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On the meaning of global health and the role of global health journals

Int Health 2018; 10:6365
doi:10.1093/inthealth/ihy010 Advance Access publication 8 March 2018
On the meaning of global health and the role of global
health journals
Seye Abimbola*
School of Public Health, University of Sydney, NSW, Australia and The George Institute for Global Health, Sydney, NSW, Australia;
Editor in Chief, BMJ Global Health
*Corresponding author: E-mail:
Received 16 January 2018; editorial decision 24 January 2018; accepted 24 January 2018
Whenever I hear the term tropical medicineor see it in print,
what often comes to mind is, how delightfully quaint!Quaint
because it is dated, reminiscent of the colonial origins of global
health. And delightful because it brings to mind how unremark-
able it has become to recognize that global solidarity is necessary
for health; that were in this together.Globalhealthdidnotbegin
that way. Indeed, my rst challenge 2 years ago when I was
appointed the inaugural Editor in Chief of BMJ Global Health was
how tricky it was to dene global health. It is an ongoing struggle.
In this editorial I describe where I am on that journey and how a
well-considered meaning of global health could transform global
health practice, research and journals.
To dene the remit of the journal, I had to rst dene global
healthwhat should qualify as a global health paper and what
should be the markers of quality of a global health paper. I
recalled a BMJ blog with a set of caricature denitions of four eras
in the history of global health
: global health 1.0 as tropical medi-
cine, beginning as an effort to keep white people and subse-
quently the labour force alive in thecolonialtropics;globalhealth
2.0 as international health, which was about clever people in high-
income countries (HICs) helping people in low- and middle-
income countries (LMICs); global health 3.0, which is (note the
change in tense) about people from HICs leading health pro-
grammes in LMICs; and global health 4.0, which is about people
from LMICs leading health programmes in LMICs.
While these denitions offer truth by way of caricature, they
say little about the why and how of global health, except for global
health 1.0, which began with a clear goal and continues today in
efforts to keep people alive by developing drugs and vaccines to
tackle largely infectious diseases. I wondered, for example,
whether global health 4.0 differs in any way from day-to-day pub-
lic health work done by nationals of LMICs in their own or neigh-
bouring countries, and whether such work only becomes global
healthwhen it is done by a person or with funds from HICs. The
denitions also made me wonder if there was any difference
between international health (global health 2.0) and global health
3.0 or 4.0. What about the health of disadvantaged groups in
HICs? Is addressing high HIV prevalence among Hispanics or
African Americans in the USA global health? Is intervening to
improve the health of indigenous peoples in Australia or Canada
global health?
These are important questions, not only for a journal editor, but
also for all of us who work in global health. We need to be able to
often dened by how it differs and departs from international
health, the difference being a focus on health equity and issues
that transcend national boundaries, being multidisciplinary and
embracing the role of non-state global actors such as philanthro-
But there is much in the international healtheratosuggest
that this is a false distinction: international health went beyond
bilateral relations (e.g., in efforts to eradicate smallpox), focused on
health equity (e.g., in the Alma Ata declaration), was multidisciplin-
ary (e.g., academic departments of international health were often
multi-disciplinary) and embraced and involved the role of non-state
philanthropies (e.g., the Rockefeller Foundation).
So is this distinction between international health and global
health in name only; differing brands, but the same substance? I
found my answer in a description of global health by Farmer et al.,
as not [an academic] discipline but a collection of problems [that]
turn on the quest for equity.
This is, for me, the distinction
between international health and global healthwhile inter-
national health focuses on helping LMICs, global health is about
health equity everywhere, including within HICs, such that a paper
addressing, for example, indigenous health equity in Australia is eli-
gible for consideration in a global health journal. This is my favour-
ite characterization of global health, as it makes no pretences
about global health being dened by global cooperation, national
boundaries and specic categories of actors. Nonetheless, this
description deserves further considerationwhat problems dene
global health and why is global health not (yet) a discipline?
For me, there are two kinds of problems: problems of discovery
and problems of delivery. Problems of discovery are about nding
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technological innovations to improve global health equity, for
example, new vaccines for infectious diseases like HIV and mal-
aria, drugs to control non-communicable diseases or a new app
to connect patients and providers. The disciplines responsible for
nding solutions to these problems either predate or would exist
without global health, so they cannot be what denes global
health. On the other hand, delivery problems are encountered in
efforts to make innovations work in practice. Unlike discovery pro-
blems, which belong in the basic sciences, delivery problems
require the social sciences, rst to understand and then to address
the information and motivation problems that may prevent or
constrain delivery.
