This document discusses the history and concepts of international health. It begins by outlining the field's origins in the early 20th century with international sanitation conferences and the 1907 establishment of the Office International d'Hygiene Publique. Key organizations discussed include the Pan American Sanitary Bureau (1902), the Health Organization of the League of Nations (1923), and the World Health Organization. The document also examines definitions and perspectives of international health, components that define its scope, and methods of collaboration between countries.

1. INTERNATIONAL HEALTH
Nabin Lamichhane
Purbanhcal University
Lecturer

2. INTERNATIONAL HEALTH
“Nothing on earth is more international
than disease.” -Paul Russel

3. International Health
• Global Health
• Geographic Medicine

4. World
• Global Village
• Diseases: No boundaries of the Nations.
• MALARIA: THE DISEASE WITHOUT
BORDER.

5. History of International Health
1377
– First Recorded quarantine legislation for
prevention of transshipment of rodents to
Venice from foreign port.
1851
- International sanitary conference in Paris- first
step to seek international cooperation in
prevention of communicable disease with
epidemic potentials.

6. 1907
• Office international d’ Hygiene Publique (OIHP) – a precursor
of League of Nations and World Health Organization.- “Paris
Office”
• created to disseminate information on communicable
diseases and to supervise international quarantine measure

7. 1902
– Pan American Sanitary Bureau.
– coordinate quarantine procedures in the American States.
– "The Pan American Sanitary Code“ (1924)
– Pan American Sanitary Organization (PASO)-1947
– PASO would serve as the WHO Regional Office for the
Americas.-1949
– In 1958, the name was changed to Pan American
Health Organization (PAHO). PAHO has grown from a
small information centre to a major health agency
with its headquarters in Washington, D.C. The Pan
American Sanitary Bureau was the World's first
international health agency

8. The Health Organization of the
League of Nations (1923)
• First World War (1914-18)
• “Take steps in matters of international concern
for the prevention and control of disease".
• League branched out into such matters as
nutrition, housing and rural hygiene, the training
of public health workers and the standardization
of certain biological preparations. The League
analyzed epidemiological information received,
and started the series of periodical
epidemiological reports now issued by the WHO.

9. International Health
• “INTERNATIONAL HEALTH” first appeared
sometime in early 20th century & become well
known following the establishment of
International health commission in US in
1913.
• Commission helped in opening first school of
public health in 1917 in US at JHU but only in
1960 international health division was
established in JHUSPH.

10. International Health
• There is much debate about the definition of international
health (or global health as it is sometimes known) and
there are many different interpretations of the term.
• Global health is a broad discipline that develops students’
understanding of the local, national and international
determinants of health and healthcare delivery.
• Studying global health, students examine the wider
influences of health such as poverty, debt, globalisation,
healthcare financing, human rights, famine, environment,
violent conflict and the movement of populations. Global
health draws from a number of disciplines including
politics, economics, sociology, demography, anthropology,
epidemiology and philosophy.

11. Definitions of IH
• International health has been defined in many
ways.
• Public Health with an international dimension.
• Interactions taking place in the field of health
an international level.
• Uses the tools of public health, takes into
account the information received from other
discipline and addresses the questions that
transcend the frontiers of country.

12. “IH has been defined as a field of research and intervention
embracing the international dimensions of health disease
process and care system”.
Broadly Speaking, “International Health is a systematic
comparison of the factors that affect the health of all human
population’’.

13. US Institute of Medicine referred to 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 cooperative actions and
solutions".

14. Different Perspectives of IH
• Public Health Worker: Protection of population from
illness.
• Epidemiologist: study of distribution and control of
disease.
• Clinician: practice of medicine in remote area.
• Administrator: Organization and operation of Health
services.
• Economist: Study of Health resources allocation and
financing.
• Politician: Controlling spheres of influences.

15. Components of IH
• It uses principles of epidemiology while appreciating
the root causes of ill health in the world in general and
in defined populations in particular, with an aim of
alleviating the global burden of diseases.
• It deals with psychosocial aspects while understanding
the psychosocial effects of diseases or health related
events on individuals, families and communities.
• Demographic aspects are important for understanding
the composition of population segments in individual
countries and of populations in different countries.

