What is Global Health?: Miguel Ángel González Block


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As proposed by the Declarations of the Alma Ata and challenged by the Millennium
Development Goals, action by players and stakeholders of diverse specialties and
backgrounds is required to achieve health for all. This assembled expert panel
drawn from different backgrounds will enrich the discussion with their own experiences.

Published in: Education, Health & Medicine
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What is Global Health?: Miguel Ángel González Block

  1. 1. National Institute of Public Health Development of Global Health in Mexico Miguel Ángel González Block Nelly Salgado Laura Magana Lisa de María
  2. 2. Global Public Goods <ul><li>Local, national and international values of global health significance </li></ul><ul><ul><li>Disease control </li></ul></ul><ul><ul><li>Best practices </li></ul></ul><ul><ul><li>International health regulations </li></ul></ul><ul><ul><li>Universal human rights </li></ul></ul><ul><ul><li>Validated knowledge </li></ul></ul>
  3. 3. The virtuous circle of global public goods <ul><li>Local public goods </li></ul><ul><li>Malaria control </li></ul><ul><li>Equity policy </li></ul><ul><li>Regional public goods </li></ul><ul><li>Malaria elimination </li></ul><ul><li>Equity legitimation </li></ul><ul><li>Global public goods </li></ul><ul><li>Prospect for malaria eradication </li></ul><ul><li>Universal human rights </li></ul>
  4. 4. Outline <ul><li>A marriage of convenience: the early history of public health education and research in Mexico </li></ul><ul><li>Capacity building: the Foundation of the National Institute of Public Health </li></ul><ul><li>Strategic Alliances and global leadership </li></ul><ul><li>Conclusions </li></ul>
  5. 5. Global institutions in the formative period <ul><li>Social institutions to address orphanage </li></ul><ul><li>The Balmis expedition: the first global, vertical public health campaign </li></ul><ul><li>Pasteur’s influence in Mexico: scientific advice at the margin of power </li></ul>
  6. 6. Pasteur’s influence in Mexico: scientific advice at the margin of power <ul><li>Consejo Superior de Salubridad </li></ul><ul><li>First international conferences </li></ul>Dr. Eduardo Liceaga
  7. 7. Foundations of modern public health in Mexico <ul><li>School of Public Health of Mexico. 1922 </li></ul><ul><li>Rockefeller collaboration 1920´s-1950s </li></ul><ul><li>The era of vertical campaigns: 1950s-1970s </li></ul>
  8. 8. Godparenthood and social capital = =
  9. 9. Religious cults to address epidemics and floods
  10. 10. The Balmis expedition: the first global, vertical public health campaign
  11. 11. A marriage of convenience
  12. 12. The School of Public Health 1922-1987
  13. 13. Capacity building: the Foundation of the National Institute of Public Health
  14. 14. Center for Public Health Research (CISP) in 1984 <ul><li>Generate the evidence base for the structural reform </li></ul><ul><li>Scientific excellence and relevance </li></ul><ul><li>Public health research and training </li></ul><ul><ul><li>generation, reproduction, and transfer of knowledge on health conditions and social response at the population level </li></ul></ul><ul><li>Attracted young scientists for the development of a critical mass in research </li></ul><ul><li>Greater acceptance by the Establishment </li></ul><ul><li>International support through Scientific Advisory Committee </li></ul>
  15. 15. Pillars of institution building <ul><li>The conceptual base </li></ul><ul><li>The production base </li></ul><ul><li>The reproduction base, and </li></ul><ul><li>The utilization base </li></ul>
  16. 16. The National Institute of Public Health: 1987-2000s <ul><li>Strengthening of public health research </li></ul><ul><ul><li>170 researchers </li></ul></ul><ul><ul><li>High specialty model </li></ul></ul><ul><li>Health sector fragmentation </li></ul><ul><li>New challenges with decentralization </li></ul>
  17. 17. New Challenges, Strategic Alliances and Global Leadership
  18. 18. At the threshold of a new era <ul><li>Combination of challenges and opportunities </li></ul><ul><li>Growing interdependence raised the visibility of public health threats </li></ul><ul><li>An unprecedented investments in global health </li></ul><ul><ul><li>development agenda </li></ul></ul><ul><ul><li>security agendas </li></ul></ul><ul><ul><li>New public and private actors </li></ul></ul><ul><li>Extraordinary opportunities for relaunching institution building in public health </li></ul><ul><li>Innovative responses to current realities, both at the global and the local levels </li></ul><ul><li>Global movement to establish, expand, and strengthen NPHIs </li></ul><ul><li>Key components of the institutional architecture for improving health system performance in developing countries </li></ul>
