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Turcotte- TremblayA- M, etal. BMJ Global Health 2020;5:e002545. doi:10.1136/bmjgh-2020-002545
Global health is more than just ‘Public
Health Somewhere Else’
Anne- Marie Turcotte- Tremblay ,1 Federica Fregonese,2 Kadidiatou Kadio,3,4
Nazmul Alam,5 Lisa Merry6
To cite: Turcotte- TremblayA- M,
FregoneseF, KadioK, etal.
Global health is more than just
‘Public Health Somewhere
Else’. BMJ Global Health
2020;5:e002545. doi:10.1136/
Received 29 March 2020
Accepted 6 April 2020
1School of Public Health,
Université de Montréal,
Montreal, Quebec, Canada
2Research Institute of McGill
University Health Center,
Montreal, Quebec, Canada
3Institut de Recherche en
Science de la Santé (IRSS),
Centre National de la Recherche
Scientique et Technologique
(CNRST), Ouagadougou, Burkina
4Institut de Recherche pour le
Développement, Ouagadougou,
Burkina Faso
5Department of Public Health,
Asian University for Women,
Chittagong, Bangladesh
6Faculty of Nursing, Université
de Montréal, Montreal, Quebec,
Correspondence to
Anne- Marie Turcotte- Tremblay;
annemarie. turcottetremblay@
gmail. com
© Author(s) (or their
employer(s)) 2020. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published by
Summary box
Global health can be anywhere as it often focuses
on large- scale health inequities that are rooted in
transnational determinants.
Some global health initiatives and actors aim to nd
solutions to domestic problems.
King and Koski’s denition of global health may
exacerbate inequities by reserving the right to call
oneself a global health researcher to those who are
privileged and have access to funding that enables
them to travel to other settings.
An inadequate denition of global health based on a
‘here’ vs ‘somewhere else’ dichotomy could result
in less funding for a eld already characterised by
limited resources.
The decolonisation of global health requires promot-
ing and valuing reexivity, critical approaches, equi-
table partnerships and accountability.
King and Koski1 recently published a bold
commentary in BMJ Global Health that defines
global health as ‘public health somewhere else’.
It raises important concerns about the justi-
fication, scope, efficiency and accountability
of the field. We appreciate that the commen-
tary compels us to reflect on the definition
of global health, its application and how the
field could be improved. We also agree that
many of the issues highlighted by the authors
(ie, political priorities driven by the North,
expertise from the North being overvalued)
do exist in some global health interventions.
Many of us have heard of or witnessed disas-
trous situations caused by seemingly well-
intentioned people. However, the problems
described are not unavoidable or intrinsic
characteristics of global health. Moreover,
we believe the proposed definition of global
health is not adequate to conceptualise the
field. Rather than prompting improvements,
it could result in mistrust towards global
health and be a step backwards for the field.
In the following, we contend that global
health is more than just ‘public health somewhere
else’ and argue that an inadequate definition
entails risks for the field.
First, we argue that King and Koski’s1 defini-
tion is not adequate, because global health
is not always ‘somewhere else’. According to
Koplan et al,2 the term global refers to the
scope of problems, not their location. In
fact, we believe that global health can be
anywhere. This field of research and practice
often addresses problems that are rooted in
transnational determinants or ‘supraterrito-
rial’ links3 (eg, war, climate change, natural
disasters, colonisation, international trade,
forced migration, international policies) and
that have negative effects on national and
local determinants of health (eg, employment
conditions, access to healthcare, income
differentials). The populations of interest in
these instances can be anywhere (low, middle
and high- income countries) and include
anyone affected and facing health inequities
due to these transnational or global issues.
The solutions can also be global or transna-
tional in nature.
The coronavirus pandemic is an example
of a global health problem that is affecting
people everywhere, especially vulnerable
groups. Due to the ever- increasing move-
ment of people across borders, viruses like
covid-19 can spread easily and quickly around
the world and affect anyone, irrespective
of whether they are in the global North or
South. A global health response involving
most countries that includes data sharing
and coordinated efforts to stop the spread,
find treatments and a cure as well as protect
vulnerable groups (eg, elderly, migrants, pris-
oners, homeless) is therefore necessary.