16. Contd……
• Economic aspects come into play when it deals with public
health expenditure and out of pocket expenditure on
health, resource allocations and the cost of illness to
individuals, families, communities and countries.
• It also dwells upon health system and governance while
discussing the health systems of the countries, their health
infrastructure and their governance and also of the health
ministries and their interactions with other ministries which
have a direct impact on the health.
• It also includes certain miscellaneous aspects like ethical
issues, utilization of alternative medicine by various
population segments, humanitarian response to disasters
and emergencies and the participation of various
governmental, non-governmental and private agencies.

17. Methods of International Health
• Comparative studies of healthcare system
• Comparative studies of health status
• International regulations
• International collaborations
• Studies of influence of global relations in
health

18. Scopes of International Health
– Health is an international concern. Problem of one
part affect the other part.
– Problem can be solved or minimized through joing
effort between the nation or global effort
– Experience of one nation can be useful for other
– There has been rising relationship between the
nations (global relationship) affecting the health
of one another.

19. Rationale of concept of International
health
• Globalization in knowledge and technology
• Communication network extension
• Trade liberalization
• Emergence and Remergence of communicable
disease

20. Health is international concern
• Concept of transborder transmission of
disease
• Disease is not only the problem of small part
but also of whole world
• International commitment on health

21. Collaborative efforts in IH
• Action collaboration: Conference, Bilateral
Cooperation, Disaster management, SDG, MDG.
• Research collaboration
– GAVI
– Research projects
• Experience sharing among countries
– Learning form each others experience eg success of
CPHC in Cuba, bette indicator of health service in
Srilanka.

22. The World Bank's criterion for classifying
economies of countries is gross national
income (GNI) per capita. Based on its GNI per
capita, every economy is classified as:
- Countries with low-income economies
- Countries with lower-middle-income
economies
- Countries with upper-middle-income
economies
- Countries with high-income economies.

23. World within the world
• Four Worlds
After World War II the world split into two large geopolitical blocs
and spheres of influence with contrary views on government and
the politically correct society:
1 - The bloc of democratic-industrial countries within the American
influence sphere, the "First World".
2 - The Eastern bloc of the communist-socialist states, the "Second
World".
3 - The remaining three-quarters of the world's population, states
not aligned with either bloc were regarded as the "Third World."
4 - The term "Fourth World", coined in the early 1970s by Shuswap
Chief George Manuel, refers to widely unknown nations (cultural
entities) of indigenous peoples, "First Nations" living within or
across national state boundaries.

24. First World
• "First World" refers to so called
developed, capitalist, industrial countries,
roughly, a block of countries aligned with the
United States after World War II, with more or
less common political and economic interests:
North America, Western Europe, Japan and
Australia.

25. Second World
• Second World" refers to the
former communist-socialist, industrial states,
(formerly the Eastern bloc, the territory and
sphere of influence of the Union of Soviet
Socialists Republic) today: Russia, Eastern
Europe (e.g., Poland) and some of the Turk
States (e.g., Kazakhstan) as well as China.

26. Third world
• Third World" are all the other countries, today
often used to roughly describe the developing
countries of Africa, Asia and Latin America.
The term Third World includes as well
capitalist (e.g., Venezuela) and communist
(e.g., North Korea) countries, as very rich (e.g.,
Saudi Arabia) and very poor (e.g., Mali)
countries.

27. Fourth World
• The term "Fourth World" first came into use in
1974 with the publication of Shuswap Chief
George Manuel's: The fourth world : an
Indian reality , the term refers to nations
(cultural entities, ethnic groups) of indigenous
peoples living within or across state
boundaries (nation states).

29. Countries are often loosely placed into four categories of
Development:
1. Developed countries ( Canada, United States, European Union members, Japan, Israel, Australia, etc.)
2. Countries with an economy consistently and fairly strongly developing over a longer period
(China, India, Brazil,South Africa, Costa Rica, Mexico, Egypt, much of South America, etc.)
3. Countries with a patchy record of development (most countries in Africa, Central America, and
the Caribbean excepting Jamaica; much of the Arab world falls in this category)
4. Countries with long-term civil war or large-scale breakdown of rule of law or non-development-oriented
dictatorship ("failed states") (e.g. Somalia, Sudan, Burma, perhaps North Korea)

30. References
• A Text Book of PSM, K. Park, 21st Edition
• Oxford Text book of Public Health
• Websites of WHO, World Bank etc.
• Annual Report of Ministry of Health of Nepal.