EXPLORING THE NEXUS OF GLOBALIZATION AND HEALTH SURVEILLANCE: THROUGH THE LENS OF INTERNATIONAL RELATIONS

ABSTRACT

This article delves into the relationship between globalisation and health problems from an international perspective. The analysis of how global markets’ integration has resulted in increased transmission of pathogens, information, trade, finance, and people, impacting public health. The article argues that the public health discourse must adopt a broader global view of health issues The increasing interconnectedness of global trade, travel, and population growth has facilitated the spread of health risks across traditional borders. Additionally, scientific advancements like reproductive cloning and xenotransplantation present ethical challenges. Moreover, environmental issues such as climate change and biodiversity loss highlight the interdependence of human health and planetary well-being. Addressing these complex challenges requires coordinated international efforts supported by strengthened collaboration between governments, non-governmental organizations, and the private sector. Through partnerships and collective action, surveillance, response mechanisms, and capacity-building initiatives can be bolstered to mitigate the impact of emerging health risks.

KEYWORDS: Globalization, Health surveillance, International relations, Global health security, Infectious diseases, Public health

INTRODUCTION 

Globalization has profoundly impacted various fields, breaking down traditional barriers and redefining global relationships. In public health, globalization has brought about significant changes, challenging established ideas of national autonomy and transforming how we manage infectious diseases. This article explores the complex link between globalization and public health, enlightening about the significant shifts in public health, challenging long-held notions of sovereignty, and changing how infectious diseases affect society. This piece delves into the intricate connection between globalization and public health, focusing mainly on transforming contagious diseases in a globalized world.

At its core, it refers to processes or phenomena that diminish a sovereign state’s ability to control events within its borders. Gordon Walker and Mark Fox highlight the integration of financial markets as a pivotal example, where capital flows denationalize, rendering national sovereignty increasingly irrelevant in global finance. However, the impact of globalization extends beyond financial markets, permeating diverse sectors such as immigration, information dissemination, environmental protection, and cultural exchange.

In public health, the conventional differentiation between national and international spheres has become outdated in the face of globalization. Historically, federal governments bore the responsibility of safeguarding public health, particularly against the transmission of infectious diseases. However, the rise and resurgence of infectious diseases over the past few decades have underscored the inadequacy of this traditional framework. The rapid global spread of pathogens has blurred the lines between national and international health concerns, necessitating a re-evaluation of existing paradigms. The need for human security cannot be overstated. It prioritizes the well-being of individuals over states, ensuring that everyone is free from fear and deprivation. It also recognizes the relationship between disarmament, human rights, and development, highlighting their interconnectedness. Furthermore, human security is vital in how societies perceive and respond to large-scale disasters, particularly in regions inhabited by marginalized communities. By prioritizing human security, we can work towards a safer, more just world for all.

This article develops a conceptual framework referred to as the “pathology of the globalization of public health” to elucidate the intricate connection between public health and globalization. It examines how the ongoing challenge of Emerging Infectious Diseases (EIDs) has permanently intertwined the globalization of public health with the fabric of international relations. Furthermore, the article investigates how the difficulties presented by globalized public health extend beyond scientific and medical realms to impact core concepts in political theory. Addressing these challenges necessitates a comprehensive approach that takes into account the evolving dynamics of global public health alongside the changing landscape of international relations. By incorporating insights from various disciplines and viewpoints, this article seeks to deepen understanding of the globalization of public health and facilitate effective responses to emerging infectious disease crises. Through careful analysis and consideration, we can navigate the complexities of this global phenomenon and safeguard the health and well-being of populations worldwide.  In disaster-prone areas, where poverty is prevalent, major disasters serve as stark reminders of societal disparities, laying bare deficiencies in fundamental human rights protections. Addressing these challenges requires the establishment of socially sustainable disaster management systems capable of meeting the expectations of an informed and globalized populace. Importantly, disaster response efforts must prioritize human security over state interests, recognizing that protecting public health during crises is a fundamental responsibility. Disasters serve as litmus tests for governments, revealing their ability to safeguard their citizens and exposing vulnerabilities that can lead to political instability.

