Public Health and Global Health: Similar but Not the Same

As I set my glass down on the bar, the question I was expecting came from the person standing right behind me.

—So, what do you do?

—Me? I ... I'm in global health.

—What's that?

—Health as it affects everyone.

—That's kind of redundant.

Bad start. I was going to have to be patient.

—Everyone on the planet, I mean, literally the entire planet.

—So it's about the health of the planet? Sounds like it's about the environment.

—Looks like I'm not explaining it very well.

The phrase ricocheted round in my head. What a hackneyed excuse. I tried again:

—Let's see if I can explain it better with a sentence: global health addresses the problems of people irrespective of where they live.

—So, it's about curing diseases and things like that.

—Not only that, it's also about preventing them.

—Not having a disease is a problem? That's a new one on me.

I winced. The brown eyes scrutinizing me were amused, like someone toying with their catch. The effect on me was a combination of excitement and discomposure.

—Damn... no. What I meant is that our work isn’t just about treating people. It’s also about making sure healthy people don’t get diseases.

—So, you give them vaccinations.

—Among other things. We also try to ensure that they have access to clean drinking water and enough to eat, for example.

That was bound to impress, it never failed.

—Isn't that the job of the social services?

—We integrate a social vision into health.

—Now, I've got it: you’re a public health specialist.

—Not exactly.

—Now, I’m the one who is getting confused.

It was starting to look like the situation might get out of hand so I decided to take a professorial attitude.

—The scope of a public health specialist is limited to a particular community. Global health goes beyond those limits, and even transcends political boundaries.

—So you are a specialist in public health on an international level.

—That might have been the term, but the labels international public health or international health have so far been used to refer to another approach.

—Enlighten me.

At this stage I was beginning to doubt that the effort was worthwhile, but I didn’t want to give up too soon—not in this case.

—International health has traditionally focussed on the health problems of developing countries.

—And global health doesn't?

—Of course it does! In fact, that is a very important part of our work.

—OK, now I'm really lost.

Was I having my leg pulled or did I really have to explain it in words of one syllable?

—We deal with the health problems of all countries, whether or not they are developed.

—So it's a kind of fusion of public health and international health.

—It is more than that: public health focuses on communities, and international health on countries. But global health transcends those limits: there are no divisions.

—There are no differences?

The tone of the interrogation had just gone up a notch. And that was too much. I had to react.

—Yes, there are—lots! And when the differences are unfair and avoidable we call them inequities.

—Differences between countries or within countries?

—Both kinds.

—You won’t get it out of my head that it’s a kind of combination of public health and international health.

I raised my voice hoping to achieve a more decisive tone, but all I managed was to sound a bit whiney.

—Pure obstinacy! Look, one thing that distinguishes global health is that it is based on the idea that the big challenges can't be resolved by any one country alone; what is needed is a multinational and multidisciplinary collaborative effort to do the research, to implement measures of prevention and control, or to eliminate the problem altogether.

—That's not new. Humans have been doing that for a long time.

—But on a smaller scale: our discipline is all-encompassing, global—as the name suggests.

—You know what?

I was afraid I had ruined everything, and resigned myself to the fact that the conversation was about to end there.   

—What?

—I’m not sure whether I understand the concept, but I like you anyway. Would you like a drink?