Global health for all by 2030

Abstract

As a professor of medical/health geography for 30-plus years, I have been teaching my students about global environment and public health. I may not have always called it that, but that’s what it is. And over the years, I have exhausted my students with three mantras: all health is global health; global health is public health; and the more things change, the more they stay the same. The current (yes, current) COVID-19 pandemic has vindicated these mantras and helped students see that yes, they did learn something in those lectures (phew!). Geographers and historians have much in common, looking at relationships between humans and the environments within which they live work and play—across space, and over time. As such, medical geographers begin teaching their discipline by first looking historically at health and illness. Many draw specifically on John Snow, seen as the grandparent of epidemiology as well as medical geography, given that he was the first to say: what if we put the incidences of mortality from cholera (ca. 1850 London) on a map to see if they create a pattern and then let’s see if that pattern points us toward a cause or determining factor? (Johnson, 2006). And like many historians, medical geographers sometimes turn to historical fiction to entertain their students with concepts and ideas that explain patterns and processes producing health and illness. This medical geographer often quotes from one of the most romantic books ever written—Love in the Time of Cholera by Gabriel Garcia Marquez (Garcia Marquez, 2003; listed in IMDB as source of one of the most romantic love scenes ever filmed)—which demonstrates the concept of diffusion of infectious disease, understandings of which are still manifest in the COVID-19 pandemic, vis-à-vis current global travel restrictions. Oh, they might have been slightly different back then—in the case of cholera in GarciaMarquez’ book, the ship in the Panama Canal ca. 1850 could not come into port until the yellow flag could be lowered indicating there was no more cholera on the ship, those affected either having recovered or (more likely) having died and been put overboard. But the concept remains the same. With few exceptions (Atiim & Elliott, 2016), we thought we were through the 5 stage of the epidemiologic transition (if you’ve never watched this video by Hans Rosling, “200 Countries, 200 years, 4 minutes”, you are missing out! www. youtube.com/watch?v=jbkSRLYSojo), but we now realize that global health is topsy-turvy: infectious disease has re-emerged as a priority public health issue in the entire world, INCLUDING THE DEVELOPED WORLD, while in developing countries, we continue to see the rise of non-communicable diseases, like type 2 diabetes, cardiovascular disease, and stroke (Gouda et al., 2019). Does that mean those developing countries are now developed? Or that all health is global health? As a result of globalization in general, we see these shifts in public and population health happening in all parts of the world now. And we also see, as Sir Michael Marmot taught us all a few decades ago (Wilkinson & Marmot, 2003), that the greatest contributors to the health of the population are the social determinants of health, not our access to formal health care facilities. This too is global; our neighbours in the developing world equally require social support, less stress, secure employment, and more resources for good early years. All health is global health, and all global health is public health. Finally, the more things change, the more they stay the same. Edwin Chadwick himself (Fee & Brown, 2005) fought for access to sanitation and safe water for urban populations, and it was those factors—not access to vaccines and medicines (McKeown, 2014)—that shifted the curve in terms of population health. And when COVID-19 hit the world in 2019, access to water—to wash our hands to stem the spread * Susan J. Elliott elliotts@uwaterloo.ca