The dual nature of globalization, characterized by both promising opportunities and looming threats, is acknowledged as an undeniable reality as humanity navigates toward a more interconnected future in the new millennium. While traditionally linked to economic processes and the development of global institutions, globalization is extended beyond these realms to encompass the intricate interconnection between individual lives and global trajectories. Specifically, globalization is denoted by the progressive increase in economic, political, and social interdependence, fostering global integration through the diffusion of capital, traded goods, people, concepts, images, ideas, and values across national borders. While its origins can be traced back to the Industrial Revolution and laissez-faire economic policies of the 19th century, the globalization witnessed in the late 20th century has attained unprecedented proportions, embracing not only the liberalization of financial markets and trade but also addressing transboundary issues such as environmental concerns like ozone layer depletion.

In addition to its economic and political dimensions, globalization significantly influences global health futures, often overlooked amidst its broader impacts. The nexus between individual well-being and global developmental contexts becomes apparent in this aspect of globalization. Changes in transnational economics, social dynamics, and technological advancements directly or indirectly shape global health outcomes. Consequently, domestic and international public health policy spheres are becoming increasingly intertwined and inseparable. Upon reviewing various works, it becomes evident that there are divergent interpretations of globalization. Economists perceive it as the emergence of a global economy, while international lawyers view it as potential alterations to the legal standing of states and their inhabitants. Information technologists define it as a global information network, and cultural studies researchers see it as a possible formation of a global culture, facilitated by mass media. These perspectives, among others, each offer distinct insights into a multifaceted puzzle, contributing to a complex understanding of globalization.

Economic growth and poverty alleviation do not solely define the narrative of global health. The widespread dissemination of new health knowledge and technologies across developing nations over the latter half of the previous century arguably had a more profound impact on improving health outcomes than economic progress alone. Many of these breakthroughs originated in wealthier nations, underscoring how the developed world has played a pivotal role in generating global public goods in medical and health-related research and development. This knowledge transfer has benefited people worldwide, spanning poorer and wealthier countries. However, this exchange is now being hindered by expanding intellectual property rights predominantly held by companies in high-income nations. The emergence of job opportunities for women in export-driven sectors presents an indirect health advantage by offering them income-generating avenues outside traditional patriarchal structures.

Impact of globalization on health surveillance and monitoring systems

In recent years, there has been a significant shift in the perception of the world since the commentary provided by the Roemers. The end of the Cold War and the demise of a world defined by competing social and political systems have ushered in massive global transformations. These changes necessitate a re-evaluation of our health development paradigm or our roadmap for understanding the world. The current transformed world is characterized by heightened competition for market share, the liberalization of trade and finance, and enhanced global communication networks. In the realm of healthcare, for instance, the liberalization of health services as per the provisions of the General Agreement on Trade in Services has the potential to blur the lines between national and “globalized” health sectors. Such transformations are fostering “powerful transnational dynamics,” suggesting an impending emergence of a “global health village” where some health issues primarily affect specific countries, while others become matters of common concern. Additionally, national health systems are undergoing intercontinental, facilitated by the ease and speed of communication, which enables the dissemination of ideas, ideologies, and policy concerns related to healthcare (as well as diseases), thus promoting a global culture of reform. 

Economic globalization has emerged as the primary driving force behind the broader process of globalization. This phenomenon is marked by a significant increase in the volume of cross-border transactions and substantial shifts in their characteristics. International trade has experienced rapid expansion, growing at an average rate of approximately 8.6 per cent annually between 1990 and 1999. Notably, the share of services in this trade has steadily risen, reaching nearly 19 per cent by 1999. However, it’s important to note that this transformation has largely overlooked low-income countries, many of which continue to heavily rely on aid inflows.

Surveillance refers to the methodical and continuous gathering, organization, and examination of data for public health objectives, along with the prompt sharing of public health information for evaluation and necessary public health interventions. The processes of globalization can have both beneficial and adverse effects on the populations they aim to assist. On the one hand, they can lead to improved access to healthcare and education, implementing laws to safeguard human and labour rights, and restricting exposure to harmful substances and products like tobacco and environmental waste. Conversely, globalization can also bring about adverse health outcomes, such as increased exposure to new health risks and challenges, disparities in access to healthcare, and potential threats to environmental protection efforts.

