This document discusses various concepts and dimensions of global health. It begins by providing context on the rise of the term "global health" and some existing definitions. It then discusses key aspects of global health such as its history, current definitions, and whether it is primarily a concern of high-income countries. Some key points made include: the field is interdisciplinary and addresses health issues that transcend national boundaries; there are debates around distinguishing global health from related terms like public health and international health; and while disease burdens are highest in low/middle-income countries, most global health centers are located in high-income countries. The document advocates for a collaborative, transnational approach to research and action aimed at promoting health for all.

1. VARIOUS CONCEPTS AND DIMENSIONS OF GLOBAL ,
ENVIRONMENTAL
AND NUTRITIONAL HEALTH
P .J. ANN MARY

2. INTRODUCTION
 The rise to prominence of the term “global health” has occurred in parallel with the popularization of globalization, an
enhanced awareness of common vulnerabilities, and a feeling of increased shared responsibility for inequalities present in
the world today [1]. With the increase in Worldwide Trade, Tourism and Migration the movement of people around the
world continues to grow day by day. Disease does not respect boundaries. Global health’ is coming of age, at least as
measured by the increasing number of academic centres, especially in North America, which use this title to describe their
interests (1). Most global health centres are in high-income countries although several have strong links with low- and
middle-income countries. A task force is establishing a mechanism to coordinate European Academic Global Health
initiatives through ASPER. Two recent papers raise important issues about the meaning and scope of global health (2, 3)
and highlight, yet again, the need for a common definition of global health which is short, sharp and widely accepted,
including by the public (4).
 the recent global crises – climate change, economic, food and energy crises – that make global health efforts even more
challenging (5).

3. GLOBAL HEALTH
 International health, in Kaplan’s view, focuses on the health issues, especially infectious diseases, and maternal and child health in low-
income countries. However, elsewhere international health is also used as a synonym for global health. For example, Merson et al. view
international health as ‘the application of the principles of public health to problems and challenges that affect low and middle-income
countries and to the complex array of global and local forces that influence them’ (6). The term ‘international health’ has also been used to
refer to ‘the involvement of countries in the work of international organizations such as WHO, usually through small departments of
international health in the Ministries of Health and as development aid and humanitarian assistance’ (7).
 Public health is usually viewed as having a focus on the health of the population of a specific country or community, a perspective shared
by Kaplan et al. (2). Fried et al. dispute any distinction between public health and global health and suggest that ‘public health is global
health for the public good’ (3). Their strong arguments are based on the need for both global and public health to address the underlying
social, economic, environmental and political determinants of health, irrespective of whether the primary focus is national or global
health.

4. CURRENT DEFINITIONS OF GLOBAL HEALTH
 Kaplan et al. define global health as: ‘an area for study, research, and practice that places a priority on improving health and achieving
health equity for all people worldwide’. This is a useful definition with a broad focus on health improvement and health equity. However,
it is wordy and uninspiring.
 Kick bush defines global health as: ‘those health issues that transcend national boundaries and governments and call for actions on the
global forces that determine the health of people’ (7). This definition also has a broad focus but has no clear goal, is passive in its call for
action, and omits the need for collaboration and research. Elsewhere, the European Foundation Centre calls for a European approach
which makes global health a policy priority across all sectors based on a global public goods foundation (8).
 In an important policy document, the Government refers to global health as ‘health issues where the determinants circumvent, undermine
or are oblivious to the territorial boundaries of states, and are thus beyond the capacity of individual countries to address through domestic
institutions. Global health is focussed on people across the whole planet rather than the concerns of particular nations. Global health
recognises that health is determined by problems, issues and concerns that transcend national boundaries’ (9). This definition contains
important ideas but is convoluted and not outcome focussed. Macfarlane et al. usefully describe global health as being the ‘worldwide
improvement of health, reduction of disparities, and protection against global threats that disregard national borders’ (1).

5. PROPOSED DEFINITION
 Our proposed definition for global health is collaborative trans-national research and action for promoting health
for all. This definition is based on Kaplan et al. but has the advantage of being shorter and sharper, emphasises the
critical need for collaboration, and is action orientated.

