global health research questions

Social Science Research Topics for Global Health and Wellbeing

Table of contents.

Open Philanthropy strives to help others as much as we can with the resources available to us. To find the best opportunities to help others, we rely heavily on scientific and social scientific research.

If you know of any research that touches on these questions, we would welcome hearing from you. At this point, we are not actively making grants to further investigate these questions. It is possible we may do so in the future, though, so if you plan to research any of these, please email us .

Land Use Reform

Open Philanthropy has been making grants in land use reform since 2015. We believe that more permissive permitting and policy will encourage economic growth and allow people to access higher-paying jobs. However, we have a lot of uncertainty about which laws or policies would be most impactful (or neglected/tractable relative to their impact) on housing production.

• Why we care: We think that permitting speed might be an important category to target, but have high uncertainty about this. 
• What we know: There are a number of different studies of the effects of changes in zoning/land use laws (e.g. see a summary here in Appendix A), but we’re not aware of studies that attempt to disentangle any specific changes or rank their importance. We suspect that talking to advocates (e.g. CA YIMBY) would be useful as a starting point.
• Ideas for studying this: It seems unlikely that there have been “clean” changes that only affected a single part of the construction process, but from talking to advocates, it seems plausible that it would be possible to identify changes to zoning codes that primarily affect one parameter more than others. It also seems plausible that this is a topic where a systematic review, combining evidence from many other studies, would be unusually valuable.
• Why we care: We are highly uncertain about how to best encourage more construction, and thus about where to target our grants.
• What we know: there have been many recent changes to permitting requirements, such as the California ADU law that requires cities to respond to permit requests within 60 days and a new law in Florida that requires cities to respond to permit requests quickly or return permitting fees. This blog post by Dan Bertolet at Sightline predates those changes, but is the best summary we’ve seen on the impacts of permitting requirements.
• Ideas for studying this: one might compare projects that fall right below or above thresholds for permitting review (e.g. SEPA thresholds in Washington state), and try to understand how much extra delay projects faced as a result of qualifying for review. It could also be valuable to analyze the effects of the Florida law (e.g. a difference-in-difference design looking at housing construction in places that had long delays vs. short delays prior to the law passing).
• Why we care: Currently, estimates of this value are typically made at the level of the metro area, but it seems plausible that we should be differentiating more – e.g. putting higher values on units built in Manhattan relative to those built in Westchester.
• What we know: there’s a lot of work on the gradient of land/house prices with regards to transit costs across metro areas, but we aren’t aware of work that explicitly tries to estimate within-metro differences ( in the vein of Card, Rothstein, and Yi (2023) , for example) .
• Ideas for studying this: it should be possible to use similar designs looking at moves at a more granular level (e.g. rather than defining effects at the metro level, use changes in distance-weighted job availability). There may also be ways to directly use the land price gradient to estimate this (though in general that will also reflect amenity values).
• Why we care: Some people have proposed that a land value tax could encourage land redevelopment and reduce the economic inefficiency of taxation, but we do not know how well this reflects the real-world impact of land value taxes.
• What we know: Land value taxes have been used in some Pennsylvania cities, and in some countries outside the US. There has also been increasing interest in implementing a land value tax in other places (e.g. this FT editorial ). See here for many more arguments and references related to land value taxation.
• Ideas for studying this: one could use a difference-in-difference design looking at when cities adopt a land value tax (or a split value tax) and examine changes in construction or other outcomes (e.g. volume of land transactions). Alternatively, one could also try a border regression discontinuity looking at differences in land transactions or other metrics at the border between a place that implements a land value tax and one that does not.

Treatments now potentially within reach may extend the human lifespan and improve quality of life. We aim to support tractable and cost-effective research on the world’s most burdensome diseases , including cardiovascular disease, infectious diseases, malaria, and others.

• Why we care: Open Philanthropy makes many grants focused on South Asian air quality . However, we still have a lot of uncertainty about the impacts of air pollution. One potentially important variable is the type of pollutant; it would be important for our grantmaking to know if some forms of pollution were much more impactful to reduce than others.
• What we know: We know that the components of PM 2.5 pollution can vary substantially by location. There has been some associational work done on this in the US context, but we are more interested in areas with high baseline PM 2.5 levels.
• Ideas for studying this: there is some existing data on how the components of PM 2.5 pollution vary across India. This could be linked with mortality data for associational studies. One could also use policy changes that changed the makeup of particulate emissions in a certain area as a natural experiment.
• Why we care: Open Philanthropy has made some grants attempting to influence public health regulation. We are interested in knowing how successful other philanthropists have been when making similar grants, and are particularly interested in knowing the effects of Bloomberg’s anti-tobacco advocacy, which we see as one of the most focused (and promising) programs of its type.
• What we know: there has been substantial research on the effects of tobacco policy, but we are not aware of any work that focuses specifically on the effect of Bloomberg’s investments.
• Ideas for studying this: some of Bloomberg’s grantmaking in tobacco is public ; one could use a variety of approaches to assess the impact of those grants (e.g. a synthetic control).
• Why we care: we have made grants on reducing lead exposure in low-income countries in the past and are likely to make more in the future. These grants are made assuming that lead affects both health and income, but we are quite uncertain about the magnitude of the effect of either, especially on health (where we think there is less data). Better estimates of the effect of lead on health would reduce the level of uncertainty around the cost-effectiveness of these grants.
• What we know: according to epidemiological (observational) studies , lead has negative impacts on cardiovascular health (see a helpful systematic review here ). However, there is limited causal evidence on the impacts of lead on cardiovascular disease in humans; our primary evidence comes from a study that leverages exposure to NASCAR races to determine changes in ischemic heart disease in the elderly, but we don’t know much about chronic exposure and are reluctant to rely heavily on a single study.
• Why we care: Open Philanthropy invests in vaccines for a variety of illnesses, with the primary (though not exclusive) goal of reducing mortality. Having better estimates for how properties of vaccines translate to demand and eventual health impact will help us prioritize when to support “good” leads in clinical trials vs. hold out longer for “great” ones.
• What we know: the efficacy of vaccines for different diseases varies considerably, and improved technologies can lead to more promising candidates even for diseases where one or more products are already available.
• Ideas for studying this: one could interact the efficacy of a given year’s vaccine (see data here for example) with propensity to get the flu vaccine to determine how this changed flu dynamics. (Though data from South Asia or sub-Saharan Africa would be even better.)
• Why we care: Much of Open Philanthropy’s grantmaking in global health R&D is focused on preventing malaria in high-risk populations (as are several charities recommended by GiveWell, with whom we work closely on global health). However, we have little causal evidence on the long-run effects of having had malaria, on either health or income. Thus, we do not have a good sense of the true (long-run) value of preventing malaria.
• What we know: a Mendelian study found that the likelihood of stunting increases with each malaria infection.
• Ideas for studying this: Mendelian randomization is a technique that looks at people with different genes to determine the causal impact of genes on observable outcomes. Being heterozygous for the sickle cell variant is symptomless but protective against malaria. Thus, those with sickle cell trait are less likely to get malaria and can be compared against those without the trait to understand the long-run impacts of malaria.
• Why we care: Open Philanthropy is interested in cost-effectively improving health. Fractional dosing has the potential to lower cost and expand coverage of vaccines. If we had better evidence on this topic, OP could know in which cases (if any) to advocate for more fractional dosing.
• What we know: a fractional dose for yellow fever and flu appeared to be non-inferior, but fractional dosing for polio was less successful.
• Ideas for studying this: we are not aware of any systematic review of fractional vaccine trials, but many such trials have been run. Studying this topic could involve simply examining data from past trials, rather than running new trials.
• What we know: as GBD covers all deaths and DALYs in the world, the team behind it necessarily spends limited time researching any one cause of DALYs. While GBD revisions attempt to address issues with previous estimates, we believe that there may still be substantial errors.
• Ideas for studying this: one could look for sharp changes in burden figures between the current and previous GBD studies, or examine a particular cause of death in detail and compare one’s own estimates to those generated by the GBD at different levels of age or geographic aggregation. 
• Why we care: new medications and medical technologies can substantially improve disease burdens and make treating or eliminating an illness more cost-effective. However, different countries adopt technologies at different rates; we are interested in knowing why. Open Philanthropy might then be able to make grants to encourage adoption of particularly promising technologies in underserved areas.
• What we know: it seems that patents, price regulation , and market structure affect drug adoption.
• Ideas for studying this: follow up on the approach in Kyle (2007) . One could extend her estimates to estimate the diffusion of FDA-approved drugs globally via patent filings and then look at predictors of diffusion: disease burden, GDP per capita, price controls, language (English vs. not), and path dependency (whether the same companies sell to the same countries repeatedly).
• Why do we care: Open Philanthropy tries to cost-effectively improve health and income. Migration is often considered to be one of the best ways to improve income; for instance, a person moving from a low-income country to a high-income country might raise their income by a factor of 50. We have previously made grants in both international and internal migration, and are interested in knowing whether there are underutilized migration channels whereby migrants might substantially increase their income. Our understanding is that aging populations are causing some HICs to offer more work visas than they previously offered, but that the uptake of these visas is poorly understood (and may be quite low).
• What we know: there are some international borders that do not require authorization for labor migration (e.g. within the EU, or between India and Nepal). At least one such border includes a low-income country (India/Nepal — India’s per capita GDP is over twice that of Nepal’s), but as far as we are aware, there is no database of such borders.
• Ideas for studying this: we think valuable descriptive papers could gather information on the relative usage levels of different work visas (in HICs or MICs) that could be accessible to people from LMICs, or on migration paths that don’t have caps on work visas (such as India-Nepal). Limiting to the largest HICs for ease of initial study (e.g. US, Japan, Germany, France, UK) would probably still be very valuable.
• Why we care: education may be one of the best ways to increase long-run income. However, most education studies focus only on a small number of treated students; it is less clear what the general equilibrium effects are (that is, effects across an entire city/region/nation). These are important in understanding how valuable education is in raising wages — and if Open Philanthropy should consider education interventions as a cost-effective way of improving income.
• What we know: this question has been examined in both Indonesia and India , but re-examination of these findings has made them seem less robust . In addition, we continue to be surprised that there are so few studies on how large schooling expansions affect wages.
• Ideas for studying this: one might use other large-scale expansions of schooling, such as Ghana’s free senior high school program or the Kenyan schooling expansion studied in Mbiti & Lucas (2012) .
• Why we care: we think that economic growth is likely to be very important, but it isn’t clear how best to produce higher growth rates through philanthropic funding. One idea would be to increase the supply of highly trained policymakers, who might be able to influence policy that affects many people.
• What we know: we’re not aware of work trying to measure the impact of policy training programs, such as the masters program at the Williams Center for Development Economics or the MPA ID at Harvard.
• Ideas for studying this: if you could get access to the admissions data for a program like one of the above examples, you could compare people who were nearly admitted to those who were actually admitted to see whether the programs have an effect on career trajectories. This wouldn’t prove anything directly about growth, but would provide evidence that the programs have some counterfactual effect.