Forty years ago, international health activities were primarily governed by the World Health Organization (WHO), governments through bilateral agreements, and non-governmental organizations. However, this landscape has undergone a significant transformation. Presently, additional influential actors such as the World Bank and, increasingly, the World Trade Organization (WTO) have emerged, exerting their influence on international health matters. With the increasing globalization of trade and markets, new coalitions and alliances are forming to address the direct and indirect health consequences. This paper aims to analyze the evolving context of cooperation in international health and express concerns regarding the potential rise of health inequalities within countries and across borders. Additionally, it explores how these changes may impact the strategies and initiatives of organizations involved in international health efforts.

Roemer and Roemer (1990) highlighted the significance of increased trade, diffusion of appropriate technologies, and the global acceptance of human rights. According to their analysis, international exchanges have facilitated the spread of technological innovations, including effective contraception methods, safe drinking water techniques, low-cost refrigeration, efficient transportation and communication technologies, as well as new therapeutic agents for diseases such as leprosy, schistosomiasis, trachoma, onchocerciasis (river blindness), and numerous others.

Amidst a historical tide of globalization, colonial powers and corporate patrons embarked on a mission to bolster public health initiatives in developing regions, aiming to stem the tide of infectious diseases. Their motives were a complex blend of political strategy, economic interests, and humanitarian ideals. Today, echoes of this endeavour resound in the realm of “global health,” signalling a contemporary evolution in discourse. Koplan and colleagues attribute this transformation to the fusion of tropical medicine’s global focus with the public health sector’s commitment to broad-based interventions and societal betterment.

Yet, the current spotlight on global health is entangled with the genuine voices of social movements challenging the dominance of market-driven neoliberal policies. These policies, characterized by their reinforcement of intellectual property rights, rampant commercialization, and fervent advocacy for trade liberalization, have cast shadows over access to vital medications and healthcare systems. Of particular concern are their ramifications for the less affluent nations, where these policies often stifle the momentum for much-needed public health reforms.

Institutional determinants encompass various factors such as infrastructure, health policy, governance structure, and legal frameworks, all of which exert influence on health services provision. Economic determinants, including occupational structure, tax policies, and market dynamics, interact with or shape the economic infrastructure, development, and trade patterns. Socio-cultural determinants encompass aspects such as religion, ideology, customs, demographics, and social organization, alongside elements like knowledge dissemination, social security measures, and communication systems, all of which contribute to social environmental lifestyles. Lastly, environmental determinants pertain to ecological factors, climate conditions, and ecosystem stability, impacting goods and services availability, including essential resources like food and water. These determinants operate in tandem, continually shaping population health outcomes and the accessibility of health services. Thus, the establishment of an effective public health system necessitates ongoing monitoring of these determinants and their effects, as society endeavours to extend life expectancy and enhance its overall quality.

Ongoing discussions concerning health equity within the United Nations’ Sustainable Development Goals (SDGs) framework underscore the imperative to invest in comprehensive health information systems (HIS). Such systems are essential for countries to analyze and address the Social Determinants of Health (SDH) and combat health disparities, ensuring that no one is left behind. The basic requirements for a comprehensive HIS capable of reporting on SDH and health equity have been established, alongside a compilation of essential health-related data sources. These encompass various chains of command, including gender, social class, race, ethnicity, and residential location, as well as a range of mortality, morbidity, and disability indicators, encompassing self-assessed physical and mental health. However, even in high- and middle-income countries, access to robust HIS still needs to be improved. The situation is notably dire in low-income countries (LICs), which confront some of the most acute health challenges. Frequently, it remains to be seen what health and socio-demographic data are available or whether existing information can effectively facilitate SDH analysis and health equity monitoring. The feasibility of acquiring disaggregated data in LICs to support national and local-level interventions is a recurring topic in scholarly literature and international fora, such as the UN Statistical Commission on SDG indicators.).

The health impacts of globalization’s multifaceted flows –

The rise in pathogen transmission:

The movement of individuals facilitates the spread of pathogens, whether it’s the threat of drug-resistant tuberculosis or the emergence of pandemic influenza. Events like SARS spawned heightened awareness within the public health community, leading to the implementation of new International Health Regulations and collaborative efforts on a multilateral scale. Additionally, global trade, which has historically been a conduit for disease transmission, introduces various health risks, ranging from disseminating pests to transmitting infectious diseases. For instance, the Latin American cholera pandemic of the 1990s was sparked by the discharge of infected bilge waters from a cargo ship.

