in low-income countries. Topics such as health equity, health systems and global health politics invariably generate discussion about students’ local context and experiences, wherever they may be. We believe that separating such discussions between a local and a global context—particularly when it involves the common phrase in definitions of global health: ‘those health issues that transcend national boundaries’—is counterproductive. It is not clear when a health issue transcends a national boundary, and frequently, understanding health issues in their national, subnational, historical, political, cultural and economic context is far more helpful, even if it is not ‘somewhere else’. Therefore, we believe that it is crucial that the definition of global health moves beyond geographical boundaries. We interpret the word ‘global’ in its abstract sense—‘of, relating to, or applying to a whole’. 6 Thus global health is about taking a holistic perspective of ‘health’, or about the disciplinary scope rather than its geographical reach.

There are some encouraging examples suggesting a move away from global health as public health somewhere else. For example, the recent renaming of the Karolinska Institute Department of Global Public Health suggests that the separation between those working in global health and those working in local health is reducing. The elective Global Medicine course for medical students at Uppsala University offers students to remain in Sweden as opposed to going abroad to gain practical experience in global health. The COVID-19 pandemic has accelerated the development of local and online global health learning activities replacing international travel. While such examples are promising, we propose further efforts to emphasise the global scope of health as opposed to the geographical reach. This includes getting students in our global health courses to reflect on health inequalities in their own society. We believe that the notion that global health is something that occurs abroad contributes to a demand for short international electives—usually presented without mention of ethical issues and their carbon footprint—while at the same time undercutting efforts to address health issues at home. Indeed, while there is great enthusiasm for ‘doing global health’ by travelling abroad to practise as a nurse or doctor, exceedingly few are interested in contributing to health equity at home. For example, primary care centres in deprived areas such as Rosengård, outside Malmö, Sweden, experience chronic vacancies.

What should the ideal global health curriculum contain? In our view, the range of disciplines necessary to understand and influence health encompasses anthropology, biology, ecology, economics, history, medicine, philosophy, political science and statistics. The history and politics of global health play particularly important roles to help understand the context of the discipline. 7 As Tollulah Oni and colleagues write:

Students should be equipped with the skills required for action focused on upstream determinants where they originate (not simply addressing the negative consequences of skewed global systems), a greater engagement by the global health community with social and political sciences, and a readiness to act politically and challenge the status quo. 8

We do believe that understanding health around the world is a core component of global health—no matter where you are from, most people live in other countries than your own. Comparing and contrasting countries is an effective learning tool, and evidently certain health issues are more concentrated in some countries than others. However, health issues exist, in varying degrees, in all communities, and improving health demands a ‘global’ view, in the widest sense of the word. We further propose that local study visits and trips should be encouraged, such as non-governmental organisations addressing social determinants of health, migration, and health centres and local health councils.

Lastly, we need the institutional support and flexibility to make these changes, without which senior staff must feel threatened in their position or their practice. We call for an open dialogue that has one thing in view: building a global health workforce that embraces and practises the achievement of equitable health for all. Yet we argue that this will only happen if we reimagine global health as a truly interdisciplinary area of research and practice—not simply public health somewhere else. As global health educators in the 21st century, it is our role to change the current narrative through good educational practice.

• ↵ Decolonizing global health conference , 2020 . Available: https://sites.duke.edu/dukedgh/ [Accessed 1 Apr 2020 ].
• Merriam-Webster
• van Wees SH
• Yudkin JS ,
• Fonn S , et al

Twitter @s_wees

SHvW and HH contributed equally.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; internally peer reviewed.

Data availability statement There are no data in this work.

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Global Health Issues: Essay Example

Global health essay: introduction.

A study conducted to investigate global health’s plight reveals that it is at its utmost disaster. The study shows that the new skills brought about by science and medicine have failed to meet the global population’s needs. Although outstanding enhancements have been prepared in the health condition globally over the last century, these improvements have not met the requirements of everyone. The reason behind this is the dissimilar living standards in different countries.