Science and Metascience

• Why we care: many of Open Philanthropy’s decisions are based on social scientific work. As such, we have a vested interest in this work being reliable and replicable. Unreliable or non-replicable work might lead us to make weaker, less impactful funding decisions.
• What we know: the peer review process does not seem to weed out papers with signs of p-hacking , but pre-registration may reduce publication bias .
• Ideas for studying this: one might consider the effects of efforts like the AEA pre-analysis plan registry or the Institute for Replication .
• Why we care: we think that scientific progress is hugely important to growth and health advances. One issue in current science is that scientists spend a huge amount of time on high-stakes grant applications instead of doing science (and that the applications may be excessively long relative to what’s necessary for identifying the best science). If this is true, advocating for changes to the grantmaking process might be a high-leverage opportunity for Open Philanthropy.
• What we know: descriptive data suggests that scientists now spend a huge amount of their time applying for grants, and that spending more time on a grant application does not increase the chance of success.
• Why we care: as above, we believe scientific progress is important to growth and health advances. Therefore, we are interested in making sure scientific funding processes work as well as possible to maximize the amount of impact per federal research dollar. If there are improvements that can be made to how science is funded, Open Philanthropy might fund advocacy for such improvements.
• What we know: Carson, Graff Zivin and Shrader (2023) find that reviewers would prefer to prioritize papers with more variance in review scores, and that if this preference were taken into account it would likely lead to different projects being funded. A review of the literature suggests that peer review of applications can identify some of the most promising ideas, but the level of signal is fairly weak.
• Ideas for studying this: one might look at data on past applications and see how the set of funded projects would have differed given the use of different selection criteria, such as max score or random selection (among projects over a certain level of quality). Alternatively, one could randomize within a specific RFP (so that some proposals are selected under different criteria) or randomize across RFPs (so that you can also see how various selection criteria affect the kinds of applications received). The Institute for Progress is currently studying this in collaboration with NSF.
• Why we care: a large share of the value of academic research comes from its ultimate impact on human decisions, but ultimate decision-makers are usually not academics who are well equipped to read and understand individual academic studies. Open Philanthropy would like to know how decision-makers use academic research, and whether there might be improvements to systematic reviews such that decision-makers could be better informed.
• What we know: We know remarkably little. This study argues that academic citation networks are significantly impacted by literature reviews, and suggests that they help to organize and orient fields. This study finds that policymakers respond more to sets of studies finding the same thing across multiple settings than to individual studies – but the results are mixed.
• Ideas for studying this: we think the rollout of evidence clearinghouses is likely pseudorandom across topics, such that measuring their impact may be tractable with difference-in-difference methods. For example, one could study outcomes across different disease categories as the Cochrane collective rolled out new systematic reviews, starting when it was founded in 1993.
• Why we care: Open Philanthropy has occasionally run prize competitions to try and generate useful knowledge. See, for example, our Cause Exploration Prizes and AI Worldviews Contest . We may run more prizes in the future; as such, we would like to know how likely a prize competition is to gather useful information and how to best attract talented entrants.
• What we know: a 2010 paper argues that proportional prize contests produce more total achievement, but another paper is less prescriptive about ideal prize structure.
• Ideas for studying this: Innocentive has done a lot of prize-like competitions; they might be able to share some useful retrospective data.
• Why we care: we believe that rigorous social scientific research is key to identifying the most impactful and cost-effective interventions and policies in developing countries, some of which we may go on to fund. We are interested in knowing cost-effective ways to produce more of said research. We have funded a new IPA office previously, and might fund more such work in the future if we had more evidence about its impact on research, both overall and specific to the target country.
• What we know: Matt Clancy, who leads our grantmaking in innovation policy , coauthored an article on the extent to which research done in one place can be usefully applied in other places. Obstacles to this include different places having different underlying conditions, as well as evidence that policymakers prefer research conducted in their own countries. The article’s bibliography includes many relevant sources.
• Ideas for studying this: Getcher and Meager (2021) collected data on the openings of developing-country offices for NGOs interested in conducting research within said countries. One could use difference-in-difference design to look at how research production (and RCT production in particular) changes when a new office opens – does it cause an increase in total research in those countries? Is there evidence of substitution from non-RCTs to RCTs? Substitution from neighboring countries to the country with a new office? Do new offices tend to produce research on different topics from existing offices (e.g. focusing more on financial inclusion instead of agriculture)?
• Why we care: Open Philanthropy is often interested in influencing policy. Therefore, we want to learn about what is most likely to influence policymakers’ decision-making. We are quite uncertain what types of evidence are most likely to influence policymakers, or in what venues this evidence is likely to be presented.
• What we know: Policy documents cite a relatively small number of scientific publications. In one study, policymakers do not seem to respond to strength of evidence in deciding what to implement; in another , policymakers cared more about external validity than internal validity; in another , policymakers cared substantially about sample size.
• Ideas for studying this: what evidence do central banks (and other governmental institutions) cite most often, and how does this differ from academic citation practices? Is there additional evidence on what types of evidence best persuade policymakers or are most likely to get cited as part of regulatory decisions? E.g. how do citations from a government agency (e.g. the FTC ) compare to citations in academic work on similar topics?
• Why we care: Open Philanthropy wants to raise income levels across society. Our previous work has suggested that public spending on R&D is one of the most effective ways for governments to increase their countries’ income levels. We are thus interested in knowing how the level of public spending on R&D is set, and if there are tractable ways that Open Philanthropy might advocate for this to be increased.
• What we know: there is relatively little information available about the process of setting national-level priorities, but there is some data available about agenda-setting within NIH.
• Ideas for studying this: we aren’t sure of the best approach. Focusing on particular periods of growth in R&D spending and producing case studies might yield evidence that could be explored in a quantitative way later.

