International Health
Encyclopedia
International health, also called geographic medicine or global health
, is a field of health
care, usually with a public health emphasis, dealing with health across regional or national boundaries. One subset of international medicine, travel medicine
, prepares travelers with immunizations, prophylactic medications, preventive techniques such as bednets and residual pesticides, in-transit care, and post-travel care for exotic illnesses. International health, however, more often refers to health personnel or organizations from one area or nation providing direct health care, or health sector development, in another area or nation. It is this sense of the term that is explained here. More recently, public health
experts have become interested in global processes that impact on human health. Globalization and health
, for example, illustrates the complex and changing sociological environment within which the determinants of health
and disease
express themselves.
area, and Care International's Iraq Director, Margaret Hassan
(a long-time Iraq resident with dual Iraqi-British citizenship) was brutally murdered on the Internet by Al Qaeda-affiliated terrorists for the "crime" of providing services equitably among Iraqis. International Medical Corps was begun in response to the suffering of the Afghan people after the Soviet invasion of 1979, and is adept at providing services in dangerous places (see Attacks on humanitarian workers
)
organizations that perform services as part of a proselytizing or evangelical campaign should be separated from the NGO category and simply be referred to as religious missionary organizations. Some religious relief organizations do provide services more as a duty or "charity", however, without requirements for the recipients to attend any preaching, prayer or other religious preconditions.
's Humanitarian Charter and Minimum Standards in Disaster Response. They have taken other new tools into the planning offices and field: in addition to the obligatory laptop computer, they typically rely heavily upon cellular and satellite communications, the Internet, and geographic information services http://www.humanitarianinfo.org/IMToolbox/web/03_Map.html, or GIS. These technological improvements allow them to better focus efforts in areas of need, respond to evolving crises, and predict future needs. Indeed, in a related effort, the United States Holocaust Museum teamed with Google Earth
to establish baseline GIS photos of crisis-torn Darfur, updating them at intervals, and uploading them to the Internet for public access. Since Internet "surfers" can browse these images and see where once-present villages are later obliterated, this teamwork gave lie to the Sudanese claim that it was engaging in neither ethnic cleansing nor genocide http://www.ushmm.org/googleearth/projects/darfur/.
of the United States Department of Defense
, as the DoD's senior medical officer, established the International Health Divisionhttp://fhp.osd.mil/intlhealth/ in late 2007 to help coordinate military health doctrine and practices in international development. The International Health Division places great emphasis upon working with NGOs to provide sustainable, culturally-appropriate development activities around the world. While critics maintain that DoD does not provide aid equitably and without regard to political influence, the Asian tsunami of December, 2004 (due to the 2004 Indian Ocean earthquake
) demonstrated that DoD was capable of working in a supporting role without regard to geopolitical gain. Indeed, the DoD was surprised at the unexpected degree of improvement in American prestige as a result of its role in Southeast Asia and months later, in the Pakistan earthquake. A similar event resulted in rapid mobilization of DoD resources in response to the 2007 Peru earthquake
, Bangladeshi Typhoon Sidr http://www.iht.com/articles/ap/2007/11/28/asia/AS-GEN-Bangladesh-Cyclone.php and Tropical Storm Nero in the Dominican Republic
, all in the last half of 2007, with no reasonable expectation of material gain for America.
In 2005, then-Secretary of Defense Donald Rumsfeld
signed DoD Directive 3000.05, "Stability, Security, Transition and Reconstruction Operations"http://www.dtic.mil/whs/directives/corres/pdf/300005p.pdf. This document requires the DoD to assign Stability, Security, Transition and Reconstruction (SSTR) the same importance in planning and preparation as it gives to warfighting.
The rationale for SSTR is intuitive: stability promotes rule of law and economic development. These provide the base for essential services such as education, public health
and sanitation
, law enforcement and fire suppression. Essential services, in turn, lead to increased stability and economic opportunity. Health in the general population, and in particular the labor force, is essential to productivity and consequent stability http://www.who.int/mediacentre/news/releases/2007/pr11/en/
Although these relationships are not necessarily linear, and there is no inherent guarantee of equitable distribution of wealth in a developing society, full employment and hope for the future may be powerful disincentives to conflict. In this way, the DoD , through SSTR operations, expects to prevent some potential conflicts and criminal activities.
