Transforming Global Health: Interdisciplinary Challenges, Perspectives, and Strategies

Severe water stress is now a global crisis. The water crises in Flint (Michigan), Toledo (Ohio), and Cape Town (South Africa) is a minutia of the global water story: one in four of the world’s 500 largest cities are water stressed. By 2030, water stress will be the reality for almost half of the world’s population, which will force governments to spend around $200 billion annually to mitigate this stress. Apart from its public health and economic im-plications, water stress presents untold geopolitical ramifications. Mark Twain rightly opined, "whisky is for drinking; water is for fighting over." Globally, water wars are expected to further complicate the existing tensions in conflict regions in the Middle East and South Asia. This chapter provides an understanding of the threats facing our common water future.

Across the lifetime, each person will experience and accumulate countless exposures to the natural, built, social, and chemical components of the environment. These exposures occur in many ways, through people’s behaviors and lifestyle choices (for example, smoking, diet or level of activity), physical contact (intentional or not) with chemicals, structures or physical forces (for example, heat waves or hurricanes), or interactions with people, institutions, policies/laws and geopolitical forces (for example, war). Whatever a person’s lifetime exposures may be, scientists believe that they affect human health in important ways, contributing either to the development of disease or to maintenance of good health. In the field of public health, exposures are called “risk factors” if they contribute to disease and “protective factors” if they contribute to health. This chapter discusses these factors.

Forces driving migration and socio-political ideologies that contribute to refugee and immigrant health are defining the global 21st Century. Complex immigration policies are often in conflict with principles of human rights, social justice, economic theory and autonomy – of individuals and societies. This chapter outlines the complicated nature of displacement, and the impact it, as well as resettlement and emplacement have on the health and wellbeing of refugees. We will also present a perspective from Buffalo, NY, a community with long experience in refugee resettlement, and with expertise in meeting the needs of asylum seekers.

Nutrition is a complex and multifaceted influencer of health. Everything we consume, from a sip of water, to those green beans from a community garden, to that egg you had for breakfast are components of nutrition. But what are the factors that influence your nutrition, and in turn your health? Consider every choice you make around what you eat. You probably consider personal preference and nutritional value of the food, but what determines the food available to eat? And what determines your ability to access that food? It turns out that nutrition is influenced by a constellation of factors that exist within a dynamic and interacting system. In this chapter, we consider three broad components of this system, land, food, and the body, in the context of child malnutrition.

As historian of medicine Shigehisa Kuriyama reminds us, we have always lived in a world replete with multiple, independent, and yet effective, medical systems. Not surprisingly, then, there remains even today much to be learned of value to practitioners and their patients from efforts to integrate traditional and modern medical practices and health perspectives. Over the course of centuries, distinct medical systems have come into contact with one another to varying degrees and with different results. The movement of peoples over time and space, such as through trade, have continually shaped and reshaped practices, beliefs, goals, expectations, institutions, and the very roles signified by categories such as “patients” and “practitioners.” Few medical systems are “islands” unto themselves; interaction, change, appropriation, and a host of (positive, negative, or neutral) “symbiotic” relations mark historic and emergent exchanges among the world’s multiple medical systems and traditions, which this chapter discusses.

Though some doctors in various parts of the world lack a sense of sophistication and/or finesse in their patient-doctor relations, they find creative ways to address the unique and complex cases of sexual assault that come into their examination room. Importantly, however, some doctors are seemingly unaware of the complex set of uses that potentiate gender-based violence (GBV), and in minimizing the problem, they offer few solutions, suggesting the need for support teams that consist of a variety of professionals: social workers, lawyers, activists, and nurses. This chapter presents cases that depict of how structural violence is located on the body, highlighting how institutions and support systems are inherently violence against women, deepening the culture and norms around GBV.

