1. Global Health and
Intersectoral Collaboration
Heather Lannin RN
MPhil, MSc, BSc
(Lecture formerly delivered by Rebecca Swan 2012)

2. GROUP WORK
o Discuss answer to key question
‘WHAT IS GLOBAL HEALTH?’
Group divide into 4 to discuss answer from
different world positions as inspired by & with
reference to Rawl’s Theory of Justice
1) Super-poor 2) Status-Quo 3) Super-rich
& 4) Special Individuals

3. RAWL’s - Theory of Justice 1971 / Fairness for all 2001
 Veil of ignorance
 Invisible hand
 Leading to…. - equality for all !!!!

4. What is Global Health?
 What is global health ?
 What does it mean ?
 What is the difference between global
health and the term international
health?

5. Alma Ata International Conference
on Primary Health Care 1978
 WHO agreed a holistic definition for
health of an individual person ….and…
 Expressed an urgent need for the
world community to protect & promote
the health of all the people of the
world (WHO, 1978).

6. Global Health
A decade ago the Institute of Medicine
defined global health as,
‘health problems, issues and concerns
that transcend national boundaries, may
be influenced by circumstances or
experiences in other countries, and are
best addressed by co-operative actions
and solutions ’ (Institute of Health Medicine 1997)

7. Global vs International comparisons
 Health experience can be related to so many
factors and be difficult to usefully generalize
as a global issue
e.g. the WHO statistics show suicide to be a key health issue in
UK / western society but in Africa it is hardly an issue
The European Observatory on Health Systems & Policies
established in 1999 create & maintain standardised comparison
‘hit’ booklets for different countries that are free to obtain
Currently cover 35 countries. New Website – www.HSPM.org
Provides a health systems and policies monitor regularly updated.
BUT DEBATE EXISTS….
Does a true global health understanding/way exist for all?
Debate @ LSE conference 2013 ‘Towards a global health policy?’

8. A truly Global Health Policy ?...
WHO Essential Medicines List
“those drugs that satisfy the health care
needs of the majority of the population,
they should therefore be available at all
times in adequate amounts and in
appropriate dosage forms, at a price the
community can afford”
April 2013 18th
Edition /4th
Paediatric Editiom
150 countries owned list last year –
WHO has model list for all 194 country regions

9. Global Health in action
 Definite need for regulation of
pharmaceutical industry globally
 Recent e.g. The country of Pakistan
worked in close collaboration with
WHO experts (who played crucial role in
investigation) to uncover fraud with use of anti-hypertensive
agents
 100 cardiac patients died
Samples sent to London lab for testing
 http:/www.who.int/features/2013/pakistan_medicine_safety/e
n/index.html

10. My Experience in Sierra Leone
 West Africa – 5 million population
 Life changing experience included
Living with orphans who had psychological
bad memories, cleaning a local hospital,
prison visits & provision of soap
 Friends and on-going relationships
 Challenges in development – ‘aid vs
trade’

11. “UK mum” to 30 African Kids….

12. Determinants of Health
 Poverty
 Nutrition
 Education
 Water and Sanitation
The Black Report 1980 Peter Townsend et al.
(classic text on causes i.e. determinants of health inequality)
http://datatopics.worldbank.org/hnp/HNP_Map/DVMap.html

13. Millenium Development Goals
The United Nations Development
Programme
In 2000, 189 nations made a promise to
free people from extreme poverty and
multiple deprivations.
This pledge turned into the eight
Millennium Development Goals.
http://bcove.me/9xtf8mgb

14. A good place to start
The Millenium Development Goals
8 Goals
 Eradicate extreme poverty and hunger
 Achieve universal primary education
 Promote gender equality and empower women
 Reduce child mortality
 Improve maternal health
 Combat HIV/AIDS, malaria and other diseases
 Ensure environmental sustainability
 Build a global partnership for development