Second, we disagree with King and Koski’s1
statement that ‘a person engages in global health
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BMJ Global Health
when they practice public health somewhere—a community, a
political entity, a geographical space—that they do NOT call
home’. To us, this is an oversimplified statement. Several
of our colleagues, and we as well, have received funding
to engage in global health in places we call home. For
example, KK has conducted research on social protection
policies in Burkina Faso, her home country. Similarly, NA
has conducted research on the health of migrant workers
in Bangladesh, where he lives. We should be applauding
and valuing global health initiatives that are led by local
researchers/practitioners rather than excluding them
from the definition.
Moreover, King and Koski’s1 definition is not adequate
because some global health initiatives are aimed at finding
solutions to domestic problems, whether it be in a high,
middle or low- income country. For example, Grand Chal-
lenge Canada funded the adaptation and transfer of inno-
vations from low and middle- income countries to make a
difference in Canada. While the innovations come from
abroad, the primary focus or end goal of such initiatives
is quite local. This also highlights the fact that solutions
for health problems in the North and South sometimes
stem from expertise in the South.4 5 According to Syed
et al,4 global health partners are increasingly seeking a
mutuality of benefits across countries.
Third, there are many public health researchers and
practitioners working ‘somewhere else’, in a place that
they do NOT call home’, whose work does not qualify as
global health. They do not view themselves as part of the
global health community, nor do they actively participate
in global health activities. Their practice and research
would also not be eligible for global health funding. For
example, a Canadian medical student’s clinical place-
ment in a public health unit in Belgium is not automati-
cally considered training in global health simply because
it is done in another country. Therefore, referring to
global health merely as public health ‘somewhere else’ is
not useful.
Fourth, we consider that King and Koski’s1 commen-
tary and definition discredit the field of global health
and fail to recognise its added value. While it is crucial
to reflect on limitations, it is also important to highlight
the field’s strengths, best practices and success stories.6 7
There are examples of global health research and inter-
ventions where countries and communities have worked
collaboratively and shared expertise, cultural knowledge
and other resources to develop appropriate and effective
Moreover, while global health is considered one of
the multiple branches of public health, the literature
does suggest there are differences among them.11 For
example, global health tends to have a broader focus (ie,
health for all worldwide), a greater emphasis on health
inequities, more interdisciplinarity2 and more ‘bridging’
between cultures and communities. Practitioners and
researchers working in global health also face unique
ethical challenges (eg, power differentials between
parties) and require that some key competencies be
further developed (eg, cultural safety and inclusion, part-
nership development).6 11 12
Recognising global health as a field in its own right
is crucial to ensure there are dedicated resources for
training and forums where the global health community
can exchange and share knowledge, so that best practices
can be further promoted, especially among students and
emerging researchers and practitioners. It is also vital
that global health be recognised as a distinct field so
that resources will be made available to support global
health initiatives that can promote the human right to
health and help meet the global pledge to ‘leave no one
The proposed definition by King and Koski1 entails
several risks. First, accepting the definition proposed
would mean that global health initiatives led by local
actors or community leaders in low or middle- income
countries, or by indigenous or migrant communities
in high- income countries, would not be acknowledged
and considered global health. This in turn could lead
to devaluing their contribution as global health actors
and limiting their access to resources to support their
work, despite there being significant needs. Therefore,
rather than moving us ‘towards an eventual decolonisa-
tion of global health’, the definition by King and Koski1
might actually reinforce the problems they highlight in
their article, including inefficiency, lack of accounta-
bility and uncritical faith in Western expertise, because
only ‘foreigners’ would be acknowledged as doing global
Second, the definition may exacerbate inequities
by reserving the right to call oneself a global health
researcher, and the related expertise, exclusively to those
who are privileged and have access to funding that allows
them to travel and practise or conduct research in other
settings that they do not call home. Third, the definition
would limit the scope of problems and solutions consid-
ered, possibly neglecting global and transnational issues.
Fourth, if global health is conceptualised as public health
elsewhere, what interest would countries and communities
have in investing in global health? This could result in
less funding for a field that already faces the challenge of
limited resources.
Lastly, the definition and commentary imply that
working somewhere else is somewhat problematic and
negative. We are concerned that this view is divisive and
dangerous. It could contribute to ethnocentrism and
ultimately limit the sharing of knowledge and expertise
across groups. A ‘here’ versus ‘somewhere else’ dichotomy
seems counterproductive. We live in a globalised world,
and more than ever we are interconnected and inter-
dependent. Everyone in high, middle and low- income
settings has a vested interest in attaining health for all and
reducing health inequities. Concerns over pandemics
(covid-19!), global warming, environmental degradation
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and potential misuse of technological advances (the easy
spread of fake news!) affect us all. Protecting the most
vulnerable is beneficial for everyone—for our economic,
social, mental and physical well- being. As a Burkinabé
saying goes, ‘we are together’.
