The Sky’s No Limit

Editor’s Note

Of the many things that come to mind when one thinks about global health, an astronaut is probably not high on the list. The front cover of this first issue of Vector for 2017 is not what we would conventionally expect of a global health journal. And yet, that is precisely the message that this issue conveys ñ the limitless diversity that global health has come to represent. We are living in an increasingly globalised world, with greater wealth and inequality we have ever encountered. We have made remarkable progress over the past few decades on the frontier of global health, including increased vaccination and access to treatment for diseases such as HIV. However, the agenda is now shifting to focus on new and emerging challenges.

Undoubtedly, healthcare in a global context is intrinsically connected to the political, social and cultural phenomena that define todayís world. The rise to power of the United States President Donald Trump raises serious questions and concerns about the future of global health, with his controversial approaches and perspectives towards climate change, refugees and migrants, as well as sexual and reproductive health. Owen Burton (p 2) provides a thought-provoking commentary on these issues, and urges Australia to consider our future potential role in leading an alternative direction rather than following the direction set by the US.

War and conflict, political stability and human rights also intersect with global health issues, as we see with the distressing increase in targeted attacks on health care facilities, Michael Wu (p 18) offers an insightful perspective into the situation of medical neutrality in conflict zones. In addition to man-made crises, natural disasters also pose a threat to human health and health care systems, with mental health implications a particular concern deserving attention, as discussed by Rose Brazilek (p 32).

Climate change is the greatest challenge we are facing in the global health arena. Personal experiences and commentary are provided by Erica Longhurst (p 8).

Noncommunicable diseases (NCDs) account for a substantial proportion of the global burden of disease. We are reminded by Charlotte OíLeary (p 14) that we need to question and redefine the approach we take towards this issue, to ensure that womenís health is not limited to reproductive health concerns, but a holistic approach over the entire life course, including addressing the risk factors and burden of NCDs specific to women and girls.

Yet whilst our focus often turns to issues ìabroadî, there is much to be addressed in global health on a local level. Health promotion amongst key populations in Australia is a particular topic of interest. A comprehensive review article by Alec Hope (p 29) describes issues regarding the promotion of HIV pre-exposure prophylaxis amongst Aboriginal gay and bisexual men in Australia. Migrant women in Australia also have lower rates of cervical cancer screening; the factors and interventions to address this issue are explored in a review article by Archana Nargendiram (p 36).

The recent health policy ìNo Jab No Play / No Jab No Payî also raises the issue of vaccination scepticism and conscientious objection, a concerning phenomenon in Australia as well as worldwide. A commentary by Elissa Zhang (p 5) provides an interesting overview of historical events like the Cutter Incident (involving the polio vaccine) and common concerns held by ëanti-vaxxersí.

With so much happening in global health, it is understandable for the general public, and particularly young people, to feel disenfranchised or disempowered. We even become desensitised and apathetic to the problems; such as conflict, mass displacement and natural disasters; that we are constantly exposed to in the media. Patrick Walker calls on us to remember the human side to the tragedies that we see, but also to promote tolerance and understanding with people who hold different views to our own (p 11).

An interview by Ashley Wilson-Smith with NASA astronaut, paediatrician and internist Professor David Hilmers (p 26) provides a window into his vast experiences in resource-poor settings, including recently in the Ebola crisis, and the interview reinforces that global health is not always what we expect it to be. Professor Hilmers is also one of our Advisory Board members, a new initiative aimed at strengthening the academic standard and longevity of Vector Journal.

There is a growing community of medical students who share a passion for global health. (Indeed, they are attending conferences around the world, including at Doctors for the Environment Australia (Belle Woody, p47) and with the IFMSA in Montenegro (p44)!) Unlike other medical specialities that have a clear career pathway, global health is a blank canvass. It is hard to define, and that lends a huge amount of potential ñ global health can be anything that you want it to be. There is ìno limitî in that sense!

I believe that the contents of this issue speak to the diversity of global health. Not only does it bring attention to some of the greatest challenges, it also celebrates the developments in research, collaboration and policies that pave the way towards new and creative solutions. We hope this issue engages you, inspires you, and challenges your ideas and assumptions about global health. I am incredibly grateful to the Vector Committee, to all of our authors and contributors, to the Advisory Board, AMSA Global Health and many other supporters.

Dear Reader, let Vector be a platform for you to launch beyond the horizon into global health.

Carrie Lee, Vector Editor-in-Chief 2017

Correspondance: carie.lee@amsa.org.au

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