6. KEY ASPECTS OF THE DEFINITION.
 The term global health is used rather than global public health to avoid the perception that our endeavours are focussed
only on classical, and nationally based, public health actions. Global health builds on national public health efforts and
institutions. In many countries public health is equated primarily with population-wide interventions; global health is
concerned with all strategies for health improvement, whether population-wide or individually based health care actions,
and across all sectors, not just the health sector.
 Collaborative (or collective) emphasises the critical importance of collaboration in addressing all health issues and
especially global issues which have a multiplicity of determinants and a complex array of institutions involved in finding
solutions.
 Trans-national (or cross-national) refers to the concern of global health with issues that transcend national boundaries
even though the effects of global health issues are experienced within countries. Trans-national action requires the
involvement of more than two countries, with at least one outside the traditional regional groupings, without which it
would be considered a localised or regional issue. At the same time, trans-national work is usually based on strong
national public health institutions

7.  Research implies the importance of developing the evidence-base for policy based on a full range of disciplines
and especially research which highlights the effects of trans-national determinants of health.
 Action emphasises the importance of using this evidence-based information constructively in all countries to
improve health and health equity.
 Promoting (or improving) implies the importance of using a full range of public health and health promotion
strategies to improve health, including those directed at the underlying social, economic, environmental and
political determinants of health.
 Health for all refers back to the Alma Ata Declaration and positions global health at the forefront of the resurgence
of interest in multi-sectoral approaches to health improvement and the need to strengthen primary health care as
the basis of all health systems

8.  GLOBAL HEALTH: A HIGH-INCOME COUNTRY CONCERN?
 Although the burden of preventable disease is predominantly in middle- and, especially, low-income countries,
most global health centres are located in high-income countries. There are several explanations for this anomaly
including the following:
 Centres in low- and middle-income countries are engaged in global health issues but under other labels. For
example, several centres in low- and middle-income countries have recently been funded by the National Heart,
Lung and Blood Institutes to undertake chronic disease prevention activities, though the focus seems to be on
national programmes of work
 Global health builds on international health interests stemming from institutions in high-income countries over a
century ago.

9.  Global health may be seen to be divorced from the health needs of low- and middle-income countries which are
grappling with a range of pressing and challenging health issues.
 An interest in global health stems from strong national public health institutions which are usually not a feature of
low- and middle-income countries.
 Whatever the explanation, encouraging and supporting the establishment of global health centres in low- and
middle-income countries, and south–south collaborations, are essential if countries with the greatest burden of
diseases are to have the best opportunity to respond appropriately. Development agencies, foundations and national
ministries of health could do much more to build public health capacity at the national level. By doing so, they will
also strengthen research and policy interests in global health and its evaluation (10).

10. GLOBAL HEALTH - CONCEPT
 “Global Health” is a widely used but poorly understood term.
 The concept of Global Health has been defined in various ways. Kaplan et al (2009) called for adoption of a
common definition and put forward the following working definition, “an area for study, research and practice that
places a priority on improving health and achieving equity in health for all people worldwide.
 Global health emphasises transnational health issues, determinants and solutions; involves many disciplines within
and beyond the health sciences and promotes inter-disciplinary collaboration; and is a synthesis of population-
based prevention with individual-level clinical care.”
 [2] Beagle hole and Bonita (2010) went further to define Global Health as, “collaborative trans-national research
and action for promoting health for all, emphasising the critical need for collaboration.” [3]

11.  The diverse range of contexts in which the term is found emphasizes how interdisciplinary and multidimensional
global health has become [4]. Despite the ongoing growth in the field of Global Health there continues be no
widely agreed definition of the term, and often continues to be used interchangeably with other terms such as
Public Health and International Health.
 Firstly, what is health? In the simplest of terms, it is a state of "not being sick". The World Health Organisation
defines Health as "a state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity.” But, what do we mean by "Global Health," as opposed to "Public Health" or "International
Health?" Kaplan et al (2009) examines the areas of overlap between these three health disciplines identifying the
key characteristics of each and attempts to draw out the primary distinctions between these three terms, the
summary of which is represented in the table below. Similarly, Maru sic[5], identify the need for a common
definition to ensure clear and effective communication across the multidisciplinary field that makes up the Global
Health Sector. In the absence of consensus on the scope of Global Health, Bantams & Matlin[6] consider what is
distinctive about the field

12. HISTORY
 In order to understand a broad concept, like global health, it is important to consider where it comes from.
 The history has developed from two major trends that shaped global health organisations including the control of
infectious diseases and the development of health care systems and structures. Overall, as the world became
increasingly interconnected global health moved from the imperial concerns of “tropical medicine” to include
more nations and other international organisations in the formations of international health policy.

