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

The Sky’s No Limit

Issue 11 Volume 1
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