It is believed that the significant risk to the existing and developing health disaster tend to be those obliged to societal determinants confirmed to harmfully affect people’s health, including poverty and unsafe living and effective surroundings. Weak health schemes, worldwide deaths, and disparities in the health staff, among others, bring about global health disorders. (Schnurr et al. 398)

As one of the most alarming disasters in global health, hunger has done a lot in slowing down many countries in the world. Haiti, my country of birth, is one of the countries affected by global health issues. Haiti is believed to be a country that has never enjoyed freedom for a long time. Many may wonder why there is so much hunger in the country; the reason behind it is because of the poverty that has dominated the country.

Poverty in Haiti is exceptional due to poor governance, education, and the continued earthquakes (Shah para. 5). The lack of support in the agricultural sector has also contributed a lot towards hunger in the country, a position that Jacques Diouf, the Director General of FAO agrees with. Diouf states, “Economic and social reconstruction of the country needs a restoration of food production and massive investment in rural area” (Jere 1752). For this reason, you will find that almost everybody in Haiti is affected directly or indirectly.

The research shows that in the 21st century, hunger is the leading risk to health worldwide. A report published by the World Health Organization reveals that hunger kills more people than cancer, heart disease, AIDS, malaria, and tuberculosis combined. It is also estimated that in every four children, one is underweight.

Due to the underweight condition, a child is likely to die from infectious diseases because of weakened immunity. According to one of the American researchers, “the hungry are the poorest of the poor, and enhancements in poverty don’t automatically reach them” (Dickenson 7) as it has been in Haiti. The impact of hunger can bring about poverty, malnutrition, and HIV/AIDS, among many more.

As many people know, poverty dramatically impacts the global health issue. The researcher has clearly proven that you may have nothing to eat if you are poor. Unlike in Haiti, many people are poor due to inadequate support from the government, which has not been stable for quite some time due to the alarming issues that arise in the country continually. It is believed that the most significant number of people in Haiti live below the poverty line causing the speedy growth of poverty in the country. (Jere, 1754)

Malnutrition

Malnutrition is not something new to the people of Haiti. Research shows that Haitians are chronically underfed due to insufficient food. Undernutrition affects the immune structure, mounting to the occurrences and sternness of diseases, and is an allied issue in approximately all children’s deaths. (Dickenson 8)

This disease will always withstand due to the lack of money caused by the country’s poor economy. In this case, many people indulge in prostitution in search of money, which is one of the most common ways of contracting HIV/AIDS. The behavior has spread rapidly due to poor governance, lack of enough to eat, and lack of education. In this situation, little is done to kick the disease out of the country. (Dickenson 9)

Current Aid Organizational

For these reasons, some organizations have come together to help this country from this alarming situation. These organizations are educating the people of Haiti, bringing about new technologies, and changing the drastically deteriorated economy. Some of these organizations include the Students for Global Citizenship Club (S4GC), Boston Aid Groups Lead, cell phones help aid groups, and the cholera struggle aid groups (Jere 1754).

Students for Global Citizenship Club (S4GC)

This organization has done a lot in promoting the responsiveness of Haitians regarding global matters and movements dealing with activism and volunteerism. The aim is to develop the lives of others. For this reason, the people of Haiti have learned how to help one another in times of need.

They have also learned the need to unite and form organizations that would take the country to great heights. Despite all the challenges Haitians face, they have something to enjoy after having centers that can now cater to their needs, especially regarding activism and leadership (Schnurr et al. 398).

Boston Aid Groups Lead

This organization has helped Haitians a lot by saving them during the earthquake. The organization also funded the victims of the earthquake. In doing so, the Haitians could not feel left behind from the comfort they received from this organization that was willing to heal their wounds even during these challenging times.

This organization has been doing wonders, even providing medical treatment for injured people during disasters. In these times of disaster, the organization remembers to advance nutritional aid and provide clean water for them to drink. It has developed and empowered the Haitians, so they can now better do the work by themselves. (Schnurr et al. 399)

Cell Phones Help Aid Group

Cell phones helped the Haitians a lot during this tough period. The main aim of this organization was to collect any relevant information that could assist the people whenever necessary. Any news that arose in the country was easily transmitted, and stern measures were taken immediately or before anything wrong happened.

