This is an introduction to the four major clusters of change in the world that present great challenges and opportunities to health.
First, there are unprecedented changes in interconnections across borders. These altered global interconnections affect every domain, and shifting interactions set the stage for both global risks and opportunities related to health. Risks and opportunities cross domains, drawing on multi-stakeholder responses, and can be game-changers for better or for worse. The many risks—and opportunities—related to these unprecedented changes affect the world in disproportionate ways, as the world’s worst-off suffer more from global risks, while the best-off enjoy more opportunities than ever before.
Second, population dynamics have changed in unprecedented ways. Global demographics are characterized by the shifts caused by three factors: migration, mortality, and fertility. There are four basic types of migration: within borders, across borders, forced, or voluntary. Migrants may contribute to growing urbanization trends, the search for better opportunities, or the crises of internationally displaced persons (IDPs) and refugees, both beyond the borders and within a country. For the first time in history, the world has rapidly progressed toward replacement fertility rates and patterns of aging across the world are shifting toward there being more people over 65 than under 5; at the same time, some countries are expected to double in population over the next 30 years due to high percentages of youth. Finally, for the first time more people dwell in an urban than a rural setting globally; this puts extraordinary stresses on urbanization and the structure and function of cities.
Third, patterns of health across the globe are changing. Overall health has improved, but this improvement is not equal: while the healthy get healthier, many sick are getting sicker. This disparity is visible between countries but also within countries related to the social determinants of health such as economic, educational, housing conditions and other disparities. As a result of these changing patterns, the world faces an “unfinished agenda,” with the need to address the increasing infectious diseases of poverty, HIV/AIDS, tuberculosis, malaria, maternal-child mortality and undernutrition. Changing patterns of health also include a rise in chronic diseases such as cancers and heart disease, a rise in injuries, and a rise in health-related consequences due to the complexities of increased globalization.
Fourth, the position of health on the global agenda has changed. This extraordinary shift is evident, for example, in the increased dollars spent on funding health initiatives as well as a new plurality of actors among the major players in health responses. This heightened attention to health by global actors may be due to three factors: a) health is both a product and also an important driver of economic development; b) health factors no longer remain within a given region but cross borders; and c) health has increasingly become a focus of the non-health sector in tackling challenges. More global attention to health—in areas of governance, business, technology, etc.—can be a good thing, but it also brings with it new complexities and questions. Are we organized enough to address these shifts constructively? Understanding the background context of today’s health risks and opportunities through a deliberate framework that takes into consideration all of these complex interactions and factors can help equip us to develop long-term solutions that succeed in advancing global health for all.
This content was developed by Professor Goldie based on the introductory global health concepts she teaches to educators and students at all academic levels and was designed primarily for an online audience. A variation of this segment was released through HarvardX as part of the 'Entrepreneurship and Healthcare in Emerging Economies' course that she co-taught with Professor Tarun Khanna of Harvard Business School in Fall 2014.