Global Development

• Why we care: Open Philanthropy makes grants in global aid advocacy and is interested in increasing both the amount and efficacy of rich countries’ foreign aid. We are interested to know how much influence agency leadership has on the distribution of aid in order to benchmark how much change we should expect over different time frames.
• What we know: we’re not aware of any work addressing this.
• Ideas for studying this: when a new Administrator is appointed, how much does the distribution of aid change across different categories? Ideally, it would be interesting to compare USAID (which is known to have many Congressional earmarks) to other countries with more flexible aid budgets.
• Why we care: we believe that sustained economic growth is one of the best ways to improve health and income. We are interested in knowing how to obtain this. Growth diagnostics are a common tool for trying to select growth-friendly policies, but we are uncertain how valuable this tool is. We are interested in knowing what additional information is gained from using growth diagnostics – how useful they are, and the extent to which this suggests that countries face common vs. distinct growth challenges.
• What we know: while there are many papers on growth diagnostics, we are not aware of any evaluation of growth diagnostics across countries.
• Ideas for studying this: taking a large body of growth diagnostics from a common source (e.g. the World Bank or Harvard Growth Lab ); using automated methods to measure the similarity of recommendations, compare how similar they are, and determine whether that similarity varies by base GDP (e.g. do similarly rich/poor countries have similar diagnostics?) or region (e.g. do Central Asian countries have similar diagnostics?).
• Why we care: many social changes — such as encouraging migration or expanding one’s moral circle to include farmed animals — are often covered in widely-viewed media channels. We are interested in knowing if such coverage changes minds.
• What we know: media seems to be able to influence decision-making (as with fertility in Brazil ). Blackfish decreased attendance at Seaworld and decreased the value of the company that owned the park.
• Ideas for studying this: we think there is more scope to study individual documentaries or shows (did Waiting for Superman affect views on education? Did Bowling for Columbine affect views on guns?). One could also conduct meta-analyses, looking across a variety of documentaries or shows to look for common effects.
• Why we care: we believe that non-competes are likely to reduce labor mobility and decrease innovation .
• What we know: there are some surveys on the prevalence of non-competes outside the US, but few are recent or comprehensive. Outside of recent work in Italy , we have little information about how prevalent non-competes are, or how harmful they are in labor markets outside the US.
• Ideas for studying this: one could gather information on the prevalence of non-competes and their effects on wages in other large labor markets, like Germany, France, and Spain.

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• Published: 07 April 2020

What is global health? Key concepts and clarification of misperceptions

Report of the 2019 GHRP editorial meeting

• Xinguang Chen 1 , 2 ,
• Hao Li 1 , 3 ,
• Don Eliseo Lucero-Prisno III 4 ,
• Abu S. Abdullah 5 , 6 ,
• Jiayan Huang 7 ,
• Charlotte Laurence 8 ,
• Xiaohui Liang 1 , 3 ,
• Zhenyu Ma 9 ,
• Zongfu Mao 1 , 3 ,
• Ran Ren 10 ,
• Shaolong Wu 11 ,
• Nan Wang 1 , 3 ,
• Peigang Wang 1 , 3 ,
• Tingting Wang 1 , 3 ,
• Hong Yan 3 &
• Yuliang Zou 3  

Global Health Research and Policy volume  5 , Article number:  14 ( 2020 ) Cite this article

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The call for “W orking Together to Build a Community of Shared Future for Mankind” requires us to improve people’s health across the globe, while global health development entails a satisfactory answer to a fundamental question: “What is global health?” To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, in-depth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word “global” in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multi-country and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of “international health” by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of the Belt and Road Initiative proposed by China.

“Promoting Health For All” can be considered as the mission of global health for collective efforts to build “a Community of Shared Future for Mankind” first proposed by President Xi Jinping of China in 2013. The concept of global health continues to evolve along with the rapid development in global health research, education, policymaking, and practice. It has been promoted on various platforms for exchange, including conferences, workshops and academic journals. Within the Editorial Board of Global Health Research and Policy (GHRP), many members expressed their own points of view and often disagreed with each other with regard to the concept of global health. Substantial discrepancies in the definition of global health will not only affect the daily work of the Editorial Board of GHRP, but also impede the development of global health sciences.

To promote a better understanding of the term “ global health” , we convened a special session in the 2019 GHRP Editorial Board Meeting on the 7th of July at Wuhan University, China. The session started with a review of previous work on the concept of global health by researchers from different institutions across the globe, followed by free brainstorms, questions-answers and open discussion. Individual participants raised many questions and generously shared their thoughts and understanding of the term global health. The session was ended with a summary co-led by Dr. Xinguang Chen and Dr. Hao Li. Post-meeting efforts were thus organized to further synthesize the opinions and comments gathered during the meeting and post-meeting development through emails, telephone calls and in-person communications. With all these efforts together, concensus have been met on several key concepts and a number of confusions have been clarified regarding global health. In this editorial, we report the main results and conclusions.

A brief history

Our current understanding of the concept of global health is based on information in the literature in the past seven to eight decades. Global health as a scientific term first appeared in the literature in the 1940s [ 1 ]. It was subsequently used by the World Health Organization (WHO) as guidance and theoretical foundation [ 2 , 3 , 4 ]. Few scholars discussed the concept of global health until the 1990s, and the number of papers on this topic has risen rapidly in the subsequent decade [ 5 ] when global health was promoted under the Global Health Initiative - a global health plan signed by the U.S. President Barack Obama [ 6 ]. As a key part of the national strategy in economic globalization, security and international policies, global health in the United States has promoted collaborations across countries to deal with challenging medical and health issues through federal funding, development aids, capacity building, education, scientific research, policymaking and implementation.

Based on his experience working with Professor Zongfu Mao, the lead Editors-in-Chief, who established the Global Health Institute at Wuhan University in 2011 and launched the GHRP in 2016, Dr. Chen presented his own thoughts surrounding the definition of global health to the 2019 GHRP Editorial Board Meeting. Briefly, Dr. Chen defined global health with a three-dimensional perspective.

First, global health can be considered as a guiding principle, a branch of health sciences, and a specialized discipline within the broader arena of public health and medicine [ 5 ]. As many researchers posit, global health first serves as a guiding principle for people who would like to contribute to the health of all people across the globe [ 5 , 7 , 8 ].

Second, Dr. Chen’s conceptualization of global health is consistent with the opinions of many other scholars. Global health as a branch of sciences focuses primarily on the medical and health issues with global impact or can be effectively addressed through global solutions [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Therefore, the goal of global health science is to understand global medical and health issues and develop global solutions and implications [ 7 , 9 , 15 , 17 , 18 , 19 ].

Third, according to Dr. Chen, to develop global health as a branch of science in the fields of public health and medicine, a specialized discipline must be established, including educational institutions, research entities, and academic societies. Only with such infrastructure, can the professionals and students in the global health field receive academic training, conduct global health research, exchange and disseminate research findings, and promote global health practices [ 5 , 15 , 20 , 21 , 22 , 23 ].

Developmentally and historically, we have learned and will continue to learn global health from the WHO [ 1 , 4 , 24 , 25 ]. WHO’s projects are often ambitious, involving multiple countries, or even global in scope. Through research and action projects, the WHO has established a solid knowledge base, relevant theories, models, methodologies, valuable data, and lots of experiences that can be directly used in developing global health [ 26 , 27 , 28 , 29 ]. Typical examples include WHO’s efforts for global HIV/AIDS control [ 13 , 30 , 31 , 32 ], and the Primary Healthcare Programs to promote Health For All [ 33 , 34 ].

The definition of Global Health

From published studies in the international literature and our experiences in research, training, teaching and practice, our meeting reached a consensus-global health is a newly established branch of health sciences, growing out from medicine, public health and international health, with much input from the WHO. What makes global health different from them is that (1) global health deals with only medical and health issues with global impact [ 35 , 5 , 36 , 10 , 14 , 2 ] the main task of global health is to seek for global solutions to the issues with global health impact [ 7 , 18 , 37 ]; and (3) the ultimate goal is to use the power of academic research and science to promote health for all, and to improve health equity and reduce health disparities [ 7 , 14 , 15 , 18 , 38 ]. Therefore, global health targets populations in all countries and involves all sectors beyond medical and health systems, although global health research and practice can be conducted locally [ 39 ].

As a branch of medical and health sciences, global health has three fundamental tasks: (1) to master the spatio-temporal patterns of a medical and/or health issue across the globe to gain a better understanding of the issue and to assess its global impact [ 40 , 41 , 42 , 43 ]; (2) to investigate the determinants and influential factors associated with medical and health issues that are known to have global impact [ 15 , 40 , 41 , 42 , 43 ]; and (3) to establish evidence-based global solutions, including strategies, frameworks, governances, policies, regulations and laws [ 14 , 15 , 28 , 38 , 44 , 45 , 46 , 47 ].