Expansion of the flow of information:

The advancement of computing and telecommunications technology has played a crucial role in driving contemporary globalization. It has facilitated the expansion of multinational corporations, the dissemination of health-related information, and technological advancements. Additionally, it has fueled the emergence of various social movements. However, despite the widespread connectivity brought about by globalization, access to the internet remains highly unequal. While most people in high-income countries have internet access, the same cannot be said for Africa, where only a small percentage of the population has access. Notably, when adjusted for per-capita income, the cost of obtaining broadband access in Africa can be significantly higher, up to 170 times greater than in the United States.

Global Trade Expansion: The rise in trade flows due to economic integration has introduced fresh avenues for prosperity and enhanced health conditions for specific groups. Nonetheless, alterations in production and trade dynamics, alongside shifts in the labour market, have left numerous individuals vulnerable to job instability, insufficient safety protocols, and environmental damage. Moreover, the energy requirements of global production networks, coupled with the heavy dependence on fossil fuels in transportation, have become notable factors exacerbating emissions and contributing to climate change.

Increased Financial Flows on Economy, Health, and Environment:

Foreign direct investment (FDI) and the recent increase in outsourced contract manufacturing have changed the way things are produced worldwide, creating a truly global workforce. However, this has also led to economic inequality and job insecurity for many workers. Additionally, the dominance of short-term financial gains has overshadowed the benefits of FDI, which has resulted in significant consequences for public health and our ability to implement policies that protect and improve health outcomes.

Impacts and Trends in Global Mobility:

The increase in human mobility, a longstanding aspect of globalization aimed at seeking better opportunities, is now primarily propelled by economic and environmental imperatives. While affluent nations continue to welcome highly skilled individuals, they often function as temporary passages for workers with fewer qualifications, particularly following the global recession of 2008.

Irrespective of their origins, two fundamental principles distinguish global health as a research, policy, and implementation framework from its previous international iteration. Firstly, there is an acknowledgement of the interconnectedness of global economies, which both influences and is influenced by the distribution of disease burdens across nations. Secondly, there is an understanding that many critical health issues countries face are now inherently transnational or global. The conditions under which people live and work, which impact their vulnerability to disease and access to healthcare, are inseparable from global distributions of power, wealth, and resources, not solely due to cross-border disease threats.

Additionally, the ongoing expansion of research into social determinants of health (SDH) introduces a new aspect. Although recognizing the influence of living and working conditions on people’s health is not new, there has been significant growth in the evidence base supporting 

this idea. Consequently, public health policies and practices must now address the various pathways through which global forces and processes impact health through the SDH. This expanded understanding necessitates a nuanced response to the intricate interplay between global factors and health outcomes.

In the early 7th century, the concept of globalized healthcare had its roots in an ancient practice. The founder of the Tibetan Empire, King Songtsen Gampo, initiated the first documented international medical conference, influenced by the recommendations of his Chinese and Nepalese wives. He invited physicians from regions along the Silk Road, including China, Nepal, India, Kashmir, and Persia (Iran), to convene on the Tibetan Plateau, known as the “Roof of the World.” They aimed to exchange medical knowledge and texts from their respective traditions for translation into Tibetan, facilitating a syncretic approach to medical study. This historic gathering marked an early instance of cross-cultural collaboration in healthcare, demonstrating an early recognition of the benefits of global exchange in advancing medical understanding and practice.

Interdisciplinary perspectives on globalization and global health

Globality connects people worldwide, yet it does not ensure universal connection. Within the context of global health, the focus extends to various factors such as water quality, sanitation, environmental conditions, socioeconomic inequality, malnutrition, infectious diseases like HIV, tuberculosis, and malaria, mental health concerns, health policy, behavioural health, maternal mortality, as well as research, education, and practice, all tied to fundamental human health rights. Global health, being trans-disciplinary, incorporates perspectives from both the natural and social sciences to comprehend the intricate interplay between social relationships, biological processes, and technologies that contribute to enhancing health on a global scale.

Alongside exploring global health, considerable attention is given to understanding the determinants of health. These determinants play a pivotal role in shaping discussions within global public health.

