- Global health starts at the local level by understanding the context, access, sustainability, and agency that shape health outcomes in one's own community. - The COVID-19 pandemic highlights health inequities that exist locally between those who are at higher risk and can access care. - Global health research can help address these inequities by deepening understanding of outcomes, designing with local priorities in mind, strengthening health systems and advocacy, and informing global policies that impact the local. - Opportunities in global health involve identifying topics of interest, building relevant skills, connecting with researchers and organizations, and staying aware of developments in the field.

1. Equity and Sustainability in
Global Health
Dr. Ebele R.I. Mogo
At the 2022 Student National Medical Association
Global Health Fellowship Program

2. What comes to mind
when you hear "global
health”?

3. Googling global health
• Image from a google search
on “global health”, the
National Institutes of Health
website

4. Global health is often thought to be foreign
• Travelling to a poorer country
• Providing free drugs
• Providing emergency
operations
• From us here, to them there
• It is not that simple

5. Questions we need to wonder about
• Who is he? And she? (Context)
• Why doesn’t he have this drug?
(Access)
• What happens after she leaves?
(Sustainability)
• What does his community
need? (Agency)

6. Let’s imagine what his story might be
Perhaps…
- Emeka is 8 years old, living in Nnewi, Anambra State, Nigeria
- His parents don’t have culturally appropriate and trustworthy
information on why and how to access the vaccine in Igbo
- People distrust pharmaceuticals because of Pfizer’s non-
consensual use of an experimental drug on Nigerian children
in 1996
- The health system is underfunded so only people who can
afford it can get regular healthcare
- Increased flooding due to climate change is leading to more
infections in his community so the burden of disease exceeds
the capacity to respond

7. Let’s imagine his story
- In the healthcare centre in his town, electricity is
irregular so they cannot store vaccines
- There is a doctor shortage because most doctors
emigrate abroad due to poor economic
conditions
- The road network to his community bad and
they can’t access existing healthcare
- Emeka’s friends would get vaccinated but the
medical team always comes when they have to
go to the stream

8. How do you imagine we
can sustainably improve
Emeka’s community’s
health?

9. Some key priorities
- Access to health insurance
- Access to primary healthcare
- Access to wellbeing systems e.g. good roads,
coordinated activities to adapt to flooding
- Access to well trained & paid health workers
- Access to culturally appropriate, convenient
and trustworthy information

10. •Context
•Access
•Sustainability
•Agency
•The questions that shape
local health outcomes
also shape global health
outcomes

11. There are global
differences in health
outcomes
• See Central African Republic versus
Australia

12. Can you think of any health
inequities that exist globally
(between regions of the world)?

13. There are also
regional
differences
• Turkmenistan versus Japan, both in Asia

14. Can you think of any health
inequities that exist regionally
(within regions of the world e.g.
within North America)?

15. And there are local-
local differences in
health outcomes
• L: Note the difference between the urban richest and
poorest in Africa, and between the urban richest in
Africa and the urban poorest in the Americas
• R: Water from St. Josephs, Louisiana, United States
which would be considered a high-income country

16. Can you think of any health
inequities that exist locally
(between communities in the same
town or country)?

17. How healthcare
practitioners can contribute
to improved global health

18. Global health starts where you are
• It is about how the local decisions intersect with
global outcomes
• It is also about how global decisions are reflected in
local outcomes
• It is about what different local contexts can learn
from one another
• It is about Context, Access, Sustainability and
Agency of initiatives

19. Global health starts where you are
• To understand health globally, you should be
curious about the history, partners, infrastructures
that create health in your neighbourhood
• Can you connect the health outcomes your patients
present to healthcare system?
• Can you connect the burdens on the healthcare
system to wellbeing systems?

20. COVID-19 pandemic: lens on
healthcare where you live
- What are the features of the patients that present
with and die from COVID-19 where you live?
- Who has the higher burdens of “pre-existing
conditions” that puts them at a higher risk for COVID-
19?
- Who has higher levels of mistrust in the healthcare
system?
- Who can access the best care, when they do fall sick?

21. How would you address
Context, Access
Sustainability and Agency
around healthcare in your
community?

22. COVID-19 pandemic: lens on
wellbeing systems
- Who has better access to healthy foods to reduce
their risk of pre-existing conditions?
- Who has cleaner neighbourhoods with unpolluted air
to reduce their risk for pre-existing conditions?
- Who was able to care for their mental health through
access to nature, safe and uncrowded housing?
- Whose neighbourhoods have the best health-
promoting infrastructure e.g. sidewalks, parks, bike
lanes?
- Whose housing situation limits them from being able
to socially distance?

23. How would you address
Context, Access, Sustainability
and Agency around wellbeing
systems in your community?

24. What kinds of questions would
you need to answer to address
Context, Access, Sustainability
and Agency?

25. Global health research
can help you…
• Deepen your understanding of health outcomes and
wellbeing systems e.g. epidemiological research
studying outcomes in their social and economic
context
• Design with Context, Access, Sustainability and Agency
e.g. through implementation research and evidence
synthesis
• Strengthen the local to address the global e.g health
systems, policy research, community health research
• Strengthen the global to address the local e.g. research
into global health policy, funding decisions, global
advocacy and decision making

26. Finding global health opportunities
• Look at the existing research, your background, interests, and evident
gaps your neighbourhood
• Identify topics, researchers and organisations of interest
• Build your knowledge of epidemiology, behavioural health, policy,
implementation to make yourself valuable and competitive
• Look for opportunities to contribute to projects e.g. research,
advocacy, intervention design, informing policy

27. Finding global health
opportunities
• Connect with people in institutions doing
the work you want to do
• How can you add value to what they are
doing?
• Build your communication skills
• Let your resume reflect a good fit for
advertised opportunities

28. Finding global health
opportunities
• Stay breast of developments – Google
Scholar alerts, newsletters, LinkedIn
• Do good work and manage relationships
well
• Reflect on your ideal career – work,
partners, outcomes, lifestyle to tailor your
approach

29. Questions?