Like public health, medicine, and other branches of sciences, global health should have three basic functions : The first function is to generate new knowledge and theories about global health issues, influential factors, and develop global solutions. The second function is to distribute the knowledge through education, training, publication and other forms of knowledge sharing. The last function is to apply the global health knowledge, theories, and intervention strategies in practice to solve global health problems.

Understanding the word “global”

Confusion in understanding the term ‘global health’ has largely resulted from our understanding of the word “global”. There are few discrepancies when the word ‘global’ is used in other settings such as in geography. In there, the world global physically pertains to the Earth we live on, including all people and all countries in the world. However, discrepancies appear when the word “global” is combined with the word “health” to form the term “global health”. Following the word “global” literately, an institution, a research project, or an article can be considered as global only if it encompasses all people and all countries in the world. If we follow this understanding, few of the work we are doing now belong to global health; even the work by WHO are for member countries only, not for all people and all countries in the world. But most studies published in various global health journals, including those in our GHRP, are conducted at a local or international level. How could this global health happen?

The argument presented above leads to another conceptualization: Global health means health for a very large group of people in a very large geographic area such as the Western Pacific, Africa, Asia, Europe, and Latin America. Along with this line of understanding, an institution, a research project or an article involving multi-countries and places can be considered as global, including those conducted in countries involved in China’s Belt and Road Initiative (BRI) [ 26 , 48 , 49 , 50 , 51 ]. They are considered as global because they meet our definitions of global health which focus on medical and health issues with global impact or look for global solutions to a medical or health issue [ 5 , 7 , 22 ].

One step further, the word ‘global’ can be considered as a concept of goal-setting in global health. Typical examples of this understanding are the goals established for a global health institution, for faculty specialized in global health, and for students who major or minor in global health. Although few of the global health institutions, scholars and students have conducted or are going to conduct research studies with a global sample or delivered interventions to all people in all countries, all of them share a common goal: Preventing diseases and promoting health for all people in the world. For example, preventing HIV transmission within Wuhan would not necessarily be a global health project; but the same project can be considered as global if it is guided by a global perspective, analyzed with methods with global link such as phylogenetic analysis [ 52 , 53 ], and the goal is to contribute to global implications to end HIV/AIDS epidemic.

The concept of global impact

Global impact is a key concept for global health. Different from other public health and medical disciplines, global health can address any issue that has a global impact on the health of human kind, including health system problems that have already affected or will affect a large number of people or countries across the globe. Three illustrative examples are (1) the SARS epidemic that occurred in several areas in Hong Kong could spread globally in a short period [ 11 ] to cause many medical and public health challenges [ 54 , 55 ]; (2) the global epidemic of HIV/AIDS [ 13 ]; and the novel coronavirus epidemic first broke out in December 2019 in Wuhan and quickly spread to many countries in the world [ 56 ].

Along with rapid and unevenly paced globalization, economic growth, and technological development, more and more medical and health issues with global impact emerge. Typical examples include growing health disparities, migration-related medical and health issues, issues related to internet abuse, the spread of sedentary lifestyles and lack of physical activity, obesity, increasing rates of substance abuse, depression, suicide and many other emerging mental health issues, and so on [ 10 , 23 , 36 , 42 , 57 , 58 , 59 , 60 ]. GHRP is expecting to receive and publish more studies targeting these issues guided by a global health perspective and supports more researchers to look for global solutions to these issues.

The concept of global solution

Another concept parallel to global impact is global solution . What do we mean by global solutions? Different from the conventional understanding in public health and medicine, global health selectively targets issues with global impact. Such issues often can only be effectively solved at the macro level through cross-cultural, international, and/or even global collaboration and cooperation among different entities and stakeholders. Furthermore, as long as the problem is solved, it will benefit a large number of population. We term this type of interventions as a global solution. For example, the 90–90-90 strategy promoted by the WHO is a global solution to end the HIV/AIDS epidemic [ 61 , 62 ]; the measures used to end the SARS epidemic is a global solution [ 11 ]; and the ongoing measures to control influenza [ 63 , 64 ] and malaria [ 45 , 65 ], and the measures taken by China, WHO and many countries in the world to control the new coronaviral epidemic started in China are also great examples of global solutions [ 66 ].

Global solutions are also needed for many emerging health problems, including cardiovascular diseases, sedentary lifestyle, obesity, internet abuse, drug abuse, tobacco smoking, suicide, and other problems [ 29 , 44 ]. As described earlier, global solutions are not often a medical intervention or a procedure for individual patients but frameworks, policies, strategies, laws and regulations. Using social media to deliver interventions represents a promising approach in establishment of global solutions, given its power to penetrate physical barriers and can reach a large body of audience quickly.

Types of Global Health researches

One challenge to GHRP editors (and authors alike) is how to judge whether a research study is global? Based on the new definition of global health we proposed as described above, two types of studies are considered as global and will receive further reviews for publication consideration. Type I includes projects or studies that involve multiple countries with diverse backgrounds or cover a large diverse populations residing in a broad geographical area. Type II includes projects or studies guided by a global perspective, although they may use data from a local population or a local territory. Relative to Type I, we anticipate more Type II project and studies in the field of global health. Type I study is easy to assess, but caution is needed to assess if a project or a study is Type II. Therefore, we propose the following three points for consideration: (1) if the targeted issues are of global health impact, (2) if the research is attempted to understand an issue with a global perspective, and (3) if the research purpose is to seek for a global solution.

An illustrative example of Type I studies is the epidemic and control of SARS in Hong Kong [ 11 , 67 ]. Although started locally, SARS presents a global threat; while controlling the epidemic requires international and global collaboration, including measures to confine the infected and measures to block the transmission paths and measures to protect vulnerable populations, not simply the provisions of vaccines and medicines. HIV/AIDS presents another example of Type I project. The impact of HIV/AIDS is global. Any HIV/AIDS studies regardless of their scope will be global as long as it contributes to the global efforts to end the HIV/AIDS epidemic by 2030 [ 61 , 62 ]. Lastly, an investigation of cardiovascular diseases (CVD) in a country, in Nepal for example, can be considered as global if the study is framed from a global perspective [ 44 ].

The discussion presented above suggests that in addition to scope, the purpose of a project or study can determine if it is global. A pharmaceutical company can target all people in the world to develop a new drug. The research would be considered as global if the purpose is to improve the medical and health conditions of the global population. However, it would not be considered as global if the purpose is purely to pursue profit. A research study on a medical or health problem among rural-to-urban migrants in China [ 57 , 58 , 60 ] can be considered as global if the researchers frame the study with a global perspective and include an objective to inform other countries in the world to deal with the same or similar issues.

Think globally and act locally

The catchphrase “think globally and act locally” presents another guiding principle for global health and can be used to help determine whether a medical or public health research project or a study is global. First, thinking globally and acting locally means to learn from each other in understanding and solving local health problems with the broadest perspective possible. Taking traffic accidents as an example, traffic accidents increase rapidly in many countries undergoing rapid economic growth [ 68 , 69 ]. There are two approaches to the problem: (1) locally focused approach: conducting research studies locally to identify influential factors and to seek for solutions based on local research findings; or (2) a globally focused approach: conducting the same research with a global perspective by learning from other countries with successful solutions to issues related traffic accidents [ 70 ].

Second, thinking globally and acting locally means adopting solutions that haven been proven effective in other comparable settings. It may greatly increase the efficiency to solve many global health issues if we approach these issues with a globally focused perspective. For example, vector-borne diseases are very prevalent among people living in many countries in Africa and Latin America, such as malaria, dengue, and chikungunya [ 45 , 71 , 72 ]. We would be able to control these epidemics by directly adopting the successful strategy of massive use of bed nets that has been proven to be effective and cost-saving [ 73 ]. Unfortunately, this strategy is included only as “simple alternative measures” in the so-called global vector-borne disease control in these countries, while most resources are channeled towards more advanced technologies and vaccinations [ 16 , 19 , 74 ].

Third, thinking globally and acting locally means learning from each other at different levels. At the individual level, people in high income countries can learn from those in low- and mid-income countries (LMICs) to be physically more active, such as playing Taiji, Yoga, etc.; while people in LMICs can learn from those in high income countries to improve their hygiene, life styles, personal health management, etc. At the population level, communities, organizations, governments, and countries can learn from each other in understanding their own medical and health problems and healthcare systems, and to seek solutions for these problems. For example, China can learn from the United States to deal with health issues of rural to urban migrants [ 75 ]; and the United States can learn from China to build three-tier health care systems to deliver primary care and prevention measures to improve health equality.