The International Health Division, charged with policy implications of DoDD 3000.05, is located within the Office of the ASD(HA), reporting through Force Health Protection & Readiness. International Health develops DoD's policy on medical ethics
and the practice of medicine in international health and development settings. International Health also identifies needs in developing nations and looks for non-governmental organizations (NGOs), intergovernmental organizations, and private voluntary organizations (PVOs) such as professional societies, that have the ability and expertise to address these problems. In this way, the NGOs develop helping relationships with the nations or regions they work in, fostering stability and sustainability.
Other DoD international health activities occurring on a regular basis include medical civic action projects
(MEDCAPs), in which Army, Navy or Air Force medical assets provide direct care, sanitation, and other public health services to host nation (HN) locals. Such MEDCAPs are generally traced to the Vietnam war
, when medical units and medical personnel assigned to combat units would organize field medical care to Vietnamese, Hmong
and others. There is a growing realization among the military that MEDCAP care may not be the best model, if the result is merely handing out antibiotics for upper respiratory infections and anti-inflammatories for aches and pains. However, projects such as de-worming, dentistry, prenatal education and care, and veterinary care, when performed in conjunction with HN health authorities and the local health infrastructure, have indisputable and long-lasting benefits to the recipients.
Similar to MEDCAPs, the military performs Medical Readiness Training Exercises
(MEDRETEs), Joint Combined Exchange Training
(JCET), and Humanitarian-Civic Action (HCA) exercises, all of which may have direct and indirect services as a feature of the training.
Finally, the military has unparalleled logistical and lift capabilities to respond to humanitarian assistance/disaster response(HADR) needs.
In conjunction with the Uniformed Services University of the Health Sciences
(USUHS), the Center for Disaster and Humanitarian Medicine (CDHAM) develops curriculum, teaches disaster and humanitarian assistance principles to graduate, medical, and post-doctoral students and publishes courses on incident command and other related topics. The handbook on military-NGO relations, "A Guide to Non-Governmental Organizations for the Military" is available free on-line.
Global health
Global health is the health of populations in a global context and transcends the perspectives and concerns of individual nations. Health problems that transcend national borders or have a global political and economic impact, are often emphasized...
, is a field of health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
care, usually with a public health emphasis, dealing with health across regional or national boundaries. One subset of international medicine, travel medicine
Travel medicine
Travel medicine or emporiatrics is the branch of medicine that deals with the prevention and management of health problems of international travelers.-Globalization and travel:...
, prepares travelers with immunizations, prophylactic medications, preventive techniques such as bednets and residual pesticides, in-transit care, and post-travel care for exotic illnesses. International health, however, more often refers to health personnel or organizations from one area or nation providing direct health care, or health sector development, in another area or nation. It is this sense of the term that is explained here. More recently, public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
experts have become interested in global processes that impact on human health. Globalization and health
Globalization and Health
Globalization and Health is an open-access peer-reviewed medical journal that covering the topic of globalization and its effects on health. It is affiliated with the London School of Economics...
, for example, illustrates the complex and changing sociological environment within which the determinants of health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
and disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
express themselves.
The Role of NGOs
Much work in international health is performed by non-governmental organizations, or NGOs. Services provided by international health NGOs include direct health care, community potable water, vitamin supplementation, and mitigation of endemic and epidemic infectious diseases and malnutrition. Examples of NGOs dedicated to international health include:- Pakistan Heart FoundationPakistan Heart FoundationThe Pakistan Heart Foundation , emanated from the Muhammadi Hospital , which merged with the International Medical Research Centre . The PHF provides non-profit cardiac care through the MH, and coordinates training for medics and paramedic, mobile health programs, clinical research and...
- CARE
- Médecins Sans FrontièresMédecins Sans Frontières' , or Doctors Without Borders, is a secular humanitarian-aid non-governmental organization best known for its projects in war-torn regions and developing countries facing endemic diseases. Its headquarters are in Geneva, Switzerland...
