Changes in the Health Field, 1960s to Present Day

PeriodInternational Health 1960s to 1990sGlobal Health 1990s to circa 2015New World Health 2008 to Present
Geopolitical originsEnd of European Colonialism with new voting members in a newly formed UNEnd of the Cold War (and the Soviet Union), freer trade, Internet, and AIDSFinancial markets crash, OECD recession, and emergent developing economies
Political economy toneCold War with East-West divide“Government is the problem,” markets and civil society the solutionReassertion of nation-state and demands for social protection
Construction of healthWHO holistic definition and social construction of healthSimultaneously, human rights and reductionist technologyMultisectoral, social determinants, and universalism
Predominant approachPrimary health care, “Health for All,” and solidarity as universal principles and movementsTop-down programs and PPPs to fight key diseases of poverty in developing countriesGrand convergence between North and South, progressive realization of UHC and global health security
International cooperationColored by foreign affairs (East-West competition, with exceptions like smallpox eradication)Explosion of NGOs, PPPs, and new philanthropy tackling the MDGs in poor countriesAssertive but interdependent nation-states sign up to the universal SDGs
Development assistance for healthNewly created UN agencies like WHO and bilateral donors like USAIDBillion-dollar platforms (Gavi, The Global Fund, PEPFAR), Bill & Melinda Gates Foundation a major player, golden era of DAHDAH stagnation, domestic resource mobilization, and graduation from assistance (except fragile states)
GovernanceWHO takes center stage in the UN architecture“Open source anarchy” (WHO's authority diluted)Sovereign states reasserted; opportunity for WHO
Private sectorEssentially proscribed from UN settings and agendaRise in prominence both through PPPs and philanthropy, IT enables global communicationsHalf of the health sector provision and growing markets in emerging economies
Civil society and community roleEmpowerment of communities after Alma-Ata Declaration of 1978Growing activism, especially linked with HIV/AIDSNational NGOs very important despite closing space in some countries
  • Abbreviations: DAH, development assistance for health; IT, information technology; MDGs, Millennium Development Goals; OECD, Organisation for Economic Co-operation and Development; PEPFAR, U.S. President's Emergency Plan for AIDS Relief; PPPs, public-private partnerships; SDGs, Sustainable Development Goals; UHC, universal health coverage; UN, United Nations; USAID, United States Agency for International Development; WHO, World Health Organization.