Globalization encompasses various policy dynamics or processes that interact with each other, making it challenging, if not impossible, to isolate their effects. The pathways from globalization to alterations in social determinants of health are not straightforward; they are interconnected and may involve multiple stages and feedback loops. This complexity bears similarities to analyzing causal links between environmental changes and human health. Such links are often intricate because they are indirect, occurring in different locations and times, and influenced by various modifying factors.

In essence, globalization operates as a multifaceted phenomenon with interconnected policy dynamics. Its impact on social determinants of health is not linear, involving complex pathways and feedback mechanisms. Similarly, understanding the causal relationships between environmental changes and human health requires navigating indirect, spatially and temporally displaced connections, influenced by numerous modifying factors. Thus, analyzing these relationships necessitates a comprehensive approach considering the intricate interplay between various elements and their dynamic interactions over time.

Globalization entails the escalating mutual influence of various globally significant factors, including political, economic, informational, and cultural exchanges. Among these, economic influence is the most potent, particularly evident through transnational corporations operating across multiple countries, leveraging political contexts for profit and advantage. Globalization is an inherently objective phenomenon, driving qualitative shifts in the global landscape and fostering greater interconnectedness and interdependence among individuals, civilizations, and nations. However, it is also a complex and paradoxical process, which accounts for the intricate nature of research surrounding it.

The globalization of socio-cultural processes in the contemporary world presents advantages and disadvantages. This phenomenon entails the worldwide division of labour, the movement of capital, human resources, and production facilities across the globe, as well as the standardization of legislation, economic practices, and technological advancements. Additionally, globalization facilitates cultural convergence and educational exchange among different nations. This systemic process affects all aspects of society and spans all levels of human existence.

From a macro perspective, globalization can be viewed as integrating countries across various domains such as economics, politics, social dynamics, culture, and technology. Individual companies, particularly industries, are also subject to globalization at the micro level.

The impacts of globalization are multifaceted. On the positive side, it entails a departure from strict adherence to political ideologies in economic matters, a shift towards a competitive market model, and recognising this model as an optimal socio-economic system. Theoretically, these developments contribute to a more homogeneous global society and raise hopes for poverty reduction, alleviation of educational disparities, and overall improvement in living standards worldwide. Cultural globalization is secondary in meaning and imperceptible on a global scale, but not noticing how people gradually pass to universal stereotypes and cultural values is impossible. The globalization of culture has affected all areas, from schooling to entertainment and fashion, people (especially teenagers) follow the same fashion, spend leisure time the same way, and listen to the same music. The notion of civilization is essential for comprehending globalization, chiefly concerned with the global spread of human culture and the emergence of a unified global civilization. The origins of globalization can be attributed to the establishment of trade networks among diverse populations, fueled by advancements in science and technology, as well as the widespread uptake of innovative technologies.

Culture, as a shared knowledge system among large groups of people, encompasses symbolic communication wherein the meanings of symbols are studied and preserved through educational institutions. It encompasses various elements, including knowledge, life experiences, values, religions, concepts of time and space, social hierarchies, and material possessions acquired by successive generations through individual and collective efforts.

Culture is expressed through defined and implied patterns of behaviour transmitted through symbols, representing the significant achievements of human societies, including their manifestation in tangible artefacts. This dynamic and multifaceted aspect of human existence plays a central role in shaping global interactions and the evolution of global civilization in the contemporary world.

Globalization presents vast educational opportunities, with the Internet as a primary educational platform for students and teachers. It offers instant access to information for contemporary students and enables distance education for individuals seeking career changes or further professional development in various fields. References to Internet resources are increasingly included in recommended reading lists across different textbooks. Moreover, the global computer network continues to witness the emergence of numerous educational websites and portals daily. Many universities publish their curricula, course materials online, and other educational resources. Furthermore, the Internet enables prospective students to swiftly access information about educational programs and courses worldwide, empowering them to make informed choices independent of national constraints. It has revolutionized student exchange programs, academic mobility, and inter-university communication. Indeed, the Internet has challenged the traditional state monopoly on knowledge dissemination and education development. Its impact extends beyond providing open access to international information resources unrestricted by national boundaries.