(Doctors Without Borders) - The International Committee of the Red CrossInternational Committee of the Red CrossThe International Committee of the Red Cross is a private humanitarian institution based in Geneva, Switzerland. States parties to the four Geneva Conventions of 1949 and their Additional Protocols of 1977 and 2005, have given the ICRC a mandate to protect the victims of international and...
- International Medical CorpsInternational Medical CorpsInternational Medical Corps is a global humanitarian nonprofit organization dedicated to saving lives and relieving suffering through health care training and relief and development programs...
- OxfamOxfamOxfam is an international confederation of 15 organizations working in 98 countries worldwide to find lasting solutions to poverty and related injustice around the world. In all Oxfam’s actions, the ultimate goal is to enable people to exercise their rights and manage their own lives...
- Partners in HealthPartners In HealthPartners In Health is a Boston, Massachusetts-based non-profit health care organization dedicated to providing a "preferential option for the poor". It was founded in 1987 by Dr. Paul Farmer, Ophelia Dahl, Thomas J. White, Todd McCormack, and Dr...
- Project HOPEProject HOPE (USA)Project HOPE is an international health care organization founded in the United States in 1958. Its most visible aspect was the SS HOPE, the first peacetime hospital ship...
- Save the ChildrenSave the ChildrenSave the Children is an internationally active non-governmental organization that enforces children's rights, provides relief and helps support children in developing countries...
In Harm's Way
These organizations often go in harm's way to provide services to people affected by natural disaster or conflict. For example, Médecins Sans Frontières has lost members in the DarfurDarfur
Darfur is a region in western Sudan. An independent sultanate for several hundred years, it was incorporated into Sudan by Anglo-Egyptian forces in 1916. The region is divided into three federal states: West Darfur, South Darfur, and North Darfur...
area, and Care International's Iraq Director, Margaret Hassan
Margaret Hassan
Margaret Hassan was an Irish aid worker who had worked in Iraq for many years until she was abducted and murdered by unidentified kidnappers in Iraq in 2004, at the age of 59...
(a long-time Iraq resident with dual Iraqi-British citizenship) was brutally murdered on the Internet by Al Qaeda-affiliated terrorists for the "crime" of providing services equitably among Iraqis. International Medical Corps was begun in response to the suffering of the Afghan people after the Soviet invasion of 1979, and is adept at providing services in dangerous places (see Attacks on humanitarian workers
Attacks on humanitarian workers
Humanitarian aid workers belonging to United Nations organisations, PVOs / NGOs or the Red Cross / Red Crescent have traditionally enjoyed both international legal protection, and de facto immunity from attack by belligerent parties. However, attacks on humanitarian workers have occasionally...
)
The Role of International Health NGOs in International Development
Health-related NGOs also provide capacity development in areas of need; that is, helping nations develop sustainable domestic health solutions through training programs. An example of this type of aid is the Center for International Rehabilitation, which has provided rehabilitation training for Iraqi physical therapists, physicians, and rehabilitation clinic managers in Tuzla, Bosnia and Amman, Jordan. These trainees then care for amputees, spinal and head injury patients in their home country.NGOs vs. Missionaries
One important characteristic of NGO work is that, in the "pure" sense, they provide services based solely upon need, without political, ethnic, religious or other considerations. Thus, strictly speaking, religious missionaryMissionary
A missionary is a member of a religious group sent into an area to do evangelism or ministries of service, such as education, literacy, social justice, health care and economic development. The word "mission" originates from 1598 when the Jesuits sent members abroad, derived from the Latin...
organizations that perform services as part of a proselytizing or evangelical campaign should be separated from the NGO category and simply be referred to as religious missionary organizations. Some religious relief organizations do provide services more as a duty or "charity", however, without requirements for the recipients to attend any preaching, prayer or other religious preconditions.
Harnessing the Power of Technology
As NGO practice evolves parallel with technology, NGOs have developed more scientific and precise methods of assessment, planning and operations in humanitarian assistance and complex emergencies. One example is the Sphere ProjectSphere Project
The Sphere Project was launched in 1997 to develop a set of minimum standards in core areas of humanitarian assistance. The aim of the project is to improve the quality of assistance provided to people affected by disasters, and to enhance the accountability of the humanitarian system in disaster...