13.  However, though the concept of global health changed greatly since its beginning, infection control and delivery of
healthcare remained important core features of global health. Discoveries in medicine and public health in the 19th
century as a result of ongoing infectious disease outbreaks like cholera were central to the development of modern
epidemiology with many of the microorganism’s responsible infectious diseases identified e.g. Malaria in 1880
and tuberculosis in 1882. The 20th century saw further medical advances in particular in relation to development
of preventive and curative treatments including penicillin in the 1920s and vaccine for tuberculosis (BCG). The
eradication of smallpox, with the last naturally occurring case recorded in 1977, raised hope that other diseases
could be eradicated as well.

14.  Following World War II, important steps were taken towards global cooperation in health with the formation of the
United Nations (UN) and the World Bank Group, with the World Health Organisation following just a few years later in
1948 which was spurred on by a cholera epidemic in Egypt in 1947 and 1948 which resulted in a huge loss of life [8]. The
WHO published its Model List of Essential Medicines and the 1978 Alma Ata declaration underlined the importance of
primary health care [9].
 The Millennium Development Goals, eight broad goals which reflected the major challenges facing human development
globally, were declared at a United Nations Summit in 2000. The Millennium Development Goals (mugs) are the world's
time-bound and quantified targets for addressing extreme poverty in its many dimensions-income poverty, hunger,
disease, lack of adequate shelter, and exclusion-while promoting gender equality, education and environmental
sustainability. They are also basic human rights - the rights of each person on the planet to health, education, shelter and
security. According to the UN, these mugs provided an important framework for development and significant progress
has been made in a number of areas [10] [11]. Despite massive commitment and global investment progress has been far
from uniform across the world-or across the Goals. There are huge disparities across and within countries and some mugs
have not yet been fully realised including maternal, new born and child health and reproductive health .

15.  Global health’ is emerging as an increasingly widely invoked and powerful discursive construct. But what does it mean?
It is described as a metaphor, a conceptual framing, a set of legal norms, and as a distinct field of practice as an emerging
science, an area of policy and research and as a formative disciplinary field of study. But the precise dimensions of the
idea remain unclear
 While we have yet to clarify what we mean by global health, we should circumspect as to what it is allowed to mean. Too
often, discourse appears to point in one direction, while reality runs rapidly in quite another. The appearance of an agreed
language may obscure and suppress important differences in philosophy, strategy and priority.6 Global health may well
be invoked to support and enable policies and actions with genuinely universal and equitable benefit. But it may also be
used to justify measures that are neither progressive nor just. We should not assume that a harmonious interpretation will,
over time, emerge. Rather, we should expect an emergent global health paradigm to be characterised by potentially fierce
contest. We should encourage that contest, played out through transparent, honest and evidence-based debate. The quality
of that debate, from the health perspective, will depend on an ability to understand, engage with and draw on insights
from a wide field of intellectual traditions and disciplines

16.  If global health is to be an organising framework for thinking and action, we should ask: what does it imply, what
does it endorse? For proponents of a global health vision characterised by health as an intrinsic social goal, and by
health equitably generated within and across populations, understanding how the concept is framed from other
political perspectives, based on other disciplinary values, will require a polymathic capability—to engage with
heterogeneous concepts in macro, micro and behavioural economics; in sociology, political science, international
relations and public policy and in anthropology and institutional ethnography. It will require going beyond
advocacy simply rooted in ‘health’, to understand what health means from other intellectual and political
standpoints, and to engage and challenge where such standpoints traduce the values we seek in global health.

