Fast track — Health PolicyGlobal public health: a scorecard
Introduction
The midpoint for achieving the Millennium Development Goals (MDGs), the framework for health development, is a good time to review global progress in public health, especially in the context of unprecedented interest in matters of global health (panel 1).1 This article is based on the Cochrane Lecture delivered to the Society for Social Medicine, Southampton, Sept 17, 2008.
In this paper, and stimulated by Archie Cochrane's ability to synthesise and simplify complex health issues (panel 2),2 we explore the achievements of public health from a global perspective by summarising recent progress in global public health, identifying the unfinished and the new global agendas for public health, developing a scorecard for global public health to measure progress, and suggesting ways of improving the effectiveness of public health.
Section snippets
What is global public health?
Global public health is the collective action we take worldwide for improving health and health equity,3 aiming to bring the best available cost-effective and feasible interventions to all populations and selected high-risk groups. Essential collective actions for health improvement include disease prevention, health promotion, health protection, and the provision of health care. There are many frameworks for global public health: health security, foreign policy, economic development, charity,
Recent trends
A snapshot of global health status (panel 3) suggests that there is much to celebrate in global health progress, but also there are areas of concern. Figure 1 summarises global trends in life expectancy at birth, a simple index of progress, for the past half century. Substantial improvements are apparent, especially in low-income and middle-income countries with low mortality, such as China. The convergence between these countries and high-income countries is striking. So too is the fact that
The unfinished agenda: the MDGs
Recent encouraging trends in the control of infectious disease and reductions in child mortality have been driven, in part, by the MDGs (panel 1). Achievement of the three health MDGs by the target date of 2015 represents the unfinished agenda of global public health. Although progress is being made, for example, impressive poverty alleviation in China (but not in India), it is variable and is threatened by new crises, involving factors ranging from fuel to food; the number of people living in
The new agenda
The new agenda for global public health includes the rising burden of chronic non-communicable diseases, global environmental changes, and the underlying socioeconomic determinants of health. These issues are not yet firmly on the global agenda possibly because they were not part of the discussions taking place in the run up to the Millennium Declaration.20
A global scorecard for public health
Our first assessment of the state of global public health 10 years ago suggested that public health was at a crossroad.42 Despite substantial and unappreciated achievements over the second half of the 20th century, we were cautiously optimistic that public health practitioners were beginning to embrace the full breadth of the challenges that were then apparent.
We believe that this optimism was justified. Here we summarise, in the style of Cochrane, the current situation with a scorecard that
Improving the effectiveness of public health: next steps
The next steps in the development of the scorecard are the agreement on the criteria for a more formal measurement of status and progress, development of national scorecards for public health, which could feed into regional scorecards, and finally the development of a more sophisticated global scorecard based on the regional and national scorecards. WHO, in consultation with member states and non-governmental organisations such as the Institute for Health Metrics and Evaluation, could assume
Conclusion
Progress in global public health has been substantial in the past decade; this is not surprising given the level of interest from G8 countries, development agencies, and foundations. Most of the progress has been around specific issues, although the recent prominence of global environmental changes and the underlying determinants of health and health equity augur well for a broader public health approach to global health.4 The eradication of poverty and extreme hunger and the reduction in
References (70)
- et al.
Public health for the new era: collaborative actions for population health improvement
Lancet
(2004) - et al.
Five metaphors about global-health policy
Lancet
(2008) - et al.
Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015
Lancet
(2007) - et al.
Generation of political priority for global health initiatives: a framework and case study of maternal mortality
Lancet
(2007) Countdown to 2015: a report card on maternal, newborn, and child survival
Lancet
(2008)G8 meeting disappoints on global health
Lancet
(2008)- et al.
MDGs: chronic diseases are not on the agenda
Lancet
(2005) - et al.
Preventing chronic diseases: how many lives can we save?
Lancet
(2005) - et al.
The global burden and costs of chronic diseases
Lancet
(2007) - et al.
How to prevent 100 million deaths from tobacco
Lancet
(2007)