Currently, global health may not be perfectly practised,
but we need inclusive definitions, frameworks and
training programmes that set the standards towards
which we should all strive. We can have transparent
discussions and be critical of global health academic
programmes, research and practices, while sharing an
adequate definition. We should condemn bad practices,
rather than condemn the whole field. True partnerships
across disciplines and geographic boundaries, which
have resulted in meaningful projects, exist and can be
further promoted.9 13 We need to promote the strengths
and best practices of the field and value success stories
while learning from failures.
Ultimately, the decolonisation of global health
requires training programmes that teach reflexivity, crit-
ical approaches, equitable partnerships and account-
ability. Such training programmes, and all global health
initiatives more broadly, should include participatory
approaches and ensure there are benefits for all stake-
holders involved. Resources should also be expended
equitably. These are all good practices that are attainable.
This is the morally ‘right way’ to do global health, and
also a more effective way to achieve ‘health for all’.
Twitter Anne- Marie Turcotte- Tremblay @AnneMarieTrem
Acknowledgements This commentary was written by members of a global health
community of practice, which is supported by the Global Health Research Axis and
the Global Health Research Capacity Strengthening Program (GHR- CAPS) of the
Quebec Population Health Research Network.
Contributors AMTT conceived the main idea presented. All authors contributed to
the conception and writing of the commentary.
Funding We thank the Quebec Population Health Research Network for its
contribution to the nancing of this initiative. Moreover, AMTT received a training
bursary from the Canadian Institutes of Health Research (CIHR). LM was supported
by a research scholar junior 1 award from the Fonds de Recherche du Québec-
Santé (FRQS).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
Data availability statement No data was used for this commentary.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non- commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the
use is non- commercial. See:http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.
Anne- MarieTurcotte- Tremblay http:// orcid. org/ 0000- 0002- 6138- 9908
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on May 8, 2020 by guest. Protected by copyright. Glob Health: first published as 10.1136/bmjgh-2020-002545 on 7 May 2020. Downloaded from
... The focus of global health courses on certain diseases in low-and middle-income countries also often overlooks the political-economic systems that create poverty and wealth (Birn et al., 2017;Oni et al., 2019). Particular actors (e.g., governments or NGOs in the South in partnership with international organisations or foundations in the North) and places tend to be considered as part of the domain of formal global health, with others left outside (Neely & Nading, 2017, p. 56;also Birn et al., 2017, p. xxv;Turcotte-Tremblay et al., 2020). Instead, using examples of dengue control in Nicaragua and a nutrition programme in South Africa, Neely and Nading show the influence of "regular" citizens, patients, doctors, and community health workers in producing "healthier" places (2017, p. 56). ...
... Yet despite a transition from "international" to "global health," the field has not fully adapted to such a more holistic focus or approachan issue which COVID-19 has highlighted. The pandemic is a health issue that affects people both everywhere in the world and also very unevenly within and across the world (e.g., Rose-Redwood et al., 2020), demonstrating the limitations of framings of global health as just related to particular suffering slots (Turcotte-Tremblay et al., 2020). COVID-19 highlights the need for a more holistic understanding of global health, remade around "real collaboration, solidarity, and equity" (Shamasunder et al., 2020, p. 5). ...
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... The definitions and the scope of global health are very much under debate. [8][9][10][11][12] Many scholars have viewed global health as high-income countries' (HIC) interventions in LMICs. But some others argue that the field is one that addresses inequalities between and within countries across the world. ...
... But some others argue that the field is one that addresses inequalities between and within countries across the world. 8,10 A recent article prefers an alternative definition of global health as "public health everywhere. " The authors argue that global health should emphasize the applicability of a health intervention in the global context in contrast to the specific settings where it has been piloted. ...
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Interesting debates are ongoing on how to develop practical implementation science competencies that can bridge the "know-do" gap in global health. We advance these debates by arguing that apprenticeship and mentorship models drawn from "art and craft" used in industry is the missing piece of the puzzle that will bridge the persisting gap between academics and real-world practitioners. We propose examples of such models and how they can be applied to improve existing capacity building programs, as well as implementation in practice.