17. EPIDEMIOLOGICAL CONVERGENCE?
 From an epidemiological perspective, global health may be characterised as health issues whose causes or redress
lie outside the capability of any one nation state—a growing homogeneity of challenges common across countries
at all levels of socioeconomic development. This draws on the dramatic reduction in some health inequalities
between rich and poor countries under the Millennium Development Goals (MDGs), between 1990 and 2015,
which itself underpins optimism about the possibility of a ‘grand convergence’ through which countries across the
world see a levelling of major health issues, largely in the fields of infectious disease, maternal and child mortality,
by 2035. As traditional infectious and perinatal drivers of poor-world mortality are reduced to comparable global
lows, a new world of predominantly non-communicable conditions—many with common determinant elements
and solutions—emerges. This is a positive vision of global health, but one that should be approached cautiously.
Improvement in parity between countries in health outcomes may be allowed to distract attention from structural—
and deepening—inequality within them.

18.  Convergence is predicated on significant improvement in basic universal healthcare. Yet, we know that even the
most narrowly deliverable universal services, such as immunisation, remain characterised by deep inequality in
access and uptake. In Nigeria, full immunisation ranges from 51.5% in the South-South to 9.5% in the North-West.
For other forms of healthcare requiring more complex health system functions, genuinely equitable population
coverage remains abysmally low in fact, between 1990 and 2011, coverage inequalities for reproductive, new born
and child health services increased in almost a third of 64 developing countries. In a quarter of those countries,
coverage among the bottom four deciles actually fell, and in a little under half of them, inequality in health status
rose. Income inequality has been increasing in both developed and developing countries in recent decades.
Socioeconomic inequality in adolescent health rose in 34 surveyed North American and European countries
between 2002 and 2010. If global health asserts a benign convergence between countries, it risks obscuring
growing inequity within them. That inequity is associated with underlying political and economic factors within
countries and increasingly at global level under processes of globalisation—processes which will, ineluctably,
shape the meaning of global health.

19.  Poverty reduction sits at the epicentre of socioeconomic development thinking and at the roots of action to improve
health. In a neoliberal economic framing, though, poverty is constituted as a ‘residual’ problem—the absolutely poor as
an unfortunate but technically resolvable effect of the growth process. An alternative, sociologically derived analysis
views poverty as ‘relational’—produced by the forms of social organisation we generate to enhance productivity and
growth. In this view, poverty is not a side effect but a direct consequence of the way societies is organised. The relational
view of poverty bears striking similarity to the social gradient in health. The implications of both are that technical fixes
at the bottom of the distribution are as inadequate in addressing social inequality as they are in addressing inequitable
health. How we understand poverty—and poverty-related health—has significant consequences for what we do about it.
Moreover, analysis of the MDGs process suggests that increase in household income does not automatically translate into
improvements in household health, causing us to question whether an economic interpretation of poverty is adequate in
considering wider socioenvironmental goals. Foundational policy norms, flowing from economic globalisation, will
increasingly shape health actions in coming decades. A global health vision needs to clarify how it engages with these
norms—the primacy of growth, a tolerance for inequality, the constitution of poverty as a technical problem and the pre-
eminence of individual over collective action in social and health policy and action — to accede to their authority or hone
the analytical skills required to challenge them..

20.  Understanding global health requires a nuanced understanding of domestic policymaking within national government
systems, understanding where health intersects with foreign, trade, development and security agendas and drawing on
international relations theory, public policy, political science and institutional ethnography. We can illustrate this through
the examples of aid, security and the global distribution of human resources for health.
 Aid has been a significant feature of international development financing, including for health, since the end of the
Second World War. It has also been viewed, more or less explicitly, as a medium for leveraging national, economic and
foreign policy objectives Under the MDGs, global aid allocations to health massively favoured a small set of disease-
specific interventions—most notably HIV/AIDS, tuberculosis and malaria. By contrast, between 2000 and 2015,
investment in structural aspects of health system development (basic health infrastructure, health personnel and health
education) constituted around 4% of total health aid financing. Preferences in the way aid is used remain closely informed
by the domestic politics of donor countries and deeply contested ideologically and empirically—from effective
interventions in disease prevention, to modes of financing for equitable healthcare. Global health must offer a credible
space within which competing and contesting fiscal and programmatic approaches can be tested against agreed standards
of evidence and basic values.

