World What? Day

Today was World Health Day, so designated by the World Health Organization apparently to increase awareness about … what exactly? What is meant by “world health” or “global health?”

This year’s celebration of World Health Day as featured on the WHO web site (World Health Day) features a goofy photo of some guy riding one of those odd precursors to the modern bicycle known as the high wheel. These things were mostly good at producing head injuries since they usually came without brakes and, when they did stop by running into something, tended to simply drive the rider’s noggin into the ground.

This year’s theme of World Health Day is urbanization and health. Perhaps the photo is meant to signify the health benefits of exercise, or of bicycling specifically. But to me it symbolizes what can happen when you don’t know where you’re going or how you’re getting there.

Given all the hoopla about global health, or world health, you’d think everyone would agree what it is they’re talking about. But, in fact, there is no consensus on what is meant by global health (or world health, or international health or whatever terms you prefer). For some, it means trying to improve the health of people in poor countries. For others, it means selling their drugs, devices or services worldwide. And for yet others, it appears to mean just about anything that involves something to do with health somewhere on the planet. This is not a healthy situation.

Einstein said the key to solving a problem lies in how accurately you define the problem. What are the problems we are trying to solve? Global health remains a fuzzy concept, which leaves it open to being co-opted or distorted.

I’ve written several times about this lack of definition, at most length in an article I did a while ago  (What is Global Health?) for a symposium at Pacific Lutheran University. Later, I came across an academic essay written in the Lancet by leaders in this field trying their best to define global health (Toward a Definition). Interestingly, we both began our articles by talking about how global health is now in fashion.

But fashions change, and not always for the better. When global health was done mostly by scruffy do-gooders who had no money, it was defined by default as the things done by these scruffy do-gooders. Today, there’s big money in global health and yet its mission seems increasingly diffuse as more people try to jump on the bandwagon.

I don’t know what mindset led to the design of the high wheel bicycle, but it seems to have been done by someone who neglected to consider some basic laws of physics. Is the lack of clarity in global health just a necessary phase in the field’s evolution, an intermediary step towards a better design? Or is it so poorly focused the endeavor is at risk of losing balance and getting thrown off track?



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