Modern information technologies have ushered in innovative educational methods, notably the rapid growth of distance education. Internet-based seminars and webinars have become commonplace across various fields, fostering interaction between students and teachers and among peers through platforms like Facebook and LinkedIn. Students now have the autonomy to select scientific advisors or lecturers from different institutions and locations, even across borders. The proliferation of internet-based teaching methods is evident, with discussions emerging about establishing and accreditation fully-fledged internet universities.

Looking at the players, problems, processes, and principles that make up GHD, we can identify the quantity, diversity, velocity, and instability issues in each aspect. In the current era, there is an increased number of diverse players with much more involvement of NGOs and civil society actors, which influence global health. From the problems side, we have increased concerns ranging from traditional communicable disease threats, increasing epidemics of noncommunicable diseases (NCDs), neglected tropical diseases, and deteriorating social determinants of health such as poverty, education, climate change, and gender issues. Players address these problems through various processes by using “public-private partnerships.” In the processes, there are a lot of new normative concepts, ideas, and rules resulting in the creation of new global health governance and the growing influence of health in the areas of foreign policy. UNESCO today remains the main institution that has the greatest impact on education.

The global reach and influence of who

The World Health Organization (WHO) plays a vital role in global health initiatives, with a diverse function in addressing public health issues across the world. Its responsibilities include promoting well-being, disease prevention, and ensuring equitable access to healthcare. The WHO’s influence is felt across continents, as it aids in the creation of health policies, manages responses to health emergencies, and promotes advancements in healthcare delivery through research and innovation. The World Health Organization (WHO) saw a dramatic shift from being the unchallenged leader in global health between 1948 and 1998. It now faces severe problems, including declining influence and budgetary restrictions, especially in light of the rise of new, influential players. WHO started to reinterpret its function in reaction to this shifting international political environment, stressing leadership, strategic planning, and coordination in global health projects to survive. During this change, “global health” replaced “international health,” denoting a more comprehensive emphasis and scope. Despite being used in various situations before the 1990s, the word “global” was only officially adopted and widely utilised very recently. Examples of early use include the “global malaria eradication program” of the 1950s and allusions in pamphlets and reports to the World Health Organization’s worldwide efforts to combat illness. 

The prospects and pitfalls of primary health care 1973 -1993

The World Health Organization (WHO) experiences ongoing tensions between social-economic and technology-driven approaches to public health, though they’re not inherently contradictory. These tensions fluctuate over time due to shifts in global power dynamics, the evolving interests of international actors, and the ideologies of key figures shaping health policy. In the 1960s and 1970s, WHO’s trajectory was significantly influenced by the rise of decolonization, nationalist movements, and developmental theories prioritizing socio-economic growth over short-term technological fixes. This period also saw increased advocacy for fair trade terms and development financing by developing countries, alongside shifts towards liberalism in Washington, DC, driven by civil rights and social movements. During the 1960s, the World Health Organization (WHO) recognized the importance of bolstering health infrastructure for effective malaria control, particularly in Africa. 1968 Candau advocated for a comprehensive plan integrating curative and preventive care services. Subsequently, a Soviet representative proposed an organizational study on basic health service development, approved by WHO’s Executive Board in January 1971. This study’s findings, presented in 1973, contributed to WHO’s transition towards the “Primary Health Care” approach. Influenced by grassroots experiences and China’s “barefoot doctors,” this approach prioritized community health worker training and addressing fundamental economic and environmental issues.

Halfdan T. Mahler, WHO’s Director-General from 1973 to 1988, was pivotal in championing new health approaches. Despite initial reluctance due to ideological differences with the Soviet Union, Mahler agreed to hold a significant health services conference in Alma-Ata in 1978, under pressure from the Soviet delegate. The meeting, though hosted by the Soviets, primarily reflected Mahler’s vision, emphasizing an inclusive and multidimensional approach to health and socioeconomic development. The Alma-Ata Declaration advocated for “Health for All in the Year 2000,” stressing intersectoral collaboration, appropriate technology use, and community involvement in healthcare and education at all levels. In the late 1980s and early 1990s, the World Bank emerged as a prominent player in global health, capitalizing on the perceived shortcomings of the WHO. The Bank advocated for neoliberal economic policies and greater private-sector involvement in healthcare, surpassing WHO’s budget with substantial lending for health projects. Despite controversies, the Bank acknowledged WHO’s technical expertise in health matters. Collaboration was evident in influential reports, such as the 1993 World Development Report, emphasizing a partnership between the two organizations for mutual benefit.

