Jhabindra Bhandari

Global health is increasingly an emerging discipline with a transformative potential for public policy and international development. Considering a wide range of transnational health issues, global health largely aims to improve health and achieve health equity for all people worldwide. The multidisciplinary scope of global health primarily includes contributions from clinical medicine, public health, social and behavioural sciences, environmental sciences, economics, public policy, law and ethics. Undoubtedly, it has transformative potential that can be harnessed for the world to become a healthier and more peaceful place.

Therefore, global health requires responses from, and coordination with, others sectors such as social protection, education, trade and transportation, agricultural and industrial sectors. Designing comprehensive social policies requires acknowledging how social determinants and policies interact with each other and move towards sustainable solutions. In this context, there are critical needs to explore how interactions of different actors impact the larger social, political, macroeconomic, and international trade determinants of health.

Climate crisis
In the recent years, climate crisis is increasingly considered as a health crisis. The profound impacts of climate change on human health cannot be ignored. A global policy review of the Paris Agreement, Sustainable Development Goals (SDGs) and the Sendai Framework reveals that there are limited efforts of integrating climate-resilient health systems to safeguard population and planetary health. Much more needs to be done in the area of global health resilience with increased investments and urgent actions at large.

In the era of globalisation, global health governance has emerged as a key concept that captures the dynamic roles, interests, and diverse activities of multiple actors in global health. Notably, the transition from international to global health governance requires aligning the competing values, interests, and motivations of multiple actors towards a coherent cooperative governance framework that effectively addresses emerging and re-emerging global health challenges.

Evidences suggest that health outcomes across populations are largely influenced by a range of intersecting challenges ranging from pandemic and endemic disease, conflict, and displacement to environmental degradation and climate change. In order to address these diverse challenges across countries, there is an emergent need for evidence-driven resilient health systems to achieve optimal health outcomes in the changing socio-political context. The principles of health equity, intersectoral engagement, public-private partnership, whole-of-society approach are critical to achieve ambitious goals and targets of universal access to health care and SDGs.
More significantly, human resources are the key to global health. The health workforce will be critical to achieve health and wider development objectives in the next decades. The global strategy on human resources for health outlines some policy options to optimise the health workforce and strengthen the capacity of governments to enhance the universal health coverage and achieve the ambitious of targets of health related SDGs. However, investment in health workforce is still low in most developing countries.

Wider issues of international trade and migration have not been well considered while formulating health policies and strategic interventions at national and sub-national levels. The commitments made by governments within international trade and investment agreements have both direct and indirect effects on global health. For example, the treaties can influence food environments and dietary health, regulatory policy space for alcohol control measures, as well as costs of medicines and access to healthcare.

Despite some progress in global wealth, many developing countries still struggle to progressively improve the health of their populations who are particularly marginalised and vulnerable. Obviously, the poor people remain more vulnerable to health risks, including the growing burden of chronic diseases such as diabetes or heart disease. The persisting and emerging epidemiological and demographic challenges need to be realistically addressed with evidence-informed health policies to ensure health equity and social justice. On the other hand, the increasing trends of health promoting school policies and interventions are emerging priorities for actions as these are crucial to promote health and well-being by providing a safe, secure, and healthy physical environment for learning in schools and communities.

The health emergencies contribute to poor public health outcomes for affected communities and hence create health inequalities with weak health systems. In order to manage the complex health emergencies such as the COVID-19 pandemic and other natural disasters, governments need to have comprehensive plans and strategies for preparedness, readiness, response, and recovery. Moving forward, it is necessary to further build the capacity of humanitarian stakeholders and partners on risk communications and community engagement while managing complex health emergencies.

Health in all policies is a popular framework for promoting global population health and health equity. There are increasing needs of advancing public policies and decisions that address the impacts of avoidable social inequalities which have been contributing to poor health experienced by socially disadvantaged and vulnerable populations.

Global commitment
Interestingly, there is a renewed global commitment on achieving universal health coverage. The increased investment of resources is essential to strengthen health systems at large. Despite the remarkable gains over the decades, scaling up of essential health services and protection from financial hardship remain key challenges for many developing countries.

In the age of globalisation, the increasing interconnections between people, economies, and societies have profound effects on global health. The global fight against infectious diseases and chronic non-communicable diseases will continue for many years. Like many developing countries, Nepal needs to progressively transform health policies to address health inequalities in the changing context of federalism. Without the resilient health systems, it is almost impossible to achieve the targets of health related SDGs.

(Bhandari is senior doctoral research fellow in global health and health systems)