They highlight the failure of governments,
non-governmental organizations, the private sector, service provi-
ders and communities to put in place or demand equitable health
Delivery problems dene global health. While the gulf between
discovery and delivery exists in other elds, what makes global
health peculiar is that discoveries and the decisions on whether or
how to deliver them are typically made at a distance, removed
from the realities of their targets or intended beneciaries. They
are removed not only geographically, but also socially, culturally
and economically, even when geographically proximal. Notably,
the distance is not only between HIC and LMIC actors, it is also pre-
sent within HICs and within LMICs, especially across class, social
and ethnic divides. It is present when people with resources to
address delivery problems do not have the information or motiv-
ation to either make the discoveries available or tailor them to local
circumstances. It is present when feedback takes longer or does not
work at all; i.e., feedback between actors at the global and national
and the community, or between any of the parties to these combi-
nations. It is present when there are asymmetries of power, motiv-
ation and information between the helper and the helped.
So, what do these mean for global health practice and research,
and for the journals that report them and seek to facilitate conver-
sations to improve them? First is the need to recognize an informa-
tion paradox at the heart of the delivery problem. On the one
hand, the only thing the helper in global health has more of than
the helped is power and resources. The helped have far more infor-
mation on how to get global health delivery right, on how to inter-
vene in their lives. But on the other side of the paradox, the helped
in global health (as individuals, households and communities)
often do not have the information to help themselves adopt
appropriate health practices, to help them hold their governments
and service providers to account. We helpers must acknowledge
and embrace our ignorance in our work and also reect in our jour-
nal articles how we used information from the ground to inform
our work and how we in turn channelled new information back to
the people to help them hold their governments and service provi-
ders to account.
Beyond the methodological markers of quality, which are spe-
cic to each of the disciplines that feed into global health, journals
should require that the papers they publish are informed by,
framed by and reect on delivery problems. Editors of global health
journals should demand of authors that the so what?of their
papers be articulated in terms of delivery problems, providing a
potential unifying framework for global health papers, thus helping
to full the promise (hitherto unfullled in global health) of journals
serving as a forum for the different disciplines to speak to one
another. If we think of an academic discipline as a eld in which
people share the same assumptions and engage in debates on
how to build on those assumptions
and the purpose of a journal
as a forum for such disciplinary conversation and debate, then an
important responsibility of global health journals is to foster, facili-
tate and forge a common language to link these disciplines that
will, potentially, allow global health to become a discipline rather
than only a collection of disciplines.
In the last two decades, health policy and systems research
(HPSR) has emerged as the multidisciplinary eld that addresses
delivery problems in global health, but the eld has so far not
moved towards becoming a discipline.
To create a discipline of
global health, journals should explicitly acknowledge this crucial
intersection between global health and HPSR. Beyond nding a
way for disciplines to speak to one another, global health journals
have a responsibility to make jurisdictions speak to one another.
This requires communication at a level of abstraction higher than
jurisdictional details and framing delivery problems at the level of
social phenomena. And therein lies a tension. Ensuring that
insights travel between jurisdictions requires abstraction, but to be
meaningful, published global health work requires a high level of
contextual detail. Balancing both demands is a challenge that edi-
tors of global health journals need to recognize and address, espe-
cially given the tendency of journals to require that authors limit
One way to encourage abstraction is to insist that research
papers identify the social phenomenon under inquiry and abstract
their research questions and/or their ndings in terms of social the-
ories that have been used to study or explain similar phenomena
across disciplines. This may encourage deeper thinking and multi-
disciplinary analysis and reection, and potentially advance the
health journals should work together to develop guidelines for
structured reporting of context, even if in a regular appendix to glo-
bal health research papers. It is also important that global health
journals create a space and raise the prole of practicepapers
dedicated to reports on implementation that may not achieve the
abstraction, theoretical sophistication and analytical rigour of a
research paper, but which may provide rich contextual detail and
transferable insight based on experience and descriptive data.
In conclusion, it appears to me that we have been looking in
the wrong places to denewhatisthecoreofourwork.Ifwetake
the meaning of our eld seriously, and go where that meaning
leads, we will probably do things differently, as practitioners,
researchers and journal editors. If people who are the targets and
intended beneciariesofglobalhealthworkweretodene global
health and determine how it is studied, practised and reported, I
suspect it will not be about the global commissions, discussions
and debates of the day in Geneva, New York and London and on
Twitter, and the jostling of the privileged global elite for power and
position, but rather about the information and motivation pro-
blems that limit and constrain delivery, beginning at the local level.
