![]() I heard the results of innumerable studies, and the humanitarian pronouncements of many important people. Old approaches are not per se bad but after having been in the debates about top-down vs bottom-up approaches, and after being convinced that we do need to listen closely to the people we are serving, I was surprised to find very little of this kind of conversation. There were new technologies, new statistics, and new jargon, but these were all buttressing old approaches to global health problems. My first impression of the conference was that I was hearing nothing really new. My attendance at the 2002 Global Health Council’s Annual Conference, however, gave me a different picture. Now all of us, representatives from poor and rich countries alike, can sit together at some global table and discuss as equals how to approach global health. “Globalization” is the by-word the National Council for International Health changed its name to the Global Health Council. Having considered the possibility that some communities may know what they needed, and having realized that some of the ways “they” do things may be appropriate even for us, we can truly function as an inter-related global village. With this promising background of listening in local communities, learning there, and bringing what we learned back home, I assumed (or at least hoped) that by 2002, there would be a new “global health”. But again, the importance of the ideas behind Global Leaning for Health is that some people were reflecting on their work in light of what they came back home to, and there was the possibility of a debate between the people who had learned from international health, and those who were still trying only to teach it. These workers – perhaps having learned to listen from their community-based orientation – realized that approaches they were using overseas might work equally well in the “developed” west.Īdmittedly, this idea of bringing home approaches that were learned “over there” has not caught on very well – though oral rehydration therapy has become standard of care for diarrhea in US hospitals, and some communities have parish nursing programs that utilize volunteers similar to village health workers. International health workers’ experiences in innovative health programs in the third world began to highlight the deficiencies in western health care systems. In 1993 the National Council for International Health published Global Learning for Health, an eclectic collection of experiences and thoughts about how we can "bring international health back home". What made the mid 1980s such an exciting time for international health is that there was an active debate between the “PHC” people and the more traditional public health and clinical people.īy the 90s a new element entered the conversation. These programs had some remarkable successes, such as small-pox eradication in the late 70s, and some equally striking failures, like malaria eradication in the 60s. ![]() In contrast to “horizontal” primary care programs, the vertical disease-specific programs were often “donor driven” and run by outsiders. To be sure, there was another approach still very much alive in international health: the “vertical” programs. Their communities, we were taught, should be the hub of any health and development activities those activities would be most effective when they were “community-based”. It was exciting: clinical and public health people were talking with each other, exploring the possibility that rural villagers knew what their health needs were, and that we technical people should listen to them. It was introducing these concepts to people with careers in curative missionary medicine. MAP, a global Christian health and relief organization, was a strong supporter of the kind of Primary Health Care promoted at Alma Ata in 1978. My introduction to global health – it was then called international health – was at a MAP International conference and seminar in 1984. Yet global health has not always been stuck. Instead I found people talking about the same kinds of programs they had been discussing 20 years ago – and it seemed stale. I assumed that after 16 years “in the bush” I would be out of date, and I was looking forward to being challenged. How is this field changing? What are the current trends? And mostly, what have I been missing? In May 2002, I attended the Global Health Council Annual Conference in Washington DC, expecting to be brought up to date on the latest ideas from academic and government centers. Though I rarely attend them, I do get the itch every 5-10 years. If major global health conferences are any indication, all of global health is stuck. My version of global health living where I work, not just visiting my version is working for the health systems that are here, not introducing new ones.īut it's not just me who is stuck. I admit it: I’m stuck in global health – or at least my version of it.
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