's Humanitarian Charter and Minimum Standards in Disaster Response. They have taken other new tools into the planning offices and field: in addition to the obligatory laptop computer, they typically rely heavily upon cellular and satellite communications, the Internet, and geographic information services http://www.humanitarianinfo.org/IMToolbox/web/03_Map.html, or GIS. These technological improvements allow them to better focus efforts in areas of need, respond to evolving crises, and predict future needs. Indeed, in a related effort, the United States Holocaust Museum teamed with Google Earth
Google Earth
Google Earth is a virtual globe, map and geographical information program that was originally called EarthViewer 3D, and was created by Keyhole, Inc, a Central Intelligence Agency funded company acquired by Google in 2004 . It maps the Earth by the superimposition of images obtained from satellite...
to establish baseline GIS photos of crisis-torn Darfur, updating them at intervals, and uploading them to the Internet for public access. Since Internet "surfers" can browse these images and see where once-present villages are later obliterated, this teamwork gave lie to the Sudanese claim that it was engaging in neither ethnic cleansing nor genocide http://www.ushmm.org/googleearth/projects/darfur/.
The U.S. Department of Defense
In another teamwork effort, the Assistant Secretary of Defense (Health Affairs)S. Ward Casscells
S. Ward Casscells, MD is the John E. Tyson Distinguished Professor of Medicine and Public Health, and Vice President for External Affairs and Public Policy at the University of Texas at Houston, and Senior Scholar at the Texas Heart Institute...
of the United States Department of Defense
United States Department of Defense
The United States Department of Defense is the U.S...
, as the DoD's senior medical officer, established the International Health Divisionhttp://fhp.osd.mil/intlhealth/ in late 2007 to help coordinate military health doctrine and practices in international development. The International Health Division places great emphasis upon working with NGOs to provide sustainable, culturally-appropriate development activities around the world. While critics maintain that DoD does not provide aid equitably and without regard to political influence, the Asian tsunami of December, 2004 (due to the 2004 Indian Ocean earthquake
2004 Indian Ocean earthquake
The 2004 Indian Ocean earthquake was an undersea megathrust earthquake that occurred at 00:58:53 UTC on Sunday, December 26, 2004, with an epicentre off the west coast of Sumatra, Indonesia. The quake itself is known by the scientific community as the Sumatra-Andaman earthquake...
) demonstrated that DoD was capable of working in a supporting role without regard to geopolitical gain. Indeed, the DoD was surprised at the unexpected degree of improvement in American prestige as a result of its role in Southeast Asia and months later, in the Pakistan earthquake. A similar event resulted in rapid mobilization of DoD resources in response to the 2007 Peru earthquake
2007 Peru earthquake
The 2007 Peru earthquake was an earthquake measuring 8.0 on the moment magnitude scale that hit the central coast of Peru on Wednesday, August 15, 2007; it occurred at 23:40:57 UTC and lasted for about three minutes...
, Bangladeshi Typhoon Sidr http://www.iht.com/articles/ap/2007/11/28/asia/AS-GEN-Bangladesh-Cyclone.php and Tropical Storm Nero in the Dominican Republic
Dominican Republic
The Dominican Republic is a nation on the island of La Hispaniola, part of the Greater Antilles archipelago in the Caribbean region. The western third of the island is occupied by the nation of Haiti, making Hispaniola one of two Caribbean islands that are shared by two countries...
, all in the last half of 2007, with no reasonable expectation of material gain for America.
In 2005, then-Secretary of Defense Donald Rumsfeld
Donald Rumsfeld
Donald Henry Rumsfeld is an American politician and businessman. Rumsfeld served as the 13th Secretary of Defense from 1975 to 1977 under President Gerald Ford, and as the 21st Secretary of Defense from 2001 to 2006 under President George W. Bush. He is both the youngest and the oldest person to...
signed DoD Directive 3000.05, "Stability, Security, Transition and Reconstruction Operations"http://www.dtic.mil/whs/directives/corres/pdf/300005p.pdf. This document requires the DoD to assign Stability, Security, Transition and Reconstruction (SSTR) the same importance in planning and preparation as it gives to warfighting.