21.  Health as a matter of global security arose in the 1990s as the potential impact of infectious diseases on trade,
foreign affairs, social stability and insecurity was recognised. But it remains unclear, whether ‘global health
security’ legitimises individual countries to act internationally when they perceive their domestic interests to be at
risk, and to do so through militarised means where deemed necessary, or whether it demands a stronger collective
global decision-making facility to determine, beyond the current International Health Regulations, a more
progressive route to enhancing common health security through shared action on the transnational drivers of health
risk.
 The worldwide shortage of human resources for health is now constituted as a global crisis—affecting countries at
all levels of wealth, though in distinctly different ways.40 In poorer regions and countries, there is a simple—and
often critical—dearth of trained workforce numbers; in richer countries, with shifting demographic and
epidemiological demands, the requirement for healthcare workers, in particular in nursing and social care,
increasingly outstrips domestic ability or fiscal willingness to recruit, train and employ.41

22.  A global health vision needs to be clear whether ‘globality’ now implies a marketplace through which countries at
all levels of development may freely exchange, compete for or actively source health workers (accepting the
gravitational pull of higher-income offers), or if it reflects a continuing commitment to redress the massive
distortion in skilled health workers constituting perhaps the greatest barrier to progress among the poorest states.
‘Global health’ is not a new science, though it may become one. It is not—yet—an emerging field of practice.
Right now, global health is a new terrain on which older contests—contests of ideological interpretation,
geopolitical interest, empirical method—are played out. In its best form, global health offers real opportunities for
more collective, equitable health thinking and action. But without adequate agreed definition, global health may be
used as discursive cover for a range of policies, by individual states or through multilateral institutions, which are
distinctly inequitable or poorly aligned to agreed common global interests.

23.  Arriving at a clearer sense of what a global health paradigm entails—whether in the form of consensus or, at a minimum,
agreeing the terms of debate—requires assembling and interrogating evidence and argument from multiple intellectual
and disciplinary traditions. That process of assembly and interrogation requires an arbiter—an institution at global level
with a reasonable claim to technical competence and ideological impartiality. It may be argued that the only institution
coming close to that definition is WHO. And herein lies an interesting paradox.
 As the emergence of ‘global health’ as a powerful new framing for policy and practice has illuminated the need for
arbitration as to what it means—what it implies and endorses—the one mandated institution to mediate at the global level
appears to be losing authority and influence.5 44 Perhaps, though, this is not a paradox. In the absence of a single global
actor authorised to mediate global health, ‘global health’ may be shaped to whatever the most powerful global actors
determine it to be.45 Just as, under the ascendant influence of liberal free-market economics in the 1980s, we saw the
emergence of the language of ‘governance’ displace and marginalise the traditional centrality of government as sovereign
actor in citizen health, replacing it with a fragmented galaxy of ‘stakeholders’, is it possible that, in a similar fashion, the
rise of a poorly defined ‘global health’ paradigm fits rather well with the diminution and marginalisation of WHO’s
centrality, empowering a more diffuse field in which vested interests may more easily navigate.

24. KEY PRINCIPLES OF GLOBAL HEALTH
 1. A focus on the public good
 2. Belief in a Global perspective
 3. A Scientific and interdisciplinary approach
 4. The need for multi-level approaches to interventions
 5. The need for comprehensive frameworks for health policies and financing. [12]
 Global health manifests itself in the diversity of culture, geography, demography, epidemiology, economics and
gender. Successful global health interventions require a deep understanding, appreciation and concern for the
social milieu of populations, their behaviours, customs and beliefs. When approaching global health, it is
important to understand medical interventions alone do not solve public health problems. The issues are much
more complex.