... But since that attempt at a definition, the issue of what ought to be the most appropriate common definition of global health-and by extension, global health research-has been the subject of extensive debate. [3][4][5][6] In a recent article published in BMJ Global Health, Salm et al reported a comprehensive systematic review and thematic analysis of the definitions of global health over an 11-year period. 7 They found that most definitions of global health in the articles meeting their inclusion criteria fell within one of the following four main themes: (1) a multiplex approach to worldwide health improvement taught and pursued through research institutions; (2) an ethical initiative that is guided by justice principles; (3) a form of governance that yields national, international, translational and supranational influence through political decision making, problem identification and allocation and exchange of resources across borders and (4) a polysemous concept with historical antecedents and emergent future. ...
... Interestingly, several articles published since 2019 have extended the debate on this topic of GH's definition by directly engaging questions of geography and positionality: a recent commentary by King and Kolski defining GH 'as public health somewhere else' was met with pushback by those who argue that spatial definitions of GH are limited and limiting. [99][100][101][102] ...
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Introduction Debate around a common definition of global health has seen extensive scholarly interest within the last two decades; however, consensus around a precise definition remains elusive. The objective of this study was to systematically review definitions of global health in the literature and offer grounded theoretical insights into what might be seen as relevant for establishing a common definition of global health. Method A systematic review was conducted with qualitative synthesis of findings using peer-reviewed literature from key databases. Publications were identified by the keywords of ‘global health’ and ‘define’ or ‘definition’ or ‘defining’. Coding methods were used for qualitative analysis to identify recurring themes in definitions of global health published between 2009 and 2019. Results The search resulted in 1363 publications, of which 78 were included. Qualitative analysis of the data generated four theoretical categories and associated subthemes delineating key aspects of global health. These included: (1) global health is a multiplex approach to worldwide health improvement taught and pursued at research institutions; (2) global health is an ethically oriented initiative that is guided by justice principles; (3) global health is a mode of governance that yields influence through problem identification, political decision-making, as well as the allocation and exchange of resources across borders and (4) global health is a vague yet versatile concept with multiple meanings, historical antecedents and an emergent future. Conclusion Extant definitions of global health can be categorised thematically to designate areas of importance for stakeholders and to organise future debates on its definition. Future contributions to this debate may consider shifting from questioning the abstract ‘what’ of global health towards more pragmatic and reflexive questions about ‘who’ defines global health and towards what ends.
Objectives People experiencing homelessness (PEH) are at increased risk of respiratory infections and associated morbidity and mortality. To characterize optimal intervention strategies, we completed a systematic review of mitigation strategies for PEH to minimize the spread and impact of respiratory infectious disease outbreaks, including COVID-19. Methods The study protocol was registered in PROSPERO (#2020 CRD42020208964) and was consistent with the preferred reporting in systematic reviews and meta-analyses (PRISMA) guidelines. A search algorithm containing keywords that were synonymous to the terms “Homeless” and “Respiratory Illness” was applied to the 6 databases. The search concluded on September 22, 2020. Quality assessment was performed at the study level. Steps were conducted by two independent team members. Synthesis 4,468 unique titles were retrieved with 21 meeting criteria for inclusion. Interventions included testing, tracking, screening, infection prevention and control, isolation support, and education. Historically, there has been limited study of intervention strategies specifically for PEH across the world. Conclusion Staff and organizations providing services for people experiencing homelessness face specific challenges in adhering to public health guidelines such as physical distancing, isolation, and routine hygiene practices. There is a discrepancy between the burden of infectious diseases among PEH and specific research characterizing optimal intervention strategies to mitigate transmission in the context of shelters. Improving health for people experiencing homelessness necessitates investment in programs scaling existing interventions and research to study new approaches.
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Global surgery is an essential component of Universal Health Coverage. Surgical conditions account for almost one-third of the global burden of disease, with the majority of patients living in low-income and middle-income countries (LMICs). Children account for more than half of the global population; however, in many LMIC settings they have poor access to surgical care due to a lack of workforce and health system infrastructure to match the need for children’s surgery. Surgical providers from high-income countries volunteer to visit LMICs and partner with the local providers to deliver surgical care and trainings to improve outcomes. However, some of these altruistic efforts fail. We aim to share our experience on developing, implementing and sustaining a partnership in global children’s surgery in Tanzania. The use of participatory methods facilitated a successful 17-yearlong partnership, ensured a non-hierarchical environment and encouraged an understanding of the context, local needs, available resources and hospital capacity, including budget constraints, when codesigning solutions. We believe that participatory approaches are feasible and valuable in developing, implementing and sustaining global partnerships for children’s surgery in LMICs.