This technology made the people feel connected, so they were eager to participate in the organization, finally leaving them with new knowledge. This technology simplified things since, previously, people could walk long distances to pass simple information. Now they have the chance to make use of the available technology, effectively saving on time and cost (Dickenson 10).

Cholera Intensifies Struggle for Aid Group

Due to the continued lack of proper diet, water pollution, and education, diseases had a wide path to enter the people of Haiti. This organization provided the most necessities in fighting any epidemic in the country. The organization was there to help stop the spread of disease, educate the people about appropriate hygiene, and humanize the dumping of unwanted waste. It was great for the country, making the people civilized by learning of all these (Schnurr et al. 399).

Illiteracy is among the leading issues associated with health problems. The level of illiteracy in Haiti is high, meaning that people cannot practice healthy eating habits. The discrepancy between the rich and poor is very high in Haiti. This discrepancy has led to increased health-related problems among poor citizens.

According to Kendall (293), Montrouis, Haiti has a club med that hosts the affluent people of the society and tourists. In contrast, just a few kilometers away, we have open markets characterized by raw meat, flies, homeless people, and malnourished families. It is a scenario of the rich bordering on the poor who live in adverse poverty and health-related issues. Haiti is not only the poorest state in the Western region but also cannot feed its citizens.

Due to that, people are exposed to malnutrition-related diseases like Marasmus and Kwashiorkor, among other conditions. According to Kendall (293), statistics show that an estimated 40 percent or more of the children in Haiti are chronically malnourished. The statistics also show that more than 80% of Haitians’ eating habits are poor, and they take less than 2,200 calories daily. The discrepancy is also seen in the income sector, where poor citizens are low-income earners who cannot afford food and medical services. 

Healthcare quality is low in poor nations, and people hardly receive it. Most countries in the developing world are faced with this issue. The dissemination of healthcare facilities and healthcare is expensive to deliver to the people. The cost of medicine, medical care, insurance, and accessibility to the healthcare infrastructure are the drawbacks that hinder the delivery of adequate and quality healthcare.

Hospitals lack medical services providers and health doctors. According to Goldstein (41), Haiti is one of the poorest nations that provide low-quality and inadequate healthcare, and its citizens are affected by this. Statistics by the WHO estimate that for every 100,000 Haitians, only eight doctors and ten nurses (Goldstein 41) are available. It has been recorded as the lowest ratio in the healthcare sector in the world, and hence a global issue.

The scenario is worse even in other parts of the world, whereby most clinics, national hospitals, and even health doctors located in urban centers cannot be accessed easily by low-income earners and those living in rural areas. Rural dwellers have limited access to medical and healthcare facilities. A study done in Haiti by the World Health Organization has shown that rural dwellers in Haiti face this problem, and it has become a significant concern to aid and humanitarian organizations.

Low life expectancy has become a health issue in the world. Most nations, especially the ones with low economies, face low life expectancy. In Haiti, life expectancy is as low as 53 years for women and 50 for men (Goldstein 41). Infant mortality is also high, with many children dying before their first and fifth birthdays.

The report shows that of every 1000 children, 74 die before celebrating their first birthday. Their mothers also die, with more than 520 women dying during childbirth. It has been attributed to low income, while inaccessibility to healthcare facilities has also contributed to the observed scenario. A comparison of the situation in Haiti with that of the United States reveals an existing gap between the developing and the developed countries.

Sanitation has become a global health issue affecting most societies worldwide. In developing countries, sanitation facilities like sewerage and toilets and access to cleaner and safer water are not well accessed. This situation is attributed to some of the factors and issues discussed in this paper, like poverty, low income, the discrepancy between the poor and the rich, and the management of the economies of these countries. In Haiti, access to proper sanitation is worse, given that it is an island recently hit by a devastating earthquake.

Drinking water in Haiti is not clean and is mainly drawn from rivers polluted with industrial and human wastes (Goldstein 41). Diseases such as typhoid, cholera, and hookworm, among others, are therefore widespread in the country. The situation has affected the population and has become a concern to the humanitarian and aids organization. Malaria, a killer disease in Africa, is also a considerable concern in Haiti because of the poor drainage system and malnutrition known to weaken the body, making it vulnerable to disease.