I hope that we can begin to truly decolonize global health by being
lives better than we could ever do, that they and only they can
truly improve their own circumstances and that those of us who
work in global health are only, at best, enablers.
S. Abimbola
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Authorscontributions: SA undertook all duties of authorship and is
guarantor of the paper.
Acknowledgements: The author is grateful for comments and discus-
sions at the meetings and conferences where different stages and parts
of the reections in this editorial were presented.
Funding: None.
Competing interests: None declared.
Ethics approval: Not required.
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3 Peters D. False distinctions between international health and global
health. Global Health Now 2 Nov 2017. Available from: https://www.
4 Farmer P, Kim JY, Kleinman A, Basilico M, eds. Reimagining global
health: an introduction. Berkeley: University of California Press; 2013.
5 Abimbola S. The information problem in global health. BMJ Glob
Health 2016;1:e900001.
6 Gibson CC, Andersson K, Ostrom E et al. The Samaritans dilemma:
the political economy of development aid Oxford: Oxford University
Press; 2005.
7 Greenhalgh T. Five minutes with Trish Greenhalgh: We need to be
clear that research impact isnt a single dimension. LSE Impact Blog.
Available from:
8 Bammer G. Should we discipline interdisciplinarity? Palgrave Communic
2017;3:30. Available from:
9 Stember M. Advancing the social sciences through the interdisciplin-
ary enterprise. Soc Sci J 1991;28(1):114.
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International Health
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... Such sentiments focus on a misalignment between Global Health's aspirations, claims, and achievements. Criticism on Global Health as such is not new [10], but recent years have shown a surge of critique specifically focussed on the field's colonial legacy, its preoccupation with biomedical scientific knowledge, and the unbalanced nature of Global Health funding -predominantly coming from the 'Global North' [11][12][13][14][15][16]. 1 When looking at the themes around which criticism on Global Health revolves, it becomes clear that while the field aspires universality and equity, its practices often fail to live up to these aspirations. The privileging of the knowledge and methods of Northern scholars, for instance, may result in research that is not equipped for offering local solutions to improving health [5,17]. ...
... Both the mentioned 'reflexivity statement'[47] and authorship criteria[48] are relatively recent developments, which were preceded by e.g. mandatory LMIC co-authorships.11 In the sense of "free from bias, fraud, or injustice; equitable; legitimate, valid, sound"[49]. ...
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Background While critique on Global Health is not new, recent years show a surge of criticism on the field’s colonial legacy and practices specifically. Such accounts argue that despite Global Health’s strive for universality and equity in health, its activities regularly produce the opposite. The epistemic privileging of Northern academics and scientific method, further augmented by how Global Health funding is arranged, paints a picture of a fragmented field in which ‘doing good’ has become a normatively laden and controversial term. It is specifically this controversy that we seek to unpack in this paper: what does it take to be a ‘good’ Global Health scholar? Results We used Helen Verran’s notion of ‘disconcertment’ to analyse three auto-ethnographic vignettes of Robert’s Global Health ‘fieldwork’. We illustrate that disconcertment, a bodily and personalised experience of unease and conflicting feelings, may serve as an important diagnostic of conflicting imperatives in Global Health. Robert’s fieldwork was entangled with incongruous imperatives which he constantly had to navigate through and that repeatedly produced disconcertment. The contribution that we seek to make here is that such disconcertment is not something to defuse or ignore, but to take seriously and stay with instead. Conclusion Staying with the disconcertment serves as a starting point for conversations about ‘doing good’ in Global Health fieldwork and creates opportunity for making Global Health teaching and projects more reflexive. The paper thereby positions itself in discussions about fair collaborations between the Global North and South and our analysis offers a set of considerations that can be used by Northern scholars to critically reflect on their own role within Global Health.
... 8 Nor are academic and research institutions the only type of global public health institution reckoning with this reality; such practices are increasingly being evidenced in leading global public health journals and funders. [9][10][11][12][13][14][15] Though encouraging, even commissioning reviews or adopting author reflexivity statements-a step that very few global health organisations have in fact taken-can seem like a tick-box activity if institutional commitment, willingness and resources are not provided to do the hard work to overhaul longstanding systems that were designed to preserve European and North American dominance in global health. 16 Without tangible action and institutional reform, as it has been highlighted before, statements and reviews are empty vows that shield individual and organisational reputations at the expense of people of colour, other minoritised and marginalised groups, countries that receive foreign aid, and non-western 'partners' in global health research. ...