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Developing countries can generate effective solutions for today's global health challenges. This paper reviews relevant literature to construct the case for international cooperation, and in particular, developed-developing country partnerships. Standard database and web-based searches were conducted for publications in English between 1990 and 2010. Studies containing full or partial data relating to international cooperation between developed and developing countries were retained for further analysis. Of 227 articles retained through initial screening, 65 were included in the final analysis. The results were two-fold: some articles pointed to intangible benefits accrued by developed country partners, but the majority of information pointed to developing country innovations that can potentially inform health systems in developed countries. This information spanned all six WHO health system components. Ten key health areas where developed countries have the most to learn from the developing world were identified and include, rural health service delivery; skills substitution; decentralisation of management; creative problem-solving; education in communicable disease control; innovation in mobile phone use; low technology simulation training; local product manufacture; health financing; and social entrepreneurship. While there are no guarantees that innovations from developing country experiences can effectively transfer to developed countries, combined developed-developing country learning processes can potentially generate effective solutions for global health systems. However, the global pool of knowledge in this area is virgin and further work needs to be undertaken to advance understanding of health innovation diffusion. Even more urgently, a standardized method for reporting partnership benefits is needed-this is perhaps the single most immediate need in planning for, and realizing, the full potential of international cooperation between developed and developing countries.
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Current definitions of 'global health' lack specificity about the term 'global'. This debate presents and discusses existing definitions of 'global health' and a common problem inherent therein. It aims to provide a way forward towards an understanding of 'global health' while avoiding redundancy. The attention is concentrated on the dialectics of different concepts of 'global' in their application to malnutrition; HIV, tuberculosis & malaria; and maternal mortality. Further attention is payed to normative objectives attached to 'global health' definitions and to paradoxes involved in attempts to define the field. The manuscript identifies denotations of 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic'. A fourth concept of 'global' as 'supraterritorial' is presented and defined as 'links between the social determinants of health anywhere in the world'. The rhetorical power of the denotations impacts considerably on the object of 'global health', exemplified in the context of malnutrition; HIV, tuberculosis & malaria; and maternal mortality. The 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic' house contradictions which can be overcome by the fourth concept of 'global' as 'supraterritorial'. The 'global-local-relationship' inherent in the proposed concept coheres with influential anthropological and sociological views despite the use of different terminology. At the same time, it may be assembled with other views on 'global' or amend apparently conflicting ones. The author argues for detaching normative objectives from 'global health' definitions to avoid so called 'entanglement-problems'. Instead, it is argued that the proposed concept constitutes an un-euphemistical approach to describe the inherently politicised field of 'global health'. While global-as-worldwide and global-as-transcending-national-boundaries are misleading and produce redundancy with public and international health, global-as-supraterritorial provides 'new' objects for research, education and practice while avoiding redundancy. Linked with 'health' as a human right, this concept preserves the rhetorical power of the term 'global health' for more innovative forms of study, research and practice. The dialectic approach reveals that the contradictions involved in the different notions of the term 'global' are only of apparent nature and not exclusive, but have to be seen as complementary to each other if expected to be useful in the final step.
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Information exchanges, debates, and negotiations through community social networks are essential to ensure the sustainability of the development process initiated in participatory research. The authors analyze the structural properties and robustness of a discussion network about mercury issues in a community in the Brazilian Amazon involved in a participatory research aimed at reducing exposure to the pollutant. Most of the villagers are connected in a large network and are separated from other individuals by few intermediaries. The structure of the discussion network displays resilience to the random elimination of villagers but shows vulnerability to the removal of one villager who has been a long-term collaborator of the project. Although the network exhibits a structure likely to favor an efficient flow of information, results show that specific actions should be taken to stimulate the emergence of a pool of opinion leaders and increase the redundancy of discussion channels.
Partnerships involving NGOs and academic researchers (NGO–R partnerships) are increasing in global health research. Such collaborations present opportunities for knowledge translation in global health, yet are also associated with challenges for establishing and sustaining effective and respectful partnerships. We conducted a narrative review of the literature to identify benefits and challenges associated with NGO–R partnerships, as well as approaches that promote successful partnerships. We illustrate this analysis with examples from our own experiences. The results suggest that collaborations characterised by trust, transparency, respect, solidarity, and mutuality contribute to the development of successful and sustainable NGO–R partnerships.