Observations in Global Health Issues

In general, global health issues have a significant impact on many countries, especially Haiti. It is because the country has never enjoyed the fruits of its labor, unlike the other countries. Some of the impacts, like poverty, malnutrition, and HIV/AIDS, have contributed significantly to a slowdown in the country’s economic growth. Other impacts like poor sanitation facilities, poor quality healthcare facilities, discrepancies between the poor and the rich, and low life expectancy have been part of the health issues in Haiti.

The paper summarizes how with the help of humanitarian organizations, poor Haiti now has something to smile about. Research indicates that Haitians had nothing to smile about until these organizations stepped in. They have dramatically changed the country, leaving something they can smile for with them.

Health Issues Essay: Conclusion

Hunger is a global health issue that can leave someone with no joy at all. Hunger has proven to be the leading disaster as a global health issue of significant concern to governments, and the situation is no different in Haiti. The paper clearly shows how hunger has resulted in the spread of HIV/AIDs, malnutrition, and poverty, among others, in Haiti.

The paper also shows that the discrepancy between the poor and the rich contributes to poor health in Haiti. Quality of healthcare and healthcare facilities has also contributed to most global health issues like malnutrition, low maternity, and mortality rate. Sanitation that includes sewerage, toilet, and drinking water are common issues inhibited in the world and Haiti.

Works Cited

Dickenson, Nancy. Global Health Issues and Challenges. Journal of Nursing Scholarship 36.1 (2004): 6-10. Print.

Goldstein, Margaret J. Haiti in Pictures . Minneapolis: Lerner Publications Co. 2005. Print

Jere, Behrman, “The Economic Rationale for Investing in Nutrition in Developing Countries”, World Development 11. 11(npg): 1749-1993. Print.

Kendall, Diana, E. Sociology in Our Times . Belmont, CA: Thomson/Wadsworth, 2008. Print.

Labonte, Ronald. “Setting global health research priorities. Burden of disease and inherently global health issues should both be considered” , BMJ Journals 326. 7392 (2003 ):326- 722. Print.

Schnurr, Paula, Kaloupek, Danny, Sandra Bloom, Stuart Turner & Kaltman, Stacey. “Grand Challenges in Global Health”, Science journal 302.5644 (2003): 398-399.Print.

Shah, Anup. World Hunger and Poverty . 2010. Web.

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Global Health Programs Essay

One of the most necessary and important parts of the world’s wellbeing is the healthcare system and especially global health programs. However, the way such programs and policies are designed and delivered makes the difference between just doing good and actually improving people’s health on a large scale. The purpose of this paper is to discuss global health programs and list the key ingredients to developing a successful global health policy. Also, challenges and barriers to the creation, funding, and dissemination of global health programs will be discussed. Besides, the way a past successful global health program has positively affected this professional field will be explained.

There are several factors required for every global health program to be successful. As getting public health programs work takes huge amounts of money, funding from local and international sources is necessary. Being able to afford and use new technologies, for instance, micronutrient supplements, vaccines, and drugs permits the global health program to produce health gains and work more effectively. Proper management is the third factor that affects the success rate of a program. An appropriate health service delivery needs motivated and trained workers to be available and to have the required equipment, supplies, supervision, and transportation to do their job well.

In addition, there are several challenges that any global health program faces and has to deal with. First of all, it is necessary to understand people’s needs and demands for services. These are the factors that change from time to time and influence the main goals of a new global health program that needs to aim at the most severe problems (Shiffman, 2017). Also, after creating the plan for a new program, the next step is to find enough financial resources for making it work. Finally, qualified and experienced workers are also needed for any program to be successful.

There are many cases of proven success in global health programs. One of them is defeating meningitis A in twenty-six African countries. For many centuries, it was an awful severe disease that often led to fatal consequences (Glassman & Temin, 2016). The necessary treatment was too expensive for those countries that needed it most. Fortunately, the global coalition united and found an Indian pharmaceutical company that agreed to vaccinate people for a very small price. Millions of citizens from fifteen countries have been healed, and nowadays, in these areas, meningitis A is almost destroyed.