25. CRITICAL GLOBAL HEALTH CONCEPTS
 In order to understand and to help address key global health issues such as those noted previously, there are a number of
concepts concerning global health with which one must be familiar. Some of the most important include:
 • The determinants of health
 • The measurement of health status
 • The importance of culture to health
 • The global burden of disease
 • The key risk factors for different health conditions
 • The demographic and epidemiologic transitions
 • The organization and functions of health systems

26. A FEW EXAMPLES OF GLOBAL HEALTH ISSUES

 • Emerging and re-emerging infectious diseases
 • Antimicrobial resistance
 • Eradication of polio
 • Diarrheal, measles and pneumonia in young children
 • Sexually-transmitted infections in young women
 • Tuberculosis
 • Malaria
 • HIV/AIDS
 • Parasitic infections such as hookworm

27.  Global health as such implies a global perspective on public health problems, suggesting issues that are common
across the world and working collaboratively to try and address and manage these issues.
 Global health actions may be in response to some of the world's major health burdens such non-communicable
disease (cardiovascular disease, diabetes, cancers and chronic respiratory diseases) or injury which occur in
various magnitudes across many countries, regardless of level of development.

28. ENVIRONMENTAL HEALTH

 Environmental health is a broad and complex subject area which, at its core, seeks to understand interactions of
environmental factors with biological systems. Thus, exploration of environmental health necessitates concerted
multidisciplinary approaches to understanding and addressing environmentally influenced health outcomes. This
reference module was assembled to focus on environmental health, but necessarily it encompasses a vast array of
contributing topics. The Environmental Health module itself is organized into broad topical areas, each of which is
further subdivided into more specific subject areas. Herein we present information across the spectra of Environmental
Medicine, Environmental Toxicology, Global Environmental Issues, and Social, Economic, and Policy issues, all of
which influence environmental health.
 The concept of environmental health might typically conjure up images of people living in smog-filled cities, or by
contaminated rivers or overflowing landfill sites. However, it also concerns the spaces in which people most frequently
inhabit: their homes and workplaces. Furthermore, the conditions in which people live and work can vary according to
factors such as income, occupation, education, and ethnicity, and lead to inequalities in exposure to environmental risks
and related diseases.

29. Environmental Stressors
Chemical Physical Biological
Antibiotics Electromagnetic Fields Harmful Algal Blooms
Disinfection By-Products Noise Microorganisms
E-waste Particulate Matter Zoonoses
Gases Radiation
Halogenated Hydrocarbons Ultraviolet Light
Metals & Trace Elements
Nanoparticles
Persistent Organic Pollutants
Pesticides
Petrol’s
Pharmaceuticals & Personal Care Products
Solid Waste
Table 1. Specific information on stressors is contained within the module itself.
Table 1. Environmental stressors addressed in the Environmental Health reference module

30. ANTHROPOGENIC FACTORS
 - social, political, and economic - are often major determinants of environmental health. In addition to
environmental stressors themselves, social, political, and economic constructs can mitigate or intensify ecosystem
and/or human health outcomes. Therefore, no environmental health information resource could be considered
complete without inclusion of relevant information on social determinants, law and policy, and resource
distribution. This reference resource contains articles addressing differential environmental health impacts
associated with variable access to water and food resources, medical care, jobs, shelter, and other resources which
may offset or exacerbate responses to environmental stressors. Moreover, policy decisions and regulations
affecting resource partitioning are explored within this module.
 Clearly, environmental health is a broad and complex subject area which is inextricably linked with medicine,
toxicology, ecology, and human studies. This module was assembled to focus on environmental health, but
necessarily encompasses a vast array of complimentary topics. Individually or collectively, it is hoped that this
assemblage of up-to-date articles will facilitate understanding and efforts aimed at improving environmental
“health” such that it can, in the future, truly be defined as “devoid of, or resistant to extended periods of morbidity
or … mortality.”

31.  Environmental health can be defined as the interconnections between people and their environment by which human
health and a balanced, nonpolluted environment are sustained or degraded. The two-way reciprocity of environmental
health – human activities affecting environmental quality, and environmental conditions impacting human health – makes
its relationships complex and dynamic, operating simultaneously at many scales, from individual to community to
national to global.
 Following historic pollution episodes in the twentieth century that had devastating human consequences (including air
pollution disasters in the Meuse Valley, Belgium, in 1930; Donora, Pennsylvania (PA), in 1948; and the London Smog of
1952), environmental health has blossomed into an active area of academic research that can contribute to national and
international health policy, even though it may take years for appropriate policies that reflect the findings of scientific
research to be instituted. Environmental health inequalities are evident especially in context of housing and
neighbourhood. This article focuses on housing and on the question to which extent substandard housing mediates social
and spatial inequalities in the distribution of health. The causes and extent of bad conditions in dwellings and the
neighbourhood environment, determined from empirical data, correlations of effects with social and health inequalities
determined, and their relevance for healthy housing programs are discussed.