In response to changing global circumstances and emerging health issues, the World Health Organization (WHO) underwent a significant transformation in the late 20th century, led by influential figures such as Halfdan T. Mahler and Gro Harlem Brundtland. Concerns regarding the effectiveness of WHO prompted the establishment of a working group in 1992 to review its role in global health amidst evolving challenges. This period witnessed the emergence of the term “global health” emerge, indicating a broader approach encompassing environmental, socioeconomic, and health-related concerns. Brundtland’s leadership, starting in 1998, aimed to bolster WHO’s impact through collaborations with diverse stakeholders and targeted initiatives, emphasising public-private partnerships to address specific health needs.

Under Brundtland’s tenure, WHO sought to become a more influential actor on the global stage, advocating for the interconnection of health with broader development and economic agendas. Initiatives such as the Commission on Macroeconomics and Health and the establishment, of international health partnerships underscored WHO’s efforts to address health challenges comprehensively and collaboratively. Despite criticisms and challenges, Brundtland’s leadership succeeded in repositioning WHO as a credible and visible force in global health, emphasizing the organization’s crucial role in tackling emerging health threats and promoting health equity worldwide.

Global mental health encompasses diverse approaches and initiatives, from analyzing mental health indicators internationally to studying global factors affecting mental well-being, such as climate change.

During the first century of international health diplomacy, a concerted effort was made to address global health issues involving various actors such as states, international health organizations, and non-state entities. This era witnessed the creation of substantial international laws concerning public health matters, although many of these regulations have yet to receive much attention. Notable aspects of this period included the acknowledgement of health risks becoming increasingly global due to the expansion of international trade, the imperative for states to collaborate through international legal frameworks to tackle these global threats, the involvement of non-governmental organisations and multinational corporations, and the varied effectiveness of international legal mechanisms in confronting health challenges.

In modern discussions about global public health, there is a strong emphasis on recognizing the worldwide scope of threats, such as infectious diseases and the tobacco trade, leading to calls for increased international collaboration and legal measures. The World Health Organization (WHO) is revising its International Health Regulations to tackle present-day challenges better.

Yet, global health governance faces new and unprecedented hurdles in the 21st century, such as those associated with genetic engineering and ensuring equitable access to essential medications. The rise of technologies like the Internet has given non-state actors more influence over global health governance. As a result, while there are valuable lessons to be learned from past approaches, they offer limited guidance for addressing the unique challenges of contemporary global health governance. States, international health organizations, and non-state actors grapple with these challenges using governance methods that have remained unchanged since the 19th and early 20th centuries.

CONCLUSION

In the ever-evolving landscape of modern times, global health research eludes precise definitions, continuously evolving and adapting. Rather than debate definitions, this essay opts to delve deeper into understanding international health research by examining key characteristics observed in ten exemplary partnerships. These characteristics—long-term partnerships, interdisciplinary approaches, participatory action research, and impact orientation—connect these partnerships. However, it’s essential to note that these characteristics are not standalone; they intricately intertwine with each other. For instance, participatory action research often necessitates prolonged partnerships, while impacting policy and practice requires interdisciplinary approaches that understand socio-political contexts. Thus, these characteristics form a dynamic, interconnected framework rather than rigid categories.

SUGGESTIONS

In an interconnected world, health issues transcend national boundaries and are influenced by various external factors. The field of international relations offers valuable tools for understanding global health governance, including insights from power dynamics, cooperation, conflict, and economics. Different theoretical approaches shed light on issues like inequality, gender disparities, and the impact of neoliberal policies on health. This comprehensive understanding challenges traditional security politics and emphasizes the role of public-private partnerships in global health governance. With global agendas significantly impacting national health policies, the traditional distinction between inside and outside realms of politics is fading. The interconnectedness fostered by intensified trade, travel, and production, alongside global consumption trends, means that health issues transcend borders. Consequently, both state and non-state actors are compelled to address health-related agendas that extend beyond national boundaries. Therefore, this underscores the urgency of examining public health politics alongside international politics, emphasizing the need for a collaborative and holistic approach to addressing global health challenges.

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Author: Shradha Suman Rath
Christ Deemed to be University Bangalore Karnataka

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