Glassman, A., & Temin, M. (2016). Millions saved: New cases of proven success in global health . Washington, DC: Brookings Institution Press.

Shiffman J. (2017). Four challenges that global health networks face. International Journal of Health Policy and Management , 6 (4), 183–189.

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IvyPanda. (2022, February 9). Global Health Programs. https://ivypanda.com/essays/global-health-programs/

"Global Health Programs." IvyPanda , 9 Feb. 2022, ivypanda.com/essays/global-health-programs/.

IvyPanda . (2022) 'Global Health Programs'. 9 February.

IvyPanda . 2022. "Global Health Programs." February 9, 2022. https://ivypanda.com/essays/global-health-programs/.

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IvyPanda . "Global Health Programs." February 9, 2022. https://ivypanda.com/essays/global-health-programs/.

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Mortality landscape in the global burden of diseases, injuries and risk factors study

Affiliations.

• 1 Chair of Nephrology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation; Department of Nephrology Issues of Transplanted Kidney, Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation; Moscow City Nephrology Center, Moscow City Hospital 52, Moscow, Russian Federation. Electronic address: [email protected].
• 2 IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy.
• 3 IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy; Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
• PMID: 24084027
• DOI: 10.1016/j.ejim.2013.09.002

The Global Burden of Diseases, Injuries and Risk Factors Study 2010 (GBD 2010) is an initiative that involved 486 scientists from 302 institutions in 50 countries, under the leadership of a consortium formed by the Institute for Health Metrics and Evaluation of the University of Washington, World Health Organization, the University of Queensland School of Population Health, the Harvard School of Public Health, the Johns Hopkins Bloomberg School of Public Health, the University of Tokyo and Imperial College London. The study has provided a state of the art understanding of the burden of 67 risk factors and their clusters, 291 diseases and injuries on global, regional and national levels in period from 1990 to 2010 for 187 countries. GBD 2010 estimates covered both mortality (expressed in number of deaths, years of life lost (YLL) due to premature mortality) and morbidity (mainly expressed as years lived with disability (YLD)), while the incidence and prevalence were not reported for majority of causes so far, although they were accounted and used for YLD calculations. Finally, each disease and risk factor was presented in terms of the disability-adjusted years of life (DALY) that is merely a sum of YLL and YLD. The major published results of GBD 2010 cover global and regional levels for all diseases and risk factors. Reports focused on specific conditions are also available. At country-level detailed estimates are published for UK, China and USA, and data on other countries are accessible only as aggregate partial representation via web-based tools.

Keywords: Epidemiology; Global health; Mortality; Risk factors; The Global Burden of Disease 2010 Study.

Publication types

• Cause of Death*
• Global Health*
• Risk Factors

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Worldwide CHOP Global Health Youth Essay Competition

Global health center.

Arabic | Spanish | French  | Chinese

Call for youth stories

We invite you to draw from your personal experiences to submit an essay in response to the prompt: 

“In the era of decolonizing global health, do high-income countries (HIC)* have an obligation to advance child health in low- and middle-income countries (LMIC)*?”

Eligibility

• To apply, you must be between the ages of 12 – 19 years old.
• Prior year winners are not eligible to apply.
• You can apply from anywhere in the world.

How it works

• Essays can be submitted in Arabic, Chinese, English, French, or Spanish.
• Essays must be double-spaced and typed in Times New Roman 12-point font.
• You are welcome to include an  optional  short video (1 min or less), poem, song (1 min or less), or visual art piece. Though the quality of these pieces will not be counted toward the review of your essay, they should enhance the message of your submission.
• Your submission must contain original content that speaks to your own ideas or experiences.
• Co-authorship is acceptable as long as all authors meet all eligibility criteria; however, only one submission per individual or group is permitted.
• Essays will be reviewed as they’re submitted and winners will be announced by Friday, Sept. 8, 2023. Winners will be selected based on their essay’s overall excellence excellence in response to the prompt.
• We will showcase these interviews at the 15th Annual CHOP Pediatric Global Health Conference (Friday, Sept. 29 – Saturday, Sept. 30th, 2023).
• There shall be three cash prizes: a First Prize of $150 , a Second Prize of $125 , and a Third Prize of $75 , in US dollars.
• Winners will also receive free access to any portions of the 15th Annual CHOP Pediatric Global Health Conference that will be live-streamed and/or recorded.

