Politics and policies: global health that traverses borders

Global health is intrinsically linked to the changing social, economic, cultural and political environment. Political leaders powerfully shape responses to global health, whether in a positive or negative way. Historically, when health issues have risen on the political agenda, they received greater media attention, and importantly, funding ñ the HIV/AIDS epidemic exemplifies this. The change in leadership in the World Health Organization under the new Director-General Dr Tedros offers new opportunities to advocate for issues such as universal health coverage, womenís health and rights, and climate health.

However, like many others, I find myself disappointed by the lack of political will to assist refugees and people seeking asylum. This is an ongoing problem, in Australia with the recent welfare cuts to refugees, described by Sibella Briedahl and Jasmine Sekhon (pg 2) , and internationally, with the plight of the stateless Rohingya people fleeing persecution in Myanmar, in a feature article by Jumaana Abdu (pg 50).

Over the past year, controversial policies have dominated public health discourse on both a national and international scale. Non-communicable diseases continues to rise on the agenda. A tax set to cut sugar-sweetened beverage consumption takes a step towards tackling Big Sugar in the footsteps of movements against Big Tobacco, as covered in a review by Saiuj Bhat (pg 29).

In Australia, we have also seen pushes for safe injecting rooms and pill testing at festivals. Does this reflect the global shift in attitudes from criminalisation towards harm minimisation, with decriminalisation in Portugal providing successful proof-of-concept? Raquel Maggacis overviews drug control approaches worldwide, arguing that Australia should adopt a harm minimisation approach (pg 34).

Global health does not obey borders, and health policies have far-reaching effects. Infectious diseases certainly require no passport to spread from country to country, and Madeleine Marsland and Dunya Tomic highlight the importance of strong regional surveillance systems and prevention strategies (pg 38) Moreover, so long as one child has polio, all countries remain at risk, as described by Jeanine Hourani (pg 19). However, polio eradication in Pakistan, one of the last remaining polio-endemic countries, is incredibly complex due to political instability and competing agendas.

Local policies certainly have broader international consequences, and Keyur Doolabh and Emily Feng-Gu explore issues around commercial surrogacy such as exploitation in countries where surrogacy is cheaper or poorly regulated (pg 10). Similar to drug control approaches, a harm minimisation approach may offer a better alternative to regulate processes and protect the rights of parents and children.

Other contentious topics in Australia include the Adani coal mine and the postal vote for same sex marriage. These will have significant implications both now and in the future. With the recent postal vote, the mental health and wellbeing of LGBTIQA+ people could not be of more relevance. However, as Salwa Barmaky and Alex Lee write, LGBTIQA+ people also face barriers in access to healthcare, including discrimination from the medical profession itself (pg 5).

Aboriginal and Torres Strait Islander people also experience discrimination within the health care system, as Narawi Foley-Boscott explains (pg 44). So what then is the way forward for such issues? Both authors emphasise the importance of educating medical professionals to be culturally sensitive, to be open to learning, and to be aware of the structural factors that contribute to discrimination.

John Evan Morgan (pg 21) argues that the Adani coal mine endangers our health and the environment and is a poor investment for tax-payers. It hinders Australia’s ability to fulfil its global commitments under the Paris Agreement to reduce carbon emissions and temperature rises.

Divestment offers a solution to climate change: take money away from the fossil fuel industry. We, as medical societies and the future medical profession, have an important role to add to this social movement, as thoughtfully argued by Tara Kannan (pg 17). The title of her article, “Turning up the heat”, captures the energy that connects the articles in this issue, a panoramic range of contemporary and controversial issues. It calls on us to take action and to challenge the paradigm of seeing health as purely a biomedical issue, but one inherently connected to regional and international social and political forces.

As medical students, we are well-placed to educate and upskill ourselves to contribute to global health in the future. Attend conferences (Australian Indigenous Doctors Association, pg 44 , World Congress of Public Health, pg 47.) Take elective placements in developing countries, and prepare yourself with pre-departure training (Nicholas Snels, pg 26 ). As yourself, what can we do about these global health issues? (Helena Qian, pg 54)

One of the statements that left a lasting impression on me from this yearís Global Health Conference was from the AMSA Global Health Chair, Liz Bennett: “It is not enough to be inspired… We do not have the luxury of apathy and you cannot afford to waste time thinking that you are too small to make a difference.” (pg 52).

I am continually amazed and grateful to the incredible work of the authors, editorial team, peer reviewers and Advisory Board. It has been a privilege and a half to lead Vector Journal this year and hope that this issue inspires you and challenges you to take action.

Carrie Lee

Editor-in-chief, 2017

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