Lastly, thinking globally and acting locally means opportunities to conduct global health research and to be able to exchange research findings and experiences across the globe; even without traveling to another country. For example, international immigrants and international students present a unique opportunity for global health research in a local city [ 5 , 76 ]. To be global, literature search and review remains the most important approach for us to learn from each other besides conducting collaborative work with the like-minded researchers across countries; rapid development in big data and machine learning provide another powerful approach for global health research. Institutions and programs for global health provides a formal venue for such learning and exchange opportunities.

Reframing a local research study as global

The purpose of this article is to promote global health through research and publication. Anyone who reads this paper up to this point might already be able to have a clear idea on how to reframe his/her own research project or article to be of global nature. There is no doubt that a research project is global if it involves multiple countries with investigators of diverse backgrounds from different countries. However, if a research project targets a local population with investigators from only one or two local institutions, can such project be considered as global?

Our answer to this question is “yes” even if a research study is conducted locally, if the researcher (1) can demonstrate that the issue to be studied or being studied has a global impact, or (2) eventually looks for a global solution although supported with local data. For example, the study of increased traffic accidents in a city in Pakistan can be considered as global if the researchers frame the problem from a global perspective and/or adopt global solutions by learning from other countries. On the other hand, a statistical report of traffic accidents or an epidemiological investigation of factors related to the traffic accidents at the local level will not be considered as global. Studies conducted in a local hospital on drug resistance to antibiotics and associated cost are global if expected findings can inform other countries to prevent abuse of antibiotics [ 77 ]. Lastly, studies supported by international health programs can be packaged as global simply by broadening the vision from international to global.

Is Global Health a new bottle with old wine?

Another challenge question many scholars often ask is: “What new things can global health bring to public health and medicine?” The essence of this question is whether global health is simply a collection of existing medical and health problems packaged with a new title? From our previous discussion, many readers may already have their own answer to this question that this is not true. However, we would like to emphasize a few points. First, global health is not equal to public health, medicine or both, but a newly emerged sub-discipline within the public health-medicine arena. Global health is not for all medical and health problems but for the problems with global impact and with the purpose of seeking global solutions. In other words, global health focuses primarily on mega medical and health problems that transcend geographical, cultural, and national boundaries and seeks broad solutions, including frameworks, partnerships and cooperation, policies, laws and regulations that can be implemented through governments, social media, communities, and other large and broad reaching mechanisms.

Second, global health needs many visions, methods, strategies, approaches, and frameworks that are not conventionally used in public health and medicine [ 5 , 18 , 22 , 34 ]. They will enable global health researchers to locate and investigate those medical and health issues with global impact, gain new knowledge about them, develop new strategies to solve them, and train health workers to deliver the developed strategies. Consequently, geography, history, culture, sociology, governance, and laws that are optional for medicine and public health are essential for global health. Lastly, it is fundamental to have a global perspective for anyone in global health, but this could be optional for other medical and health scientists [ 40 , 41 ].

Global Health, international health, and public health

As previously discussed, global health has been linked to several other related disciplines, particularly public health, international health, and medicine [ 3 , 5 , 7 , 18 , 22 ]. To our understanding, global health can be considered as an application of medical and public health sciences together with other disciplines (1) in tackling those issues with global impact and (2) in the effort to seek global solutions. Thus, global health treats public health sciences and medicine as their foundations, and will selectively use theories, knowledge, techniques, therapeutics and prevention measures from public health, medicine, and other disciplines to understand and solve global health problems.

There are also clear boundaries between global health, public health and medicine with regard to the target population. Medicine targets patient populations, public health targets health populations in general, while global health targets the global population. We have to admit that there are obvious overlaps between global health, public health and medicine, particularly between global health and international health. It is worth noting that global health can be considered as an extension of international health with regard to the scope and purposes. International health focuses on the health of participating countries with intention to affect non-participating countries, while global health directly states that its goal is to promote health and prevent and treat diseases for all people in all countries across the globe. Thus, global health can be considered as developed from, and eventually replace international health.

Challenges and opportunities for China to contribute to Global Health

To pursue A Community with a Shared Future for Mankind , China’s BRI , currently involving more than 150 countries across the globe, creates a great opportunity for Chinese scholars to contribute to global health. China has a lot to learn from other countries in advancing its medical and health technologies and to optimize its own healthcare system, and to reduce health disparities among the 56 ethnic groups of its people. China can also gain knowledge from other countries to construct healthy lifestyles and avoid unhealthy behaviors as Chinese people become more affluent. Adequate materials and money may be able to promote physical health in China; but it will be challenging for Chinese people to avoid mental health problems currently highly prevalent in many rich and developed countries.

To develop global health, we cannot ignore the opportunities along with the BRI for Chinese scholars to share China’s lessons and successful experience with other countries. China has made a lot of achievements in public health and medicine before and after the Open Door Policy [ 49 , 78 ]. Typical examples include the ups and downs of the 3-Tier Healthcare Systems, the Policy of Prevention First, and the Policy of Putting Rural Health as the Priority, the Massive Patriotic Hygiene Movement with emphasis on simple technology and broad community participation, the Free Healthcare System for urban and the Cooperative Healthcare System for rural residents. There are many aspects of these initiatives that other countries can emulate including the implementation of public health programs covering a huge population base unprecedented in many other countries.

There are challenges for Chinese scholars to share China’s experiences with others as encountered in practice. First of all, China is politically very stable while many other countries have to change their national leadership periodically. Changes in leadership may result in changes in the delivery of evidence- based intervention programs/projects, although the changes may not be evidence-based but politically oriented. For example, the 3-Tier Healthcare System that worked in China [ 79 , 80 ] may not work in other countries and places without modifications to suit for the settings where there is a lack of local organizational systems. Culturally, promotion of common values among the public is unique in China, thus interventions that are effective among Chinese population may not work in countries and places where individualism dominates. For example, vaccination program as a global solution against infectious diseases showed great success in China, but not in the United States as indicated by the 2019 measles outbreak [ 81 ].

China can also learn from countries and international agencies such as the United Kingdom, the United States, the World Health Organization, and the United Nations to successfully and effectively provide assistance to LMICs. As China develops, it will increasingly take on the role of a donor country. Therefore, it is important for Chinese scholars to learn from all countries in the world and to work together for a Community of Shared Future for Mankind during the great course to develop global health.

Promotion of global health is an essential part of the Working Together  to Build a Community of Shared Future for Mankind. In this editorial, we summarized our discussions in the 2019 GHRP Editorial Board Meeting regarding the concept of global health. The goal is to enhance consensus among the board members as well as researchers, practitioners, educators and students in the global health community. We welcome comments, suggestions and critiques that may help further our understanding of the concept. We would like to keep the concept of global health open and let it evolve along with our research, teaching, policy and practice in global health.

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We would like to thank those who had provided their comments for the improvement of the manuscript.

The work is funded by the journal development funds of Wuhan University.

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Xinguang Chen, Hao Li, Xiaohui Liang, Zongfu Mao, Nan Wang, Peigang Wang & Tingting Wang

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Chen XG wrote the manuscript. LI H organized the meeting, collecting the comments and editing the manuscript. Lucero-Prisno DE integrated all the comments together. Abdullah AS, Huang JY, Laurence C, Liang XH, Ma ZY, Ren R, Wu SL, Wang N, Wang PG and Wang Tt all participated in the discussion and comments of this manuscript. Laurence C and Liang XH both provided language editing. The author(s) read and approved the final manuscript

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Chen, X., Li, H., Lucero-Prisno, D.E. et al. What is global health? Key concepts and clarification of misperceptions. glob health res policy 5 , 14 (2020). https://doi.org/10.1186/s41256-020-00142-7

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Defining global health: findings from a systematic review and thematic analysis of the literature

Melissa salm.

1 Anthropology, University of California Davis, Davis, California, USA

2 University of California Davis, Davis, California, USA

Mairead Minihane

Patricia conrad.

3 VM:PMI, University of California Davis, Davis, California, USA

Associated Data

No data are available. All data relevant to the study are included in the article or uploaded as supplementary information. n/a.

Introduction

Debate around a common definition of global health has seen extensive scholarly interest within the last two decades; however, consensus around a precise definition remains elusive. The objective of this study was to systematically review definitions of global health in the literature and offer grounded theoretical insights into what might be seen as relevant for establishing a common definition of global health.

A systematic review was conducted with qualitative synthesis of findings using peer-reviewed literature from key databases. Publications were identified by the keywords of ‘global health’ and ‘define’ or ‘definition’ or ‘defining’. Coding methods were used for qualitative analysis to identify recurring themes in definitions of global health published between 2009 and 2019.