Irène Said Yes to Pediatrics

Irène Mathieu, MD, a resident in General Pediatrics and Global Health at CHOP, describes what led her to a residency in pediatrics.

Impact of Global Health Center

Each year over 5 million children worldwide die before their fifth birthday due to preventable and treatable illnesses. CHOP's Global Health Center is changing this.

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Research Topics

Opening health for all: 7 research topics shaping a healthier world.

Despite recognizing health as a fundamental human right, we currently live in a world where half the population can't access the medical care they need , according to the World Health Organization (WHO). In response, World Health Day 2024 rallies under the theme "My health, my right," demanding quality healthcare, clean air, and healthy environments for all.

The call aligns with Sustainable Development Goal #3: good health and well-being , which includes targets such as universal health coverage and strengthening the capacity of all countries, particularly developing countries, for early warning, risk reduction, and management of national and global health risks.

To second this mission, we have picked 7 Research Topics that tackle some of the world's toughest healthcare challenges. These topics cover ensuring everyone's access to healthcare, life-limiting illness as a public health challenge, and the ethical challenges in digital public health.

All articles are openly available to view and download.

1 | Public Health in the Context of Life-Limiting Illnesses: Patient-Centered Care in Advanced and Life-Limiting Illnesses

Palliative care is holistic, person-centered care and has played a critical role in recent disease outbreaks, environmental disasters, and other humanitarian crises. It is also integral to public health and public health strategies.

At least 60% of people who die have a prolonged advanced illness. The need for palliative and end-of-life care will increase due to the rapidly aging world population and the increase of multiple long-term conditions.

Consequentially, this Research Topic discusses advanced and life-limiting illness as a public health challenge. It also explores the role of palliative and end-of-life care, including rehabilitation, in shaping person-centered care.

25,000 views | 16 articles

2 | Ethical Considerations for Digital Public Health

Public health guidelines and policies relating to digital public health are essential to protecting the population. Accessing health services entails an obligation of care, and understanding the role of artificial intelligence (AI) and machine learning (ML) is also necessary.

That’s why this Research Topic focuses on ethical challenges in digital public health. It highlights advances in public health and the ethical questions that may arise when considering the best practices for tools such as AI and ML.

24,000 views | 10 articles

3 | Cardiovascular Health in Children and Adolescents: Present and future

Cardiovascular disease is the most common chronic non-infectious disease and is ranked as the number one cause of death in the world. Although usually manifested at older ages, massive studies have shown that cardiovascular risk factors are tracked from childhood and adolescence to adulthood.

Good cardiovascular health in childhood and adolescence is thus highly important for preventing the development of cardiovascular disease. With this purpose in mind, we introduce a Research Topic that sheds light on the current situation and future cardiovascular health trends in children and adolescents.

14,000 views | 34 articles

4 | Nutrition and Sustainable Development Goal 3: Good Health and Wellbeing

Good nutrition leads to improved health and well-being, which is one of the UN's 17 Sustainable Development Goals (SDGs). Therefore, this Research Topic focuses on nutrition in this context and other relevant SDGs.

Among others, it covers topics such as nutrition and physical and mental health, the role of nutrition in non-communicable and infectious diseases, universal health coverage, and the influence of data platforms on dietary shifts.

28,000 views | 41 articles

5 | Evidence-based approaches in Aging and Public Health

Aging is having a global and significant impact on health, finance, the economy, and society. It is crucial to have an evidence-based approach to understanding the causes of diseases and preventing or treating them.

In this Research Topic, scientists explore evidence-based medicine applied to aging populations, the application of AI and digital markers for early disease detection, and tools, algorithms, guidelines, and policies to facilitate healthy aging, among other matters.

