David Fleming: Global Health: A Two-way Street

David Fleming

As budget constraints tighten and we think about how to invest our education dollars at universities, tax payers have a right to expect a return on that investment.  When it comes to global health studies at universities, that return is not always obvious.  As I talk to people across King County and the country, I find that they tend to think of “global health” as something that benefits people overseas.  Yet, we increasingly find that global health is a two-way street.  What we learn and the strategies we use in global health can also greatly improve health in our own country.

Reality check: Although the United States has the world’s best medical system, we do not live as long or as well as Bosnians or Jordanians.  The U.S. is not even one of the top 25 countries with respect to indicators of health.  Why?  Because although we have poured money into our clinical health care system, we have neglected community health.  As a consequence, communities across America have health indicators on a par with those in developing countries.

What global health strategies might also work at home to improve health?  One example is community health workers–people from the community who are trained to deliver frontline health information to their neighbors.  It’s low cost and highly effective, particularly for reaching communities that have been marginalized on the basis of culture or language, and whose members may have difficulty understanding or accessing health care professionals.

Global health also teaches us that technology can leapfrog over barriers in delivery.  For example, across much of the developing world, cell phone technology is filling in for a lack of physical infrastructure—like roads and health clinics.  We could make some of the same leaps: video phones can be used to watch people take their tuberculosis medicine rather than having to send an expensive healthcare worker to the patient’s house.  Or we can use cell phones to deliver messages in an emergency in languages that are understandable to non-English speakers. 

Additionally, we should borrow a page from global health in our approach to linking health and economic development.  We know that poor health is strongly linked to poverty. Globally, micro-credit loans are being used to improve family income and health.  Why not do the same here?  For example, microloans could even pay for citizenship applications—which cost $700.  The benefit: citizenship is linked to higher incomes and higher incomes are linked to better health.  But many who are qualified and would like to become U.S. citizens cannot afford the application fee.  And all loans need not be “micro”.  Larger low interest loans could enable corner groceries in poor neighborhoods to invest in the equipment for stocking healthy, nutritious fresh fruits and vegetables. 

Let’s use the conference of the Consortium of Universities for Global Health to build out such ideas and to establish the collaborations that can make them happen.  Global health and local health is a two-way street.  The job in front of us is to make it well traveled in both directions.

David Fleming, M.D.
Director and Health Officer for Seattle and King County Public Health

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