Disability is a global health crisis. About 15% of the world’s population or approximately one billion people are living with a disability – usually defined as a motor, sensory, speech, learning/developmental/intellectual impairment or chronic illness. Disability or mental illness can affect anyone, anytime. People in the developing world and women are more likely to experience disability; 80% of people with disabilities live in developing countries. Both the UN and the WHO have found that there is a higher representation of women among the world's disabled population. In this chapter, we use a close reading of secondary literature and a collection of open-ended interviews of disabled Indonesian women to analyze the social, economic, and structural barriers women and girls with disabilities face when attempting to access healthcare in Indonesia. We use an interdisciplinary global disability studies approach that engages with the ways in which social class or caste, gender, ethnicity, language, and religion affect the lived experiences of girls and women in South and East Asia, and more specifically in Indonesia.

Mothers, fathers, and family and community members eagerly await the birth of a newborn baby the world over. Nearly 260 babies were born every minute in 2017, approximately 135 million births in total for the year. Although often a time of great joy for families, the first month of life is the most vulnerable of a child's life, with an estimated 2.6 million babies dying before reaching the 28^th day of life in 2016, approximately 2% of all newborn babies. Within the first month of life, the first week and especially the first day are the most dangerous times. This chapter discusses a variety technologies—both low- and high-tech—for improving newborn survival and health.

Antimicrobials are perhaps the greatest public health gain ever of humankind. As 2000 approached, many claimed penicillin to be the greatest discovery of the millennium; commercially available only from the early 1940s, the drug had already saved an estimated 200 million lives. Currently, however, the emergence and spread of multidrug-resistant pathogens threatens to reverse these benefits, and experts believe we are in the dawn of a post-antibiotic era. The global projections are alarming: AR infections may cause 10 million deaths/year and lead all causes of mortality by 2050. Similar to other pressing global issues, the burden of AR is inequitably distributed, with 90% of AR infections occurring in Asia and Africa. This chapter discusses various forces, natural and anthropogenic, that contribute to AR, and how successful containment demands coordinated efforts from environmental, behavioral, and medical scientists, to public health educators and leaders in agricultural and international policy.

Everyone will be impacted by oral disease at some point in life. Dental caries (tooth decay) is the most widespread chronic disease worldwide, impacting nearly 100% of adults and 60-90% of school children. In addition, about 30% of people aged 65-74 have no natural teeth, and severe periodontal disease impacts 15-20% of middle aged (35-44 years) adults globally. These staggering statistics demonstrate evidence of significant oral health neglect across the general population. This chapter discusses the challenges and solutions to improving oral health in low- and middle-income countries.

Electronic waste (e-waste) is a rising global environmental and health inequity issue. Rapid and excessive manufacture and use of electronics is causing global e-waste buildup. While there is an opportunity to recover important and/or expensive resources (e.g., recovery of plastic, copper, gold, and platinum) via recycling, these discarded electronics contain many hazardous contaminants including heavy metals (e.g., lead, chromium, copper, mercury, nickel, zinc) and organic compounds (e.g., halogenated flame retardants). Each of these chemicals has been linked with adverse health effects i.e., respiratory diseases, impairment of central nervous systems, carcinogenesis, and others. Because proper and safe e-waste recycling is expensive, informal recycling abounds, and illegal flows of e-waste (~ 60-90% of globally produced e-waste) occur from high to low- and middle-income countries (LMICs). The informal repair and recycling of electronic devices in LMICs often occur without implementing proper protective measures for the workers or their environment. Commonly, e-waste repair/recycling workers are from poor and marginalized populations and in many cases, represent highly susceptible groups, such pregnant women and children. In this chapter, we discuss how the technological advancement of the electronics field has given rise to a worldwide problem.

The landscape of access to essential medicines changes drastically across national boundaries. Inequity is severe, yet, difficult to capture accurately. Those who manage pharmaceutical supply chains rely on measures like number of pharmacies per capita, availability of essential medicines and number of pharmaceutical personnel per capita to get an estimate of the spread of this inequity. These metrics are very important in making policy level decisions on pharmaceutical spending, pharmaceutical procurement, pharmaceutical distribution, education, infrastructure, and personnel structuring. But what do these metrics mean to the consumer? How do people's health or quality of life compare in locations with starkly different indicators? This chapter provides an overview of the distribution of and access to essential medicines.