The search resulted in 1363 publications, of which 78 were included. Qualitative analysis of the data generated four theoretical categories and associated subthemes delineating key aspects of global health. These included: (1) global health is a multiplex approach to worldwide health improvement taught and pursued at research institutions; (2) global health is an ethically oriented initiative that is guided by justice principles; (3) global health is a mode of governance that yields influence through problem identification, political decision-making, as well as the allocation and exchange of resources across borders and (4) global health is a vague yet versatile concept with multiple meanings, historical antecedents and an emergent future.

Extant definitions of global health can be categorised thematically to designate areas of importance for stakeholders and to organise future debates on its definition. Future contributions to this debate may consider shifting from questioning the abstract ‘what’ of global health towards more pragmatic and reflexive questions about ‘who’ defines global health and towards what ends.

Key questions

What is already known.

• Debate around a common definition of global health has seen extensive scholarly interest within the last two decades; despite the abundance of literature, ambiguity still persists around its precise definition.
• No systematic reviews with thematic analysis have been conducted to explore extant definitions of global health nor to contribute to a comprehensive definition of global health.

What are the new findings?

• We compile and thematically analyse extant definitions of global health and propose grounded theoretical insights into what might be seen as relevant for establishing a common definition of global health moving forward.
• The need for a clear and concise definition of global health has the highest stakes in the domain of global health policy governance.

What do the new findings imply?

• Stakeholders tend to define the ‘what’ of global health: its spaces, objects and practices. Our findings suggest that the debate around definition should shift to more pragmatic and reflexive questions regarding ‘who’ defines global health and towards what ends.

Debate around a common definition of global health (GH) has seen extensive scholarly interest within the last two decades. In 2009, a widely circulated paper by Koplan and colleagues aimed to establish ‘a common definition of global health’ as distinct from its derivations in public health (PH) and international health (IH). 1 They rooted the definition of PH in the mid-19th century social reform movements of Europe and the USA, the growth of biological and medical knowledge, and the discipline’s emphasis on population-level health management. Similarly, they traced the evolution of IH back to its colonial roots in hygiene and tropical medicine (TM) through to the mid-20th century with its geographic focus on developing countries. GH, they argued, would require a distinctive definition of its own to be ‘more than a rephrasing of a common definition of PH or a politically correct updating of international health’. Their intervention built on prior research noting confusion and overlap among the three terms and thus a need to carefully articulate the important differences between them. 2–5 Additional stakeholders have since elaborated varied definitions of GH, yet consensus around its precise definition remains elusive.

To determine how GH is presently defined and to identify whether a common conceptualisation has been established, we conducted a qualitative systematic literature review (SLR) of the GH literature between 2009 and 2019. SLRs are a methodology used ‘to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question’. 6 Unlike unsystematic narrative reviews, SLRs use formal, repeatable and transparent, procedures for identifying, evaluating and interpreting available research, thus ensuring robust coverage of the current literature while reducing the biased presentation of available evidence. 7–9 Medical researchers and policy-makers have long relied on SLRs because they integrate and critically evaluate current knowledge to support decisions about important issues. 10 However, very few SLRs exploring aspects of GH have yet been published, 11–13 and no SLRs focusing on extant definitions of GH have been conducted. This paper fills that gap by exploring the thematic components of extant definitions and thereby contributes towards a comprehensive definition of GH.

Aims and objectives

The aim of this review is: (a) to examine how GH has been defined in the literature between 2009 and 2019, (b) to systematically analyse the core thematic categories undergirding extant definitions of GH and (c) to offer grounded theoretical insights into what might be seen as relevant for establishing a common definition of GH.

Aiming to capture definitions of GH in literature between 2009 and 2019, our team conducted a systematic review of the peer-reviewed literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines ( figure 1 ). 14 The sequential steps of our review process included the following.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of citation analysis and systematic literature review. 14

Search strategy: identify papers and relevant databases

Search technique.

The terms ‘global health’ AND ‘define’ OR ‘definition’ OR ‘defining’ were queried when they appeared in the title, abstract or keyword of studies. Published studies were identified through comprehensive searches of electronic databases accessible through the authors’ university library system (Web of Science, Scopus, Embase, PubMed, EBSCO). Citation tracking through Google Scholar was also completed.

Study selection criteria

Articles published in international peer-reviewed journals, including conference papers, book chapters and editorial material, were reviewed. The studies included were written in English and published between 2009 and 2019. The year 2009 was chosen as a starting point because this is the year in which Koplan et al published ‘Towards a Common Definition of Global Health’. For this review, the team excluded news articles, theses, book reviews and published papers that were not written in English.

Assessment strategy: appraise which papers to include in review

The protocol-driven search strategy required that articles included in the review must: (a) contain the keywords ‘global health’ and ‘definition’ and/or ‘define’; (b) be in the English language and (c) be published between 2009 and 2019. The number of articles containing these keywords was recorded, and all the titles uncovered in the search were imported into Mendeley, a software for managing citations. Duplicates were identified and removed, after which abstracts were screened to assess eligibility against the inclusion criteria. Full-text articles were retrieved for those that met the inclusion criteria and three team members read a designated number of the articles selected for full review. To be included in the data extraction sheet, each article needed to: (a) focus on and explicitly name GH, (b) offer an original definition or description of GH and/or (c) cite an already-existing definition of GH. Articles that mentioned the query terms without any relation to these requirements (eg, did not provide a definition of GH or descriptive data to support interpretations of a GH definition) were excluded. Assessment for relevance and content was conducted by two investigators who reviewed all identified articles independently. Disagreements were resolved by consensus with a third investigator.

Synthesis strategy: extract the data

Based on the research goals, the team designed an initial coding template in Google Sheets as a method of documentation, with the following coding variables: author, title, typology, definition(s), conclusions and conceptual dimensions. To achieve a high level of reliability, the review team open-coded the same five articles, compared their coding experiences, and reconciled differences before adopting a final coding template and evenly dividing the remaining articles to be analysed. Extracted data included the type of study or research paradigm of each publication, the location and disciplinary affiliation of each study based on the contact information of the corresponding author, definitions and descriptions of GH and specialised dimensions of GH. Whenever articles contained more than one definition or description of GH, those items were organised line-by-line under the author on the data extraction sheet.

Analysis strategy: analyse the data

The team conducted thematic analysis of the data to understand how GH has been defined since 2009. Our approach to thematic analysis was based on the guidelines described by Thomas and Harden 15 and further informed by principles in grounded theory. 16 Our strategy consisted of three main stages: Initial Coding—remaining open to all possible emergent themes indicated by readings of the data; 16 17 Focused Coding—categorising the data inductively based on thematic similarity at the level of description 17 and finally, Theoretical Coding—integrating thematic categories into core theoretical constructs at a higher level of analysis. 18

In the first cycle, open descriptive codes were generated (eg, differences between PH and IH, GH education requirements, social justice values) directly from the definitions and descriptions of GH found in the articles. Individual sentences defining or describing GH were treated as unique line items on the data extraction sheet and coded accordingly in order to generate a range of ideas and information on which to build.

In the second cycle, a focused thematic analysis was carried out to identify general relationships and patterns among definitions in the literature and to confirm significant links between the openly coded data. Thematic phrases (eg, GH is multidisciplinary, GH promotes equity) were developed and reapplied to coded definitions on the data extraction sheet. Team members wrote and attached analytic memos to each coded datum—reflecting on emergent patterns and further ‘codeweaving’, 18 which is a term for charting possible relationships among the coded data. At this stage, additional coding techniques were utilised. Attribute coding was applied as a management technique for logging information about the characteristics of each publication. 19 Data segments coded in this manner were extracted from the main data extraction form and reassembled together in a separate Google Sheet for further analysis. The team also coded extracted definitions of GH by type: (a) original definition, (b) cited definition, (c) original description to track possible relationships between citational practices and developments in the conceptualisation and definition of GH.

In the third cycle, thematic phrases were ordered according to frequency then commonality and abstracted for overriding significance into theoretical categories. At this stage, the conceptual level of analysis was raised from description to a more abstract, theoretical level leading to a grounded theory. This resulted in the construction of four thematic categories, which are presented below with their supporting subthemes.

Patient and public involvement

Patients and public were not directly involved in this review; we used publicly available data for the analysis.

The search strategy retrieved bibliographic records for 1363 papers. The assessment strategy resulted in the elimination of 1237 papers after the removal of duplicates. Consequently, 78 papers were subjected to our strategies of synthesis (data extraction) and analysis.