15. Progress to date
 The target of reducing extreme poverty by half has
been reached five years ahead of the 2015
 The target of halving the proportion of people who
lack dependable access to improved sources of
drinking water.
 Conditions for more than 200 million people living in
slums have been ameliorated—double the 2020 target.
 Primary school enrolment of girls equalled that of
boys.
 Accelerating progress in reducing child and maternal
mortality.
http://www.un.org/millenniumgoals/pdf/report-
2013/2013_progress_english.pdf

16. A long way to go
 In 2015 more than 600 million people worldwide will still be using
unimproved water sources
 Almost one billion will be living on an income of less than $1.25 per day,
mothers will continue to die needlessly in childbirth, and children will
suffer and die from preventable diseases.
 Hunger remains a global challenge, and ensuring that all children are
able to complete primary education remains a fundamental, but
unfulfilled, target that has an impact on all the other goals.
 Lack of safe sanitation is hampering progress in health and nutrition.
 Biodiversity loss continues apace, and greenhouse gas emissions
continue to pose a major threat to people and ecosystems.
http://www.undp.org/content/dam/undp/library/MDG/english/The_MDG_Report_2012

17. Real Girl Power!
 Mothers’ education remains a powerful
determinant of inequity.
 Children of educated mothers—even
mothers with only primary schooling—
are more likely to survive than children
of mothers with no education.
 “Malala’s” experience has helped this
campaign globally to gain public support

18. Reducing under fives mortality
It is possible to speed up the decline in under-five
mortality by
 Ensuring education,
 Empowering women,
 Removing financial and social barriers to accessing basic services.
 Making critical services more available to the poor and improving
health system.
An equity-focused approach brings greatly improved
returns on investment by averting far more child
deaths and episodes of under nutrition and by
expanding key primary health and nutrition interventions.
UNDP Millenium Development Goals Report 2012

19. Nurses role
‘Global nurses practice in a way that is
consistent with the values and
mindsets and behaviours associated
with global citizenship and play a role
in leading change’ Rafferty 2010

20. Global issues
 By 2025 more than 800 million of the worlds
population will be over 65, two thirds will be in
developing countries.
 Chronic diseases associated with aging are
increasing with soaring costs in poor and rich
nations alike.
 Nurses need to manage care with attention to
ethical, economic and moral implications for a
specific population e.g. obesity, organ
transplants (xenografting), some technologies
available in US but not elsewhere

21. Intersectoral Collaboration
‘Promoting partnerships will require
changing working relationships and
the norms and values within agencies
and governments to ensure that a
more equal and more ‘listening’ approach
is adopted.’ (Caddall and Pinder 2005)

22. Examples of Intersectoral
Collaboration
Using the example of London 2012
Olympic & Paralympic Games
 Can you think of the agencies /sectors
involved?
 What are some the global planning
issues/responses to this area of public
health?
Discuss in your groups/pairs

23. Key Organisations

24. Development
‘Third World’ and ‘Developing World’ suggests
different stages in the size of a countrie’s economy.
‘Third World’ poverty and development issues are issues
that are relevant to all societies. All countries have
problems that relate to poorer & more marginalised
Groups e.g. UK Policy 1998 on Health Action Zones.
Yet for global economic comparison the world is sometimes
divided into low, middle & high income countries

25. Challenging Assumptions- examples
 Despite low level per capita income Kerala
State in India has a long history of organised
health care + girl’s education & position of
women in emerging health care. Widespread
public awareness of social need & responsibility
 Sri Lanka is another such case - Excellent
social development with low per capita incomes
 Cuba has been a model for good local,
accessible public health visited by our own
politicians i.e. health @ low £ (1 in every 9
people is a qualified GP !)