Worldwide, improving health literacy is a compelling need. Health literacy is the degree to which individuals have the capacity to obtain, synthesize and understand basic health information and processes needed to make appropriate health decisions. The use of code speak and inadequate communication about taboo subjects undermines efforts to understand basic health information and services. The interrelationship between serious illness, dying, death and fear influences how diagnoses and prognoses are understood, whether or not and how treatment is delivered. Clear communication taking cognizance of cultural and societal characteristics will optimize understanding about death/ dying/ illness. It is essential for helping people who have serious illnesses to make meaningful choices when they are nearing death. This chapter describes the imperative to have a clear understanding of the best practices in different cultural settings to meet the needs of the dying in addressing death at individuals’ level of comfort.

Our understanding of the information contained within our genomes (our DNA) is revolutionizing the way we consider personal and public health and well-being, as well as our concepts of race, ancestry, and identity. At the same time, we are at risk of exacerbating existing health and socioeconomic disparities by limiting the voices that are part of the conversations addressing the impact of genomic data. This chapter is a call to action – to recognize the importance of genomic information across disciplines and to promote an understanding of that importance across societies – a call for broad-based genomic literacy.

Media coverage of contemporary civil wars convey the public health consequences of violence, but also veil the reasons for and extended consequence of brutality. Because of civil wars and the violence they engender, public health systems degrade, access to basic needs such as food and clean water declines, and people are forced from their homes and into refugee camps where infectious diseases easily spread. These consequences of civil war significantly affect the lives of noncombatant populations, degrading their health and reducing their lifespans at both individual and population levels. Yet, the most direct and often brutal consequence of civil conflict for civilian populations comes in the form of directly targeting noncombatant populations with atrocious violence. This chapter discusses the unintuitive yet “rational” thinking and acts of combatants, and their resultant effects.

Approximately 36.7 million people are living with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) and another 1.8 million are infected every year. As one of the biggest global health challenges, HIV attracts attention from researchers, government and non-government organizations (NGOs), and the pharmaceutical industry to discover better drugs/vaccines, stop the spread of the disease, and promote adherence to treatment. Progress in fighting HIV/AIDS has been geographically uneven with a huge burden on low- and middle-income countries (LMICs). Antiretroviral drugs (ARV), the only known way to prevent AIDS-related death, can be costly and legally challenging to produce and distribute in LMICs. While cost of treatment has decreased, challenges in countering HIV include access, the quality of care, and prevention. In this chapter, we examine the geographic aspects of HIV, ARV production, and the role of international stakeholders. We argue that inclusive innovation involving multi-stakeholder and multidisciplinary collaboration is critical for halting and reversing the trends.

All regions of the global are experiencing unstable weather and climate conditions that are unfavorable for human wellbeing and which place a disproportionate burden on the poor, people of color, people who live in the global south and marginalized groups. Societal risks of extreme events are driven by carbon-based industrialization, the ways in which we design and build cities, the ways in which we manage extreme events and the differential ways socials groups develop capacity to cope with these events. This chapter describes how adaptive governance approaches and collaboration across professions of public health, engineering, architecture, urban planning, public works, emergency management, and meteorology can shape more resilient planning and design responses to extreme weather events.

Influencing physical, mental and social well-being, our home’s physical character is one of the most critical elements of our lives. Extensive research has proven the dramatic impact of poor living environments on health. Informal settlements, therefore, must be one of the extreme examples exposing the critical influence of architecture on health. Such poor living conditions are increasing worldwide, despite record levels of global wealth, advances in architecture and construction technologies, and urban development. This chapter postulates strategies for improving health and wellbeing amidst the constraints and challenges of informal settlements.

Traditional medicine (TM) as defined by the World Health Organization is “the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.” The objective of this study is to introduce more (TM) practices, central to the local culture, into the Peruvian public health system (PPHS) in Northern Peru. There are three interrelated parts: (1) to help public health service personnel understand the local TM practices of their patient population to supplement the therapy for these patients, (2) to inform the patient population that many of the herbal remedies of TM are the same as the medicines used in the allopathic medical tradition, (3) to promote conservation programs by educating the public and maintaining gardens of native medicinal plants. The work involves an interdisciplinary approach of ethnobotany, medical anthropology, microbiology and pharmaceutical sciences to improve patient satisfaction with public health services and to preserve local medicinal plants and the knowledge concerning their use.