32.  Environmental health was defined in a 1989 document by the World Health Organization (WHO) as: Those aspects of the
human health and disease that are determined by factors in the environment. It also refers to the theory and practice of
assessing and controlling factors in the environment that can potentially affect health. Environmental health as used by
the WHO Regional Office for Europe, includes both the direct pathological effects of chemicals, radiation and some
biological agents, and the effects (often indirect) on health and wellbeing of the broad physical, psychological, social and
cultural environment, which includes housing, urban development, land use and transport.[1]
 As of 2016 the WHO website on environmental health states "Environmental health addresses all the physical, chemical,
and biological factors external to a person, and all the related factors impacting behaviours. It encompasses the
assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing
disease and creating health-supportive environments. This definition excludes behaviour not related to environment, as
well as behaviour related to the social and cultural environment, as well as genetics."[2] The predominant agency
associated with global health (and international health) is the World Health Organization (WHO). Other important
agencies impacting global health include UNICEF and World Food Programme. The United Nations system has also
played a part with cross-sectoral actions to address global health and its underlying socioeconomic determinants with the
declaration of the Millennium Development Goals[7] and the more recent Sustainable Development Goals..

33. NUTRITIONAL HEALTH
NUTRITIONAL HEALTH
 Your food choices each day affect your health — how you feel today, tomorrow, and in the future.
 Good nutrition is an important part of leading a healthy lifestyle. Combined with physical activity,
your diet can help you to reach and maintain a healthy weight, reduce your risk of chronic diseases
(like heart disease and cancer), and promote your overall health
Ultimately, energy balance, the dynamic relationship between energy consumed and expended, is
critical for determining nutritional health and well-being. In the industrialized world, low levels of
physical activity coupled with relative abundance of food create a net surplus of energy, or a positive
energy balance. Conversely, among rural food producing societies of the developing world, limited
energy availability and heavy workloads produce widespread under-nutrition (negative energy
balance).

34. • To assess long term energy balance (physical nutritional status) nutritionists typically
measure body weight and composition (i.e., fat and muscle). One of the most widely
used measures of physical nutritional status is the body mass index (BMI). The BMI is
a weight-for-height measure that is calculated as weight (in kg) divided by height (in
meters) squared. Because the BMI is strongly correlated with levels of body fatness it
provides good long-term measure of energy balance. In the developing world, under-
nutrition has declined over the last 40 years; however, it remains a persistent problem.
As shown in
• While under-nutrition remains a severe problem in rural regions of the Third World,
increasing rates of obesity are being found among urban populations of the developing
world. This trend has been documented in North Africa (e.g., Morocco and Tunisia)
and South America (e.g., Brazil and Chile), and is likely attributable to the
Westernization of dietary habits and more sedentary lifestyles. As in the United States,
diabetes and other cardiovascular diseases have increased as a consequence of the rise
in obesity. It thus appears that much of developing world is now undergoing a rapid
nutritional transition such that obesity and under-nutrition exist as parallel problems.

35. CONCLUSION
 Global health is the health of populations in the global context;[1] it has been defined as "the area of study,
research and practice that places a priority on improving health and achieving equity in health for all people
worldwide".[2] Problems that transcend national borders or have a global political and economic impact are often
emphasized.[3] Thus, global health is about worldwide health improvement (including mental health), reduction of
disparities, and protection against global threats that disregard national borders.[4][5] Global health is not to be
confused with international health, which is defined as the branch of public health focusing on developing nations
and foreign aid efforts by industrialized countries.[6] Global health can be measured as a function of various global
diseases and their prevalence in the world and threat to decrease life in the present day.