26. How can you impact global health
 Be a great nurse! Your research and practice is an important contribution to improving
global health
 Help to create a more sustainable world
http://www.sdu.nhs.uk/documents/publications/1260355467_LNhx_fit_for_the_future.pdf
 Ensure environmental consideration at work and at home
http://www.rcn.org.uk/support/the_working_environment/sustainability__and__greening_the_workplace
 Campaign for Fair Trade (localised (Regional) Fair trade would greatly reduce the carbon
footprint)
 The world as a whole can, and usually does, produce much more food than is required to
feed all of us now, and even with a predicted global population of about 9 billion by 2050.
(Sachs, J)
 Don’t be a bystander -Protest at inequity and take action
http://www.guardian.co.uk/education/2012/nov/29/students-wed-rather-go-naked-than-wear-swe
 Keep & promote WHO health days e.g. World Immunization Week (last week in April
2013)
http://www.who.int.gho/publications

27. Keep updated - use useful
social network links …..
 WWF Earth Hour
 United Nations Foundation
 DFID – UK
 UN Development Programme
 World Food Programme
 Join in the fun….. Take part in local public
Health Events e.g. in Manchester May-
diabetes, liver, heart screen of 1000 people to
raise awareness
 Facebook /Twitter e.g. @OBShealth

28. Challenges ahead
Evidence suggests that care may
have to be provided in under
resourced, chaotic healthcare
environments; managing the
increasing demands for nursing care
in a context of work force
shortages…and the challenge of
providing safe, quality, timely care.

29. Promoting Equality
 Be a champion for NHS led by the
NHS Equality & Diversity Team
 Be alert to promoters of fairness for
all e.g. the Equality Trust
Key Text –
The Spirit Level: Why More Equal Societies
Almost Always Do Better is a book by Richard
G. Wilkinson and Kate Pickett, published in
2009 by Allen Lane.

30. Finally
‘The world is now truly a global village, a world where
communication is so rapid and intensive that both
the good and the bad things that happen anywhere
are registered within minutes around the globe. This
intensifies the emotions generated by greater
inequities. Greater social justice can only be
achieved by a more substantial engagement of the
richer countries with the poorer, and moreover on a
full partnership basis’ (Macdonald 2009)

31. Remember
‘Things will only change if , we the
rich, recognise in fullest measure the
worth, dignity and the ineffable
potential of every single one of our
fellow human beings’
(Macdonald, 2009)
http://www.youtube.com/watch?
feature=player_detailpage&v=IHyH3MPgZ
Do

32. References
World Health Organisation Publications http;//who.int.gho/publications
Board on International Health, Institute of Medicine. (1997). America'svital interest in global
health: Protecting our people, enhancing our economy, and advancing our international interests.
Washington, DC:National Academy Press. Available at
http://www.nap.edu/openbook.php?record_id=5717&page=2[Contxt Link] Accessed on [02/11/12]
Health Care Without Harm. Global Green and Healthy Hospitals. (2011) Available at
www.noharm.org/lib/downloads/building/GGHHA.pdf. Accessed on [03/11/2012]
Journal of Environmental and Public Health (2010) Strengthening Intersectoral Collaboration for
Primary Health Care in Developing Countries: Can the Health Sector Play Broader Roles?
Macdonald, H., T,. (2009) ‘Removing the Barriers to Global Health Equity’ Radcliffe, Oxford
NHS Sustainable Development Unit. Saving carbon, improving health. 2009. Available online at
www.sdu.nhs.uk/documents/publications/1237308334_qylG_saving_carbon,_improving_health_nhs_
carbon_reducti.pdf Accessed on [29/11/2012]
.

33. References
Sneyd J, Montogery H, Pencheon D. 2010‘The anaesthetist and the environment’
Anaesthesia; 65:435-42.
The Open University (2006) ‘TU872’ Institutional Development Conflicts, Values and
Meanings. Readings for Part 1
Hopkins J (2010) ‘A global Profession’ Nursing Magazine available online at;
http://magazine.nursing.jhu.edu/2010/08/a-global-profession/ Accessed on
[30/11/12]
WHO Bulletin
Zephaniah, B. (1996) Funky Chickens, ‘Health Care’ Puffin Books
WHO annual reports - Highlights incidences of different health problems across
nations