23,000 views | 15 articles

6 | Education in Public Health: 2022

Public health professionals play a vital role in maintaining the health and well-being of the population by working to prevent disease and ultimately prolong individuals' lives.

These researchers work to influence policy, educate everyone on improving their health, and bridge the inequality gap by encouraging equal opportunities for the whole population.

Considering this reality, this Research Topic addresses the current issues faced by principal investigators, lab managers, and student supervisors who educate and train new and early-stage researchers in the field of public health.

15,000 views | 18 articles

7 | Urban Green Spaces and Human Health

Urban green spaces significantly impact living conditions and public health, which are closely associated with several SDGs, including SDG #3: good health and well-being.

Numerous studies have linked access to green spaces—such as the quality and distribution of green space, distance from home, and diversity of non-human elements—to various aspects of health, including birth weight, body mass index, mental and cardiovascular illnesses, and mortality rates.

Accordingly, this Research Topic focuses on recent advances and research on the theory and application of urban green spaces and human health to enhance urban green space's environmental sustainability and contribute to global fair and inclusive sustainable development.

19,000 views | 17 articles

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Health Policy Analysis Webinar Series Brings Together Global Health Policy Scholars

When COVID-19 shut down much of society across the world in early March 2020, researchers at the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Advanced International Studies (SAIS) sought a way to start a dialogue on global health policy research, an area of public health that was critically important as governments around the world were seeking answers on how to stop the pandemic’s spread and impact while addressing a growing economic crisis.

Thus, the Health Policy Analysis Webinar Series was launched in April 2020 with the aim of holding research and policy discussions around global health policy issues in a way that encourages dialogue on different issues, is open to researchers at all career stages, and can connect those from all over the world with an interest in health policy analysis. Originally only held virtually due to the pandemic, the series continues to be held solely online, which allows it to remain accessible to those who otherwise might not be able to attend in person, broadening the scope of discussions and allowing for a more diverse array of voices.

The series is the brainchild of Jeremy Shiffman, PhD, MA , Bloomberg Distinguished Professor in the Department of International Health at the Bloomberg School and at SAIS. “We wanted to provide opportunities for researchers, especially doctoral students and junior faculty, to share work that connects to global health policy and get feedback from others working in that space,” says Shiffman.  

Currently in its fourth year, the series has spanned a wide range of global health topics, including COVID-19 policy, violence against women and children, nutrition policy, child health, and global tobacco policy. Speakers have presented and sought feedback on issues pertaining to the quality of global health governance (such as the role of the European Union), decolonizing global health, and efforts to address specific diseases (such as tuberculosis, polio, and neglected tropical diseases).

Miranda Bain , a doctoral student at the Bloomberg School who provides organizational support to the series, has found the series particularly helpful for early-career researchers such as herself to get valuable feedback that can inform their work. “As a student at the Bloomberg School, having a space to discuss policy that has a huge impact and talk about big picture issues has been hugely helpful. I see a lot of students coming to the webinars and it has been a very rich experience and place to learn,” says Bain.

So far, the series has not only connected researchers within the Johns Hopkins community—such as SAIS and the Johns Hopkins Berman Institute of Bioethics —but has also provided a network for institutions from all over the world. The emphasis in each webinar is on discussion—in the hour-long sessions, speakers only have about 15 minutes to present, and the remainder of the time is focused on feedback and dialogue. Speakers are encouraged to share work that is in progress, where they can gain insight and make adjustments before their research is published.

The fields of global health policy and health policy analysis are emerging, unlike epidemiology or tuberculosis, which are already established fields of research. The health policy analysis webinar series serves as a platform to bring researchers together to talk about scholarship in progress. The series spans the spectrum in terms of stage of career: doctoral students, junior faculty, and senior scholars all present their work.

Upcoming sessions in the webinar series will feature sustainable donor transition and health systems strengthening in Uttar Pradesh. Interested participants can register for each session or reach out to Miranda Bain to join the Health Policy Analysis listserv and receive more information on the webinar series.

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