Characteristics of study

A variety of studies were included in this review. The majority (27) were commentaries, viewpoints or debates. 1 20–48 Twenty-four were grouped as review/overview articles. 45–68 There were 25 original research articles, of which 13 used qualitative methods, 69–81 11 used mixed-methods 82–92 and one 93 used quantitative data from a survey to proffer definitions of GH. Two studies included in the review were book chapters. 94 95

The typologic, geographic and disciplinary distribution of the studies in this review are shown in table 1 . Most studies were authored in North America (40), 1 20–31 39–41 43 46 47 50 54–58 61 63 66 68 70 73 74 76–80 83 84 86 87 89–91 94 followed by European countries (29), 22 26 28 32 34–38 42 44 45 48 51 52 59 62 64 65 67 71 75 82 85 88 92 93 95 96 countries in Asia (2), 33 72 Latin America and the Caribbean (2), 60 81 and New Zealand (1). 20 Disciplinary fields represented in our sample included health (56), 20 22–27 30–32 34–40 42 43 45–51 54–56 58–61 63–69 72 74 75 77–79 82–84 86 88–91 93 95 law, social and cultural professions (19), 1 20 28 29 33 41 44 52 53 57 62 70 71 73 76 80 81 87 92 94 and education (2). 20 31

Summary of characteristics of retrieved publications

Attributes of definitions

All 78 studies under review defined, described and/or cited extant definitions of GH. The 34 papers shown in table 2 included descriptive definitions of GH that were formulated distinctly by its authors, that is, they were presented as original and without direct reference to other definitions.

How global health has been defined by academics since 2009

Several scholars engaged directly with the Koplan et al definition of GH 1 to stipulate definitions of their own. For example, some authors proposed amendments to Koplan et al that would place greater emphasis on inequity reduction and the need for collaboration, 20 particularly with institutional partners from developing countries. 73 Others were more critical of the broad yet weak conceptual idealism 86 of Koplan et al and recommended detaching normative objectives from its definition, 26 such as the value-laden concept of equity, which could compromise the definition’s technical neutrality by rendering it ideological. 91 Other authors sought to analytically clarify the meaning of ‘the global’ 26 in the definition provided by Koplan et al , distinguish it more clearly from IH 78 or dispute their distinction between GH and PH. 27 Indeed, the impact of the definition of GH proposed by Koplan et al has been substantial. It was variously adopted by the Consortium of Universities for Global Health, 47 the Canadian government, 23 Global Health for Family Medicine, 89 the German Academy of Sciences 75 and the Chinese Consortium of Universities for Global Health. 77

In general, GH was defined as a term, 37 51 95 and in particular, an umbrella term 49 75 or a concept; 69 and more broadly as a zone 76 or field 32 48 91 94 or area of research and practice, 1 56 as an achievable goal, 50 an approach, 48 82 a set of principles, 45 83 an organising framework for thinking and action 96 or a collection of problems. 35 94 GH was frequently contrasted to IH 32 35 68 69 94 95 and PH, 20 21 31 32 35 or else seen as indistinguishably from PH and IH. 27 Additionally, several papers explicitly specified and subsequently defined certain dimensions of GH, such as ‘global health governance’ (GHG), 32 33 35 38 42 51 52 58 69 80 81 87 ‘global health diplomacy’ (GHD), 24 28 95 ‘global health education’, 36 39 46–49 59 70 74 75 77 78 82 89 93 ‘global health security’, 26 41 76 88 92 97 98 ‘global health network’, 41 81 ‘global health actor’, 52 ‘global health ethics’, 69 ‘global health academics’ 64 67 and ‘global health social justice’ 61 (see table 3 ).

Frequently defined facets of ‘Global Health’ with exemplary definitions

Grounded theory approach based on thematic analysis

Definitions and descriptions of GH were aggregated into nine thematic codes reflecting the contents and scope of GH definitions, the functionality of those definitions and/or perceptions about defining GH. Codes were: (1) GH is a domain of research, healthcare and education, (2) GH is multifaceted (disciplinary, sectoral, cultural, national), (3) GH is rooted in a commitment to equity, (4) GH is a political field comprising power relations, (5) GH is problem-oriented, (6) GH transcends national borders, (7) GH is determined by globalisation and international interdependence, (8) conceptually, GH is either similar or dissimilar to PH, IH and TM and (9) GH is perceived as definitionally vague.

These codes were grouped selectively into higher analytical categories or theoretical statements as grounded in the literature: (1) GH is a multiplex approach to worldwide health improvement and form of expertise taught and researched through academic institutions, (2) GH is an ethos (ethical orientation and appeal) that is guided by justice principles, (3) GH is a mode of governance that yields degrees of national, international, transnational and supranational influence through political decision-making, problem identification, the allocation and exchange of resources across borders, (4) GH is a polysemous concept with many meanings and historical antecedents, and which has an emergent future ( table 4 ).

Defining global health with grounded theory analysis—table of themes, code categories and quotes from text

IH, international health; PH, public health; TM, tropical medicine.

Theme: global health is a multiplex approach to worldwide health improvement taught and pursued through research institutions

Subtheme: gh is a domain of research, healthcare, education.

GH was repeatedly defined as an active field of knowledge production that is composed of the following key elements: research, education, training and practice related to health improvement. 1 20 21 23 32 33 35 38 40 44–49 52 55–58 61 63–69 72 74 75 77 78 80 82 90–92 94 Few authors defined GH as a new, independent discipline within the broader domain of medical knowledge, 17 33 38 46 63 74 80 82 90 and some outlined discipline-specific competencies that were considered integral to the definition of GH, at least in curriculum development; for example: clinical literacy, 80 medical humanities, 82 cross-cultural sensitivity, 33 38 46 59 63 80 90 experiential learning 47 and critical thinking skills. 72 82 Several authors defined GH as a diffuse arena of scholarship that spans an array of academic disciplines, including anthropology, engineering, law, agriculture and healthcare administration. 44 56 59 63–65 78 91 94 Others defined GH explicitly as a ‘transdiscipline’ that seeks to transcend the restricted gaze of any single discipline and consequently integrate knowledge from a variety of sources. 67 94 Several authors explicitly defined GH as a necessarily collaborative field. 1 20 22 24 36 43 45 47 57 61 63 68 77 78 80 91

Subtheme: GH is multifaceted (disciplinary, sectoral, cultural, national)

The prefix ‘multi-’ was consistently applied in definitions of GH to describe a perspective that focuses on the multitude of interrelated factors, dimensions, values and features that underpin health as well as efforts to improve and study it. There was broad agreement that multidisciplinarity is a defining characteristic of GH. 1 23 25 32–34 36 38 40 45–47 49 52 55–57 59 60 64–69 72 75 77 78 80 82 91 However, there was some debate whether multiple disciplines are always needed and beneficial—and therefore essential—to the definition of GH. 23 One author argued that the multidisciplinary nature of GH is precisely what differentiates it from PH and IH. 68 Although some claimed that GH, with its focus on social and economic determinants, is inherently ‘predisposed to include aspects of the liberal arts and social sciences’, 75 others critically observed that most GH educational opportunities still cater predominantly to medical students, 32 35 48 72 which suggests that greater efforts will be required to achieve multidisciplinarity in the field moving forward.

There was a correspondence between GH definitions citing multidisciplinarity and cultural competency. 32 33 38 48 49 56 78 82 90 Curiously, multisectorality was less frequently mentioned than multidisciplinarity in definitions of GH, though it was referenced in some papers. 20 22 43 52 66 83 86 95

Theme: global health is an ethical initiative that is guided by justice principles

Subtheme: gh is rooted in values of equity and social justice.

Equity and social justice were the two most commonly and explicitly referenced values undergirding GH definitions and goals. Equity was repeatedly framed as a ‘main objective’ 60 and core component of GH research and practice. 23 25 43 46 48 53 66 67 77 78 84 However, it remains unclear whether the authors in our sample share the same meaning of equity. Velji and Bryant defined equity broadly as ‘ensuring equal opportunities and resources to enable all people to achieve their fullest health potential’. 66 Meanwhile, others rooted their conceptualisation of equity more specifically in the principles of social justice 30 61 69 88 89 or the human rights concept of equality, 54 62 67 83 86 which asserts that ‘all people are equal in regard to dignity and rights, regardless of their origin and all biological, social or other specific differences’. 59 This postwar sensibility echoes the 1978 Alma Ata Declaration of ‘health for all’, 20 24 as well as a traditional humanitarian ideal, even if now associated with principles grounded in national and global security. 24 54 88

Occasionally, the terms ‘equity’ and ‘equality’ were used interchangeably, suggesting they possess a commonly shared valence and reciprocal relationship despite slight differences in signification. Whereas equity refers to the provision of resources and opportunity based on specific needs, equality connotes providing the same level of resources and opportunities for all. 86 Nevertheless, other scholars questioned whether equity or equality should be included in official definitions of GH, at all, 27 48 75 insofar as what counts as ‘equitable’ for one country may be different for another. 26 32 48

Theme: global health is a form of governance that yields national, international, transnational and supranational influence through political decision-making, problem identification, the allocation and exchange of resources across borders

Subtheme: gh is a political field comprising power relations at multiple scales.

