Why the Alliance

Why the Eurasian Academic Alliance for Global Health?

As the world becomes more globalized, so does health of its population. Global health challenges require effective trans-national actions in order to preserve human health.  While cooperation on global health issues is important among all countries of the world, it is particularly essential for the countries located in closer geographic proximity, since they are more tightly linked to each other by the external factors – trade, tourism, environment, climate, socio-cultural influence – to name a few, that may play catalytic role in exacerbating health challenges of their populations. 

These actions need to be based on mutually reciprocal responsibilities among countries, aimed at achieving commonly agreed health objectives, and should be executed through internationally agreed coordination mechanisms. This is precisely what global health does:  It sets a frame for conceptual, technical and operational understanding of what countries and key global health actors should do in order to better protect human health in the globalized world.  

Humans have lived with continual changes since the migration of Homo erectus out of Africa a million years ago. Globalization, in this sense, has gone hand in hand with the evolution of human societies and has caused global health challenges, such as for example pandemic outbreaks, that have ravaged societies throughout the history. In different epochs countries have crafted international agreements and taken other forms of international collaboration in order to protect health of their populations, which meant protection of their economies, and ultimately of their national interests. However, the contemporary global health explores how the new economic, political and social realities of the 21^st century necessitate new types of responses to new types of global health challenges.

From the 1990s, awareness of the impact of globalization on health shifted the focus from international health to global health. The term International Health has mainly been used to encompass approaches to health problems in developing countries and the flow of resources and knowledge from the developed to the developing world.

Global Health, in contrast, addresses health issues and concerns, which transcend national and political boundaries of all countries, and create a relationship of global, mutual interdependence. Pandemic outbreak of COVI D19 is the best illustrative example of a global health challenge.  Thus, global health focuses on the health needs of the people of the whole planet, above the concerns of particular nations, and emphasizes the shared susceptibility to, experience of, and responsibility for health, that will be best addressed by coopera­tion among all nations.

Like for many other complex concepts, arriving to a consensus on a single, commonly agreed definition of the term “Global Health”, has been difficult. Multiple definitions proposed up to date unpack the concept by focusing on several key points:

	Global Health	International Health	Public Health
Geographical Reach	Focuses on issues that directly or indirectly affect health, which transcend national boundaries	Focuses on health issues in low- and middle-income countries and on providing technical and financial support from developed to developing nations	Focuses on issues that affect the health of the population of a particular country
Level of Cooperation	Development and implementation of solutions requires global cooperation	Development and implementation of solutions usually requires at least bi-national cooperation	Development and implementation of solutions does not usually require global cooperation
Access to Health	Health equity among nations and for all people is a major objective	Seeks to help people of other nations	Health equity within a nation or community is a major objective
Range of Disciplines	Highly interdisciplinary and multidisciplinary within and beyond health sciences	Embraces a few disciplines but has not emphasized multi-disciplinary approaches	Encourages multi-disciplinary approaches, particularly within health sciences and with social sciences

Source: Kaplan et al. 2009

The U.S. Academy of Medicine has 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 cooperative actions and solutions”. Global health in this definition is portrayed as going beyond health-related communication between governments to refer to the health needs of people across the world, irre­spective of borders, thus depoliticizing the field.

The UK Government also refers to global health in a similar way: “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”.  

A definition provided by Koplan and colleagues is focused on the importance of combining technical/academic and practical/operational components, and defines the term as “an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide”.  

A few key aspects embedded in the above definitions deserve further attention.

• Collective action emphasizes the critical importance of coordination and collaboration in addressing global health issues, which have a multiplicity of determinants and a complex array of institutions involved in finding solutions. Such an approach promotes inter-disciplinary work/science in global health.
• 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 regional issue. At the same time, trans-national work is usually based on strong national public health institutions.
• 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 emphasizes 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.
• Equity stresses the principle of “no one left behind”, and endorses the human rights-based approach to health.

While ample technical and technological solutions exist for many of the most pressing global health problems, closing the global health gap requires massive political and financial commitment in both developed and developing countries as well as a reorientation in policy and strategy. Indeed, the very fact that solutions exist but are not equally accessible for all countries, is one of the key driving forces of the global health agenda. This entails resolving the participatory gap in setting global health priorities, the operational gap in building efficient and sustainable public health responses and the accountability gap in addressing the health needs of the poorest at the local and the global level.

The landscape of the global health field has been transformed in recent years by various factors: the entry of large number of new stakeholders, the rise of innovative financing methods, overall reduction of the total funding base due to competing priorities in other development areas, accumulated technical knowledge on high-impact interventions and others. These factors promote increased awareness among capacity among global health actors and provide opportunities to explore new synergies. One of the major challenges remains creation of a well-coordinated global agenda for global health. Since politicians are usually more focused on domestic health issues the political processes, included budget planning and program development are often inward looking, which interferes with establishing jointly executed collaborative actions at the global level. However, the latest development, notably the COVI19 pandemic, as well as military conflicts, natural disasters, environmental challenges – have played a significant role in elevating the importance of global health to the highest international political levels, which will inevitably affect resource allocation and improved operationalization. 

Furthermore, global health is the critical component of the 2030 Agenda for Sustainable Development, adopted by all United Nations Member States, which provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. At its heart are the 17 Sustainable Development Goals (SDGs), which are an urgent call for action by all countries – developed and developing – in a global partnership.

In recognition of global health’s importance for societal wellbeing, political stability and economic development, Western European and Northern American countries have developed their academic capacities in this field since the early 2000s. They have also supported low-income countries in Africa and Asia to build technical expertise in global health. However, middle-income counties in the Eurasian region often do not qualify for the same degree of external support; nor do they have sufficient financial and technical  resources to develop global health as an academic discipline themselves. Currently, most countries in the Eurasia region do not have an established global health role on the world stage, nor have they developed global health academic centers to generate and disseminate knowledge on global health challenges and solutions. This creates  risk for both themselves, and for other countries, since global health addresses those health challenges that are not contained within countries’ political borders. Many global health issues are reaching crisis point. Outbreak of the COVID19 pandemic has demonstrated how unprepared the world has been to face and effectively address major global health challenges. These challenges   demand a truly internationally collaborative effort. Therefore, countries which lack the capacity to be actively engaged in global health cooperation should prioritize building technical capacity in the area of global health and should develop effective collaboration mechanisms, including for academic cooperation. This necessitates creation of a joint platform for academic institutions in the Eurasian region which can help these countries improve their professional competencies in the area of global health to firmly establish themselves on the global health scene.