Changes in the Health Field, 1960s to Present Day
| Period | International Health 1960s to 1990s | Global Health 1990s to circa 2015 | New World Health 2008 to Present |
|---|---|---|---|
| Geopolitical origins | End of European Colonialism with new voting members in a newly formed UN | End of the Cold War (and the Soviet Union), freer trade, Internet, and AIDS | Financial markets crash, OECD recession, and emergent developing economies |
| Political economy tone | Cold War with East-West divide | “Government is the problem,” markets and civil society the solution | Reassertion of nation-state and demands for social protection |
| Construction of health | WHO holistic definition and social construction of health | Simultaneously, human rights and reductionist technology | Multisectoral, social determinants, and universalism |
| Predominant approach | Primary health care, “Health for All,” and solidarity as universal principles and movements | Top-down programs and PPPs to fight key diseases of poverty in developing countries | Grand convergence between North and South, progressive realization of UHC and global health security |
| International cooperation | Colored by foreign affairs (East-West competition, with exceptions like smallpox eradication) | Explosion of NGOs, PPPs, and new philanthropy tackling the MDGs in poor countries | Assertive but interdependent nation-states sign up to the universal SDGs |
| Development assistance for health | Newly created UN agencies like WHO and bilateral donors like USAID | Billion-dollar platforms (Gavi, The Global Fund, PEPFAR), Bill & Melinda Gates Foundation a major player, golden era of DAH | DAH stagnation, domestic resource mobilization, and graduation from assistance (except fragile states) |
| Governance | WHO takes center stage in the UN architecture | “Open source anarchy” (WHO's authority diluted) | Sovereign states reasserted; opportunity for WHO |
| Private sector | Essentially proscribed from UN settings and agenda | Rise in prominence both through PPPs and philanthropy, IT enables global communications | Half of the health sector provision and growing markets in emerging economies |
| Civil society and community role | Empowerment of communities after Alma-Ata Declaration of 1978 | Growing activism, especially linked with HIV/AIDS | National 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.