... While 'parent' organisations and their statements did not fall within our search parameters, we recognise how organisational hierarchy might affect substructures, such as an individual school or journal, issuing public statements and commitments on racial justice. The level of autonomy that the highest-ranking global public health universities, Box 2 Working definitions of terms [12][13][14][15] Antiracism A movement and practice that seeks to dismantle white supremacy and all forms of racism. ...
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Introduction Two years since the murder of George Floyd, there has been unprecedented attention to racial justice by global public health organisations. Still, there is scepticism that attention alone will lead to real change. Methods We identified the highest-ranked 15 public health universities, academic journals and funding agencies, and used a standardised data extraction template to analyse the organisation’s governance structures, leadership dynamics and public statements on antiracism since 1 May 2020. Results We found that the majority of organisations (26/45) have not made any public statements in response to calls for antiracism actions, and that decision-making bodies are still lacking diversity and representation from the majority of the world’s population. Of those organisations that have made public statements (19/45), we identified seven types of commitments including policy change, financial resources, education and training. Most commitments were not accompanied by accountability measures, such as setting goals or developing metrics of progress, which raises concerns about how antiracism commitments are being tracked, as well as how they can be translated into tangible action. Conclusion The absence of any kind of public statement paired with the greater lack of commitments and accountability measures calls into question whether leading public health organisations are concretely committed to racial justice and antiracism reform.
... The model builds from the individual experience of person, place, time, and events to a set of integrative strategies that allow us to understand, clarify and where necessary influence these components to advance the health and wellbeing of the population. The fields of "public health, " "global health, " "planetary health, " and "health systems" are captured and understood in the context of population health rather than as distinct fields of practice and enquiry and avoids the ongoing attempt to define the distinct nature of these areas (32)(33)(34)(35)(36)(37). ...
... For the student, this convergence model provides a clear sense of agency in relation to the needs of their patients and their communities. This supports greater in-country ownership of equity issues and encourages students to see research career opportunities driven by questions within their country and within their control (38), contributing to the health equity goal of "global health" (36). ...
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Health sciences curricular planners are challenged to add new content to established education programs. There is increasing pressure for content in public health, health systems, global health, and planetary health. These important areas often compete for curricular time. What is needed is a convergence model that builds a common framework within which students can integrate areas and better align this knowledge to the individual client or patient who they have responsibility to support. A population health framework is proposed for health sciences education programs that supports a common conceptual understanding of population health. The framework links five thematic areas that have influence on health and wellbeing and a sixth element that defines the range of methodologies essential to understanding health and wellbeing, from the individual to the population. The five areas providing convergence are: (1) the biopsychosocial development of the individual, (2) the socioeconomic factors that influence health and wellbeing, (3) the physical natural and built environment including climate, (4) the continuum of public health and health care systems, and (5) the nation state and global relationships. Using this framework, students are encouraged to think and understand individual health and wellbeing in context to the population and to utilize the appropriate methodological tools to explore these relationships. Planning for a new undergraduate medicine program illustrates the curricular elements that will be used to support student learning with foundation knowledge applied and tracked throughout the program. The proposed framework has application across health sciences disciplines and serves to build a common understanding that supports cross professional communication and collaboration.
... introducing reform and development, resisting proxy colonising forces' direct and indirect structural influence. As Abimbola (2018) [38] explains: ...
... We can begin to truly decolonise global health by being aware of what we do not know, that people understand their own lives better than we could ever do, that they And only they can truly improve their own circumstances and that those of us who work in global health are only, at best, enablers [38]. Robertson and colleagues (2004) [39] advise that when recipients of global health evaluation efforts are empowered and sovereign at the individual level, they are no longer performing the role of passive objects of research and interventions. ...
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... Similarly, prominent journals and leading authors of global health research remain largely associated with the United States, the United Kingdom, and other colonial powers, even as their work is largely concerned with formerly colonized places and people. These and similar observations about the inequalities of influence and decision making have informed demand for the decolonization of global health [7][8][9][10][11][12]. ...
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This paper explores the decolonization of global health through a focus on malaria and European colonialism in Africa. We employ an historical perspective to better articulate what “colonial” means and to specify in greater detail how colonial ideas, patterns, and practices remain an obstacle to progress in global health now. This paper presents a history of malaria, a defining aspect of the colonial project. Through detailed analysis of the past, we recount how malaria became a colonial problem, how malaria control rose to prominence as a colonial activity, and how interest in malaria was harnessed to create the first schools of tropical medicine and the academic specialization now known as global health. We discuss how these historical experiences shape malaria policy around the world today. The objective of this paper is to advance discussion about how malaria and other aspects of global health could be decolonized, and to suggest directions for future analysis that can lead to concrete steps for action.