  19. 19. Diversity, complexity, and change <ul><li>Diversity </li></ul><ul><ul><li>between and within different geographical areas </li></ul></ul><ul><ul><li>Poverty, exclusion, and discrimination </li></ul></ul><ul><ul><li>WHO Commission on Social Determinants of Health </li></ul></ul><ul><li>Complexity </li></ul><ul><ul><li>triple burden of ill-health </li></ul></ul><ul><ul><li>biomedical and communications technologies </li></ul></ul><ul><ul><li>new managerial innovations </li></ul></ul><ul><ul><li>new financial formulas </li></ul></ul><ul><ul><li>health care as a fundamental human right </li></ul></ul><ul><ul><li>renewed tendency of vertical programs </li></ul></ul><ul><li>Change </li></ul><ul><ul><li>from standardized, pre-packaged interventions </li></ul></ul><ul><ul><li>towards matching global solutions to local needs </li></ul></ul><ul><li>Policy making moving from technical and highly hierarchical approach towards recognizing new actors and processes in a political and participatory environment. </li></ul>
  20. 20. New Alliances <ul><li>Globalization is changing public health perspectives on the origin and scale of risks </li></ul><ul><li>Role and importance of national and local capacities to respond effectively to them </li></ul><ul><li>National and local public health authorities are now being called to re-build their capacities to respond to multiple risks, ranging from natural disasters to pandemics and bioterrorism </li></ul><ul><li>Scale of risks varies from localized problems to rapidly spreading global threats </li></ul><ul><li>New capacities to </li></ul><ul><ul><li>co-ordinate health sector responses effectively </li></ul></ul><ul><ul><li>shape interdisciplinary teams </li></ul></ul><ul><ul><li>respond at both the national and global levels </li></ul></ul><ul><ul><li>relate government and civil society organizations </li></ul></ul>
  21. 21. Capacity limitations to engage in balanced collaboration North and South <ul><li>Cross-national, comparative health systems analyses are led mostly by institutions in the North </li></ul><ul><ul><li>Bibliometric analysis found that 74% of all international health systems research publications are led by high-income country authors </li></ul></ul><ul><ul><li>Seven countries concentrate 60% of the papers led by developing country institutions </li></ul></ul><ul><ul><li>Authors from institutions in the United States and the United Kingdom concentrated between them as many as 68% of the papers led by high-income countries </li></ul></ul><ul><ul><li>Predominance of technical capacity from the North and in a handful of developing countries when addressing global public health issues </li></ul></ul>
  22. 22. Role for National Institutes of Public Health in the South <ul><li>Imperative to participate and lead in regional and global networking mechanisms </li></ul><ul><li>Institutional development should be based on the relative advantages of partners to lead research, training, surveillance, and health system development efforts </li></ul><ul><li>Advantages could be assessed on the basis of technical capacities as well as on the closeness to problems of national and global significance </li></ul><ul><li>Well balanced and reciprocal collaboration across institutes in the North and South, and particularly the capacity to network across neighboring countries and regions in the developing world. </li></ul>
  23. 23. <ul><li>Health status evaluation and analysis </li></ul><ul><li>Public health surveillance, problem investigation, and risk control </li></ul><ul><li>Prevention and health promotion </li></ul><ul><li>Social participation in health </li></ul><ul><li>Planning and management </li></ul><ul><li>Regulation and enforcement </li></ul><ul><li>Evaluation and promotion of equitable access to necessary health services </li></ul><ul><li>Human resource development and training </li></ul><ul><li>Quality assurance in personal and population-based health services </li></ul><ul><li>Public health research </li></ul><ul><li>11. E mergency and disaster mitigation </li></ul>Core NPHI functions correspond with essential public health functions
  24. 24. International Association of National Public Health Institutes (IANPHI) <ul><li>Global initiative dedicated to creating, strengthening and linking national public health institutes to improve the scientific basis for public health policies and programs. </li></ul><ul><li>IANPHI links today over 60 national public health institutes globally, </li></ul><ul><li>Scientific focal points for ministries of health </li></ul><ul><li>Critical mass of skills and knowledge to provide leadership for protecting and enhancing the public’s health </li></ul>
  25. 25. The International Association of National Public Health Insitutes (IANPHI) Objectives <ul><li>Develop an internationally accepted NPHI Framework and a Toolkit for use in assessing and guiding the development of NPHIs </li></ul><ul><li>Work collaboratively with low-resource countries to strengthen existing NPHIs and to create new ones </li></ul><ul><li>Increase public health advocacy and knowledge </li></ul><ul><li>Create a new international community of public health leadership </li></ul>Improve the health of populations by helping to create and strengthen NPHIs and fostering an international community for NPHI leadership development, peer assistance, and public health advocacy.