Numerous papers defined GH as embedded within a political field comprising power relations at multiple scales. 20 22–24 26 28 29 31–33 35 41 42 45 48 51–54 56 58 60 63 66 70 72 76 79 87 95 ‘Political field’ refers here to a sphere of influence and jurisdiction wherein institutions determine governing modalities (eg, laws, policies, instruments) to assure a range of activities, such as determining priorities, coordinating stakeholders, regulating funding mechanisms, establishing accountability, allocating resources and providing access to health services for the general public. ‘Power relations’ refers to the capacity of institutions, individuals, instruments and ideas to affect the actions of others; and ‘at multiple scales’ refers to levels of analysis (ie, worldwide, regional, national, local, etc.).

Within the literature on GHG and GH security, authors argued the need for a universal definition of GH to shape policy frameworks that ensure compliance with IH law. 32 45 51 88 95 Here, it is important to note that the ability to shape GH policy is, itself, an exercise in power: some GH actors, defined as ‘individuals or organizations that operate transnationally with a primary intent to improve health’, 56 are more capacitated than others to impact the formulation of policies and amount of attention and resources that certain GH issues receive. 32 41 45 52 95 For example, several papers discussed how ‘GH actors’ like the World Bank and the WHO shaped discussions around the response to Ebola, leading to refined definitions of GHG 35 87 88 and GH security. 41 Similarly, definitions of GH in line with the 2015 United Nations Millennium Development Goals, were also commonly referenced, 25 35 45 51 reflecting the influence of certain GH actors on the conceptualisation of GH.

Subtheme: GH is determined by globalisation and international interdependence

Numerous authors linked interdependence and accelerating globalisation (the process of integrating governments and markets, and of connecting people worldwide) with the need for a cohesive definition of GH, particularly to address issues of governance. 24 32 35 45 68 88 GHG and GHD were outlined as two influential subdomains in which the interconnections between globalisation, foreign policy and international relations were viewed as indispensable to definitions of GH. Two articles quoted David P Fidler’s definition of GHG as ‘the use of formal and informal institutions, rules, and processes by states, intergovernmental organizations, and nonstate actors to deal with challenges to health that require cross-border collective action to address effectively’. 35 58 Elsewhere, GHD was described as ‘bringing together the disciplines of public health, international affairs, management, law and economics and focuses on negotiations that shape and manage the global policy environment for health’. 95

Subtheme: GH issues transcend national borders

Across several papers, we observed a common refrain that GH ‘crosses borders’ and ‘transcends national boundaries’. 1 20 23 42 45 52 60 67 68 74 Authors frequently described GH concerns as those exceeding the jurisdictional reaches of any individual nation-state alone. 34 42 45 51 52 54 77 95 One paper claimed that GH is ‘transnational by definition’, 74 and others characterised GH problems as those experienced transnationally. 20 32 48 50 68

Studies focusing on GH research and training frequently referenced specific diseases and health risks that ‘transcend national borders’ alongside parallel recommendations to include an international component in the development of GH curricula. 16 48 49 63 74 93 While crossing national borders to research and promote health for all is widely perceived as an historical condition for GH 24 that has led to GH’s emergence as an academic discipline, 63 several scholars argued that GH should also focus on domestic health disparities 1 27 38 46 and for local issues to be simultaneously understood as universal or worldwide 48 74 75 to the extent they may occur anywhere 22 and are almost always impacted by global phenomena. 56

Subtheme: GH is problem-oriented

Medical anthropologists, Arthur Kleinman and Paul Farmer, described GH as a collection of problems rather than a distinct discipline. 35 94 Several authors in our review delineated GH problems through identification of specific diseases, such as HIV/AIDS, malaria, TB, Zika and Ebola. 24 29 30 35 45 83 Lee and Brumme noted that it has become common for experts to define GH problems by identifying their objects, namely diseases, population groups and locations. 58 Indeed, some authors outlined GH problems as the set of challenges ‘among those most neglected in developing countries’, 86 among them: emerging infectious diseases and maternal and child health; 43 65 diabetes, cardiovascular disease and other noncommunicable diseases in ‘local’ communities 25 63 and even neurological disorders among refugees arriving in Europe. 93 How these types of object-based definitions of GH problems come to shape GH agendum is important to note.

Clark made a compelling argument against the definition of GH problems in terms of specific diseases, writing that such ‘medicalisation’ may ‘prove detrimental for how the world responds and resources actions designed to alleviate poor health and poverty, redress inequities, and save lives’. 72 Brada also argued against defining GH problems geographically and instead urged experts to consider how the processes by which GH and its quintessential spaces, namely ‘resource-limited’ and ‘resource-poor settings’, are actively constituted, reinforced and contested. 70 Several authors similarly suggested that focusing on the social, political, economic and cultural forces contributing to health inequity and diseases of poverty better captured the scope of GH problems than naming any particular set of diseases or places in the world. 33 43 56 58 69 72 73 86 92

Lack of consensus regarding what counts as a ‘true’ GH problem was linked to the lack of a clear and concise definition of GH. Indeed, several scholars argued that the current inability to define GH made it difficult for stakeholders to define precisely what the ‘problem’ is. 44 45 48 86 Furthermore, the diagnosis of GH problems determined what types of GH ‘solutions’ were proposed in response. For example, when GH problems were defined as universally shared and transnational, then cross-border solutions were developed; when GH issues were framed epidemiologically in terms of distributed risk, then actions targeting specific determinants and burdens were proposed. 1 20 23 67 68 92 When GH problems were framed as threats to inter/national security, strategies were formulated to protect borders, economies, health systems and to improve surveillance mechanisms. 41 45 54 76 80 88 When the problem of inequality drove definitions of GH, recommendations to alleviate poverty, food insecurity, poor sanitation, etc. were proposed. 32 53 60 72

Although Kuhlmann suggested that GH tends to over-prioritise problem-identification to the detriment of critical solution-oriented work, 31 our analysis suggests that the type, scope and quality of solutions proposed are contingent on the elaboration of problems. Similarly, Campbell wrote, ‘Unlike a science or an art, the field of global health is very much about providing solutions to current problems. As such, it would be short-sighted not to consider the causes of global health problems in order to better formulate the solutions. The causes ought to be included in a comprehensive and complete definition of the field’. 23

Theme: global health is a polysemous concept with historical antecedents and an emergent future

Subtheme: gh is conceptually dis/similar to ph, ih and tm.

GH was consistently traced back to and compared with PH, IH and TM. 1 20 27 32–34 43 57 69 71 75 84 86 88 Disagreement or confusion regarding the degrees of similarity and difference between these domains seemed to stem from a shared understanding that GH, in fact, evolved to a varying degree from each of these fields and does not, therefore, denote a clear-cut break with nor full-blown departure from any of them. 84 94

Several authors argued that the scope and scale of GH is distinct from PH. 1 20 32 69 71 Some argued that ‘public health is equated primarily with population-wide interventions; global health is concerned with all strategies for health improvement,’ including clinical care; 20 and that ‘public health acknowledges the state as a dominant actor, (while) global health recognizes the rise of other actors like international institutions’. 35 GH was also seen as placing a greater emphasis on multidisciplinarity and promoting a more expansive conceptualisation of ‘health’, itself, compared with PH. 69 Beyond the prevention of and response to biomedicalised health risks at the population level, Rowson defined GH as oriented towards the ‘underlying determinants of those problems, which are social, political and economic in nature.’ 32 It is questionable, however, to assume similar notions of health have not also been pursued in PH. Meanwhile, opposing views found GH and PH conceptually indistinguishable, 27 43 86 either as terms that could be used interchangeably, 95 or else as coconstitutive of one another, such that PH could be understood as a descriptive component of GH. 33 86

Differences between GH and IH echoed those drawn between GH and PH. For example, GH was characterised as more attentive to multidisciplinarity, while IH was said to implement a more limited biomedical approach to healthcare and health research. 1 69 95 Undergirding a major point of distinction between GH and IH was the belief that IH focuses on health problems in developing countries 1 22 32 43 45 48 54 83 86 93 and relies on ‘the flow of resources and knowledge from the developed to the developing world’, