From the Dean: Globalizing Health

From the Dean: Globalizing Health

A remarkable, and tragic, number of children in low-income countries—ten million—die each year before reaching the age of five. Two million of them die from diarrhea, a condition that we, in the affluent nations, consider a temporary annoyance. The same number succumb to pneumonia. Another half a million perish as a result of measles, a vaccine-preventable illness. What causes these deaths? In a word, poverty. Half of childhood deaths are attributed to malnutrition. Other causes—all related to poverty—include unsafe water, poor sanitation, exposure to insect disease vectors, and a lack of basic medical and preventive services, including vaccinations.

These are all problems that, in concept, have easy solutions. They are not expensive. What they require—but what neither we in the United States nor the rest of the developed world has mustered—is a generosity of spirit to resolve them, the organizational capacity to do so, and the political will to make it all happen.

starving childThere are cautious signs that the world is beginning to awaken to this devastating and unnecessary source of human misery, as well as to the myriad other avoidable health problems that plague our globe, especially its poorest sectors. The Bush administration has committed $15 billion to a five-year campaign against HIV/AIDS in Africa. The Gates Foundation—a financial behemoth even before the infusion of Warren Buffet’s breathtakingly generous gift—has chosen, wisely, to focus on health in poor countries. Given its size and vision, the Gates Foundation is perhaps the first foundation that has the ability to get the attention of whole governments. Almost single-handedly, it could change the face of global health. The United Nations Millennium Development Project concentrates on eliminating poverty, the single biggest cause of avoidable illness around the world.

Everyone now appreciates that the globe is increasingly interconnected. The very nature of commerce and ease and rapidity of travel have globalized disease. Over the past quarter century, we have witnessed the emergence and devastating spread of HIV/AIDS throughout every continent on the earth’s surface (save for Antarctica). More recently, SARS highlighted both the risk of rapidly disseminated disease and the potential for effective disease management. Today, the frightening prospect of a global pandemic of avian flu commands the attention of health ministries in all corners of the world.

Infectious disease is not the only form of globalized disease. The epidemic of obesity, rapidly becoming a pandemic, reflects the complex interaction of economic, technological, and social forces that shapes, and transfers, health-affecting behaviors around the globe.

In some ways the most virulent form of globalized disease is the epidemic of hatred, manifested most notoriously in international terrorism, with its associated toll of mental as well as physical distress.

Seeking remedies to such problems requires deliberate, concerted, substantial, and often collective action. Thankfully, the pursuit of such remedies is rising on the social agenda in recent years, the result of several not entirely independent factors. These include globalization itself, and the fears it has wrought; real and potential disease outbreaks like SARS and avian flu, respectively; the aforementioned development of powerful new philanthropic efforts; and the emergence of a new generation of students who, like many earlier generations, see service to humankind as a worthy life’s work, but whose vision of such service extends beyond our country’s borders.

The expression “global health” encompasses three very different but intertwined interests. One of these concentrates on the effects of globalization on health—as we saw in 2004, for example, with the outbreak and rapid spread of SARS and have witnessed in the devastating spread of HIV/AIDS. Another involves comparisons of different countries’ health systems, and particularly their health care systems. The third, and in my judgment the most important, relates to the pervasive, devastating—and avoidable—disease problems in the world’s poorest nations, noted at the beginning of this column.

There is, of course, another connotation to “global health”—namely, the health of the globe itself. If we fail to deal with global climate change, the long-term costs to our children and our children’s children will be beyond calculation. Picture the plight of humanity—the social, psychosocial, health, economic, and environmental impacts—as every coastal city around the world becomes half-flooded like New Orleans was following Katrina.

What is the University of Michigan School of Public Health doing to address all of these domains of global health? Along with schools of public health at many other universities, we are devoting increasing resources to grappling with the research questions, instructional needs, and service-delivery issues that pervade the problem of how to reduce the toll of avoidable sickness and death around our increasingly interconnected globe. In our case, our heavily subscribed Globalization and Health Interdepartmental Concentration introduces numerous public health students to the issues that define global health. American students learn about global health, as well, by interacting daily with the 139 international students from 25 different countries— comprising 17% of the student body—who are stu-dying for their public health degrees at UM SPH. At least two-dozen faculty are actively engaged in global health research and service.

And this year, the University of Michigan will open a Center for Global Health. Developed by SPH, the center will seek new solutions to pressing global health problems, while training the new generation of professionals who will implement them. As you are reading this, we are conducting an international search for a director for the new center. If you have any suggestions or nominations of worthy candidates, please send them to Dr. Rachel Snow, search committee chair, at

global imageYou will learn more about some of the school’s efforts in global health in this issue of Findings. You can learn still more by visiting Global Public Health. I hope that you will conclude that, in our small way, UM SPH does have the generosity of spirit to which I referred earlier, a spirit necessary to resolve some of the greatest global health challenges confronting us. With the development of our new center, we are working on increasing our organizational capacity to do so. The political will to make it all happen must come from all of us.

We live in an era in which our country employs military might in a thus-far strikingly unsuccessful effort to encourage the emergence of democracies around the world. Might we not win far more hearts and minds, and promote democracy far more effectively, by demonstrating that the richest nation is also the most compassionate and generous, that we care about the welfare of our neighbors? What better place to start than health?

Dean Kenneth Warner

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