The rationale for SSTR is intuitive: stability promotes rule of law and economic development. These provide the base for essential services such as education, public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
and sanitation
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...
, law enforcement and fire suppression. Essential services, in turn, lead to increased stability and economic opportunity. Health in the general population, and in particular the labor force, is essential to productivity and consequent stability http://www.who.int/mediacentre/news/releases/2007/pr11/en/
Although these relationships are not necessarily linear, and there is no inherent guarantee of equitable distribution of wealth in a developing society, full employment and hope for the future may be powerful disincentives to conflict. In this way, the DoD , through SSTR operations, expects to prevent some potential conflicts and criminal activities.
The International Health Division, charged with policy implications of DoDD 3000.05, is located within the Office of the ASD(HA), reporting through Force Health Protection & Readiness. International Health develops DoD's policy on medical ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
and the practice of medicine in international health and development settings. International Health also identifies needs in developing nations and looks for non-governmental organizations (NGOs), intergovernmental organizations, and private voluntary organizations (PVOs) such as professional societies, that have the ability and expertise to address these problems. In this way, the NGOs develop helping relationships with the nations or regions they work in, fostering stability and sustainability.
Other DoD international health activities occurring on a regular basis include medical civic action projects
Civic action program
A civic action program also known as civic action project is a type of operation designed to assist an area by using the capabilities and resources of a military force or civilian organization to conduct long-term programs or short-term projects...
(MEDCAPs), in which Army, Navy or Air Force medical assets provide direct care, sanitation, and other public health services to host nation (HN) locals. Such MEDCAPs are generally traced to the Vietnam war
Vietnam War
The Vietnam War was a Cold War-era military conflict that occurred in Vietnam, Laos, and Cambodia from 1 November 1955 to the fall of Saigon on 30 April 1975. This war followed the First Indochina War and was fought between North Vietnam, supported by its communist allies, and the government of...
, when medical units and medical personnel assigned to combat units would organize field medical care to Vietnamese, Hmong
Hmong people
The Hmong , are an Asian ethnic group from the mountainous regions of China, Vietnam, Laos, and Thailand. Hmong are also one of the sub-groups of the Miao ethnicity in southern China...
and others. There is a growing realization among the military that MEDCAP care may not be the best model, if the result is merely handing out antibiotics for upper respiratory infections and anti-inflammatories for aches and pains. However, projects such as de-worming, dentistry, prenatal education and care, and veterinary care, when performed in conjunction with HN health authorities and the local health infrastructure, have indisputable and long-lasting benefits to the recipients.
Similar to MEDCAPs, the military performs Medical Readiness Training Exercises
Civic action program
A civic action program also known as civic action project is a type of operation designed to assist an area by using the capabilities and resources of a military force or civilian organization to conduct long-term programs or short-term projects...
(MEDRETEs), Joint Combined Exchange Training
Joint Combined Exchange Training
Joint Combined Exchange Training or JCET programs are exercises designed to provide training opportunities for American Special Forces who are stationed outside of the United States by holding the training exercises in countries that the forces may one day have to operate in, as well as providing...
(JCET), and Humanitarian-Civic Action (HCA) exercises, all of which may have direct and indirect services as a feature of the training.
Finally, the military has unparalleled logistical and lift capabilities to respond to humanitarian assistance/disaster response(HADR) needs.
In conjunction with the Uniformed Services University of the Health Sciences
Uniformed Services University of the Health Sciences
The Uniformed Services University of the Health Sciences is a health science university run by the U.S. federal government. The primary mission of the school is to prepare graduates for service to the U.S. at home and abroad in the medical corps....
(USUHS), the Center for Disaster and Humanitarian Medicine (CDHAM) develops curriculum, teaches disaster and humanitarian assistance principles to graduate, medical, and post-doctoral students and publishes courses on incident command and other related topics. The handbook on military-NGO relations, "A Guide to Non-Governmental Organizations for the Military" is available free on-line.