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Global health: a time of radical change?



What strategies should governments adopt to improve the health of their citizens? Against the backdrop of COVID-19, it would be easy to focus on global health security – at least on strong health and wellness systems. WHO bases its global health strategy on three pillars: overall health coverage, emergencies, and improving health and well-being. Integral elements of strong public health and health care are well known and endlessly rehearsed – a working medical force; efficient, safe and high-quality provision of services; health information systems; access to essential medicines; sufficient funding; and proper management. But was the view of world health too narrow? Have health care managers and lawyers lost the most important factors that determine human health?

The latest Global Burden of Disease, Injury and Risk Factors (GBD) report for 201
9 raises awkward questions about the direction global health has taken in the 21st century. On the one hand, the news seems good. The health of the world’s population is steadily improving. Global life expectancy at birth increased from 67 · 2 years in 2000 to 73 · 5 years in 2019. Healthy life expectancy has increased in 202 of 204 countries and territories. In 21 countries, the average life expectancy at birth increased by more than 10 years between 1990 and 2019, and the increase was up to 19 · 1 year. It is estimated that the number of deaths in children under 5 years of age has decreased from 9.6 million in 2000. To 5 million. infectious, maternal, neonatal and foodborne diseases – and progress has been the fastest in a decade.

But GBD also once again finds that health depends not only on health systems. The strong correlation between health care and the socio-demographic index – a generalized metric of the country’s overall development based on average per capita income, education level and overall birth rate – suggests that the health sector should consider rethinking its scope of activities. .

GBD 2019 also offers a revised theory of demographic transition, outlining seven separate stages. A special innovation is the idea of ​​late and post-transition stages, disaggregated by migration status. 35 countries, mainly in sub-Saharan Africa and the Middle East, are in the middle of the transition period, with declining birth and death rates (as of 2019, no country was in the pre-transition stage). Countries such as Brazil, China and the United States are in a late transition period, with mortality rates declining and birth rates declining. The final post-transition phase is when the birth rate is lower than the death rate and the natural population growth is negative, as is the case in Japan, Italy and Russia. Migration is an important and ignored impact on these demographic stages. 17 countries, including Spain, Greece and many Eastern European countries, are in a “volatile state” – in the process of transition with net emigration. Policies are needed here to reduce the social and economic consequences of the increasingly inverted population pyramid – encouraging immigration can be one way to help.

None of these arguments should suggest that overall health coverage and global health security are irrelevant to health. According to the authors of GBD 2019, in some countries life expectancy is longer than expected by their stage of development. These over-performing countries – such as Niger, Ethiopia, Portugal and Spain – are likely to have higher health and health policies. GBD 2019 shows that the global health community needs to radically reconsider its vision. Exclusive attention to health care is a mistake. Healthcare is created on the basis of a broader prospectus, which includes the quality of education (from primary to higher), economic growth, gender equality and migration policy.

This conclusion is directly relevant to national strategies to combat COVID-19. Although attention should be paid to controlling the transmission of severe acute respiratory syndrome by coronavirus 2 in the community and protecting those most vulnerable to its consequences, success will require a more comprehensive strategy. COVID-19 is a syndrome of coronavirus infection combined with an epidemic of non-communicable diseases that interact on the social substrate of poverty and inequality. GBD reports that unless deep-rooted structural inequalities in society are addressed and a more liberal approach to immigration policies is adopted, communities will not be protected from future outbreaks and the health of the population will not be able to achieve the benefits seek global health advocates. It is time for the world health community to change direction.
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