... Global health (GH), a rapidly growing field focused on advancing international and interdisciplinary healthcare [1][2][3][4][5][6][7][8][9][10][11][12] while addressing health inequities, 13 is an increasingly common component of graduate medical education and international partnerships. 1,14 The COVID-19 pandemic disrupted in-person GH education (GHE) activities such as international clerkships and rotations 15,16 and worsened inherent inequities in GH. 17,18 Typical challenges encountered in GHE work, including distance, communication, and barriers to bidirectional exchange of staff and learners 6 worsened throughout the pandemic, 19,20 highlighting the need for thoughtful development of virtual GH curricula and practice. ...
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... Global health, previously known as "tropical medicine," was established to keep "white men alive" in the tropics during colonialism (Smith, 2013). The process of colonialism exploited the social and economic abilities of many Indigenous communities globally, violating their human rights while disabusing them that their ways of living were inferior (Abimbola, 2018). This ideology is carried over into teaching global health courses, which characterize disease burdens in places in Africa without highlighting the existence of these same issues in the global north. ...
COVID-19 has highlighted the importance of social justice in understanding and addressing health disparities by amplifying how environmental conditions have increased the risk in some populations.Within a social justice agenda, there is a need for nurse educators to design courses that highlight how contextual factors influence health more so than genes.In this paper we propose seven core topics foundational to an undergraduate global health course along with teaching strategies using the “think global and act local” approach.
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Could we overcome the challenges of embedding interdisciplinarity in the academic mainstream if relevant expertise were defined and recognised as a new discipline? Such expertise includes the ability to combine knowledge from different disciplines, as well as to assess which disciplines and stakeholders have relevant perspectives, figure out how elements of problems are interconnected, decide how to deal with critical unknowns, and use research to support evidence-based change. A new discipline of integration and implementation sciences (I2S) would codify such knowledge and skills, especially for dealing with complex societal and environmental problems. It would operate in an analogous way to the discipline of statistics, as a: (1) collaborative hub within teams, (2) focus for dedicated methods journals and (3) lobby group for effective application. Key initial tasks are to develop a repository of currently hard-to-access methods, and an identifiable academic community; both guided by a unifying and motivating vision of where disciplining interdisciplinarity will lead.
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What's wrong with development aid? It is argued that much of aid's failure is related to the institutions that structure its delivery. These institutions govern the complex relationships between the main actors in the aid delivery system, and often generate a series of perverse incentives that promote inefficient and unsustainable outcomes. The theoretical insights of the new institutional economics are applied to several settings. First, the institutions of Sida, the Swedish aid agency, is investigated to analyze how that aid agency's institutions can produce incentives inimical to desired outcomes, contrary to the desires of its own staff. Second, cases from India, a country with low aid dependence, and Zambia, a country with high aid dependence, are used to explore how institutions on the ground in recipient countries might also mediate the effectiveness of aid. Suggestions are offered on how to improve aid's effectiveness. These include how to structure evaluations in order to improve outcomes, how to employ agency staff to gain from their on-the-ground experience, and how to engage stakeholders as 'owners' in the design, resource mobilization, learning, and evaluation process of development assistance programs. © C. Gibson, K. Andersson, E. Ostrom, and S. Shivakumar, 2005. All rights reserved.
Although interdisciplinary work in universities has expanded in recent decades, the influence of academic disciplines is pervasive. The article makes explicit the opportunities and challenges of interdisciplinary for the social sciences. The strategies offered for enhancing the interdisciplinary enterprise include selecting appropriate group members, establishing ground rules, explicating and bridging epistemological and methodological differences, and promoting infrastructural support.
Moving from global heath 3.0 to global health 4.0
  • Smith
Smith R. Moving from global heath 3.0 to global health 4.0. BMJ Opin 8 Oct 2013. Available from: richard-smith-moving-from-global-heath-3-0-to-global-health-4-0/
Five minutes with Trish Greenhalgh: 'We need to be clear that research impact isn't a single dimension'. LSE Impact Blog
  • T Greenhalgh
Greenhalgh T. Five minutes with Trish Greenhalgh: 'We need to be clear that research impact isn't a single dimension'. LSE Impact Blog. Available from: 02/five-minutes-with-trish-greenhalgh/.
Five minutes with Trish Greenhalgh: ‘We need to be clear that research impact isn’t a single dimension’
  • Greenhalgh
False distinctions between international health and global health. Global Health Now 2
  • D Peters
Peters D. False distinctions between international health and global health. Global Health Now 2 Nov 2017. Available from: https://www.