  26. 26. What is a NPHI? <ul><li>A science-based organization or network of organizations </li></ul><ul><li>Provides national leadership and expertise </li></ul><ul><li>Multi-faceted organizations that include people with a wide range of skills and experience </li></ul><ul><li>Perform critical public health functions </li></ul><ul><li>A trusted source of counsel for policy- and decision-makers </li></ul><ul><li>Part of the government (usually under the Ministry of Health) or closely attached to it </li></ul>
  27. 27. Core attributes of a NPHI <ul><li>National scope of influence </li></ul><ul><li>National recognition </li></ul><ul><li>Limitations of political influence </li></ul><ul><li>Scientific basis for programs and policies </li></ul><ul><li>Focus on the major public health problems affecting the country </li></ul><ul><li>Adequate human and financial resources </li></ul><ul><li>Adequate infrastructure support </li></ul><ul><li>Linkages with key organizations </li></ul><ul><li>Accountability </li></ul>
  28. 28. Conclusions <ul><li>International efforts to establish solid health research systems are yielding positive results in many developing countries </li></ul><ul><ul><li>Rich array of institutions </li></ul></ul><ul><ul><li>Networking is proving its value </li></ul></ul><ul><li>Research systems cannot be conceived in isolation given diversity, complexity and rapid change </li></ul><ul><li>Alliances are critical for institution-building efforts </li></ul><ul><li>Institutions are vehicles whereby human beings mobilize their talents, values, and interests towards the pursuit of shared goals </li></ul><ul><li>National and networked institutes will be key players in launching the new era of public health </li></ul>
  29. 29. REFERENCES <ul><li>Binder S, Adigun L, Dusenbury C, Greenspan A, Tanhuanpää P. National public health institutes: Contributing to the public good. J Public Health Policy. 2008 ; 29:3–21. </li></ul><ul><li>Birn, AE. A marriage of concenience. The Rockefeller Foundation and Revolutionary Mexico. Rochester, Rochester UP, 2006. </li></ul><ul><li>Bossert T Larrañaga O Giedion U et.al (2003). Decentralization and Equity of Resource Allocation: Evidence from Colombia and Chile. Bulletin of the World Health Organization , 91, 95-100. </li></ul><ul><li>Bruce M. Altevogt, Andrew M. Pope, Martha N. Hill, and Kenneth I. Shine (Eds.). Research Priorities in Emergency Preparedness and Response for Public Health Systems. A Letter Report. Committee on Research Priorities in Emergency Preparedness and Response for Public Health Systems. Washington DC, Institute of Medicine, 2008. </li></ul><ul><li>Frenk, J. La Nueva Salud Pública. México, 2004 </li></ul><ul><li>Frenk J & MA González Block, Institutional Development for Public Health: Learning the Lessons, Renewing the Commitment. Commentary. Journal of Public Health Policy (2008) 29, 449–458. </li></ul><ul><li>Garret L (2007). The challenge of global health. Foreign Affairs , 86, 14-38. </li></ul><ul><li>Gonzalez-Block M.A, Leadership, Institution Building and Pay-Back of Health Systems Research in Mexico. Draft, INSP 2008. </li></ul><ul><li>Gonzalez-Block M.A, The state of international collaboration for health systems research: what do publications tell? Health Research Policy and Systems 2006, 4: 7. http://www.health-policy-systems.com/content/4/1/7 </li></ul><ul><li>Hutton G (2002). Decentralization and the sector-wide approach in the health sector. Basle, SDS. </li></ul><ul><li>Irwin A Valentine N Brown C et. at. (2006). The Commission on Social Determinants of Health: Tackling the Social Roots of Health Inequities. PLoS Med 3(6): e106 doi:10.1371/journal.pmed.0030106 . </li></ul><ul><li>Molineux D Nantulya V (2004). Linking Disease Control Programmes in Rural Africa: A Pro-Poor Strategy to Reach Abuja Targets and Millennium Development Goals. British Medical Journal 328: 7448 1129 – 32. </li></ul><ul><li>Rodríguez-López MH. Commentary. A perspective from Mexico. J Public Health Policy . 2008;29:26-31. </li></ul><ul><li>Soberón G, Frenk J, Sepúlveda J. The health care reform in Mexico: Before and after the 1985 earthquakes. Am J Public Health. 1986;76:673-80. </li></ul><ul><li>Unger JP De Paepe P and Green A (2003). A code of best practice for disease control Programmes to avoid damaging health care services in developing countries. International Journal of Health Planning and Management , 18 , S27-S39. </li></ul><ul><li>WHO 1996. Investing in Health Research and Development. Report to the Ad Hoc Committee on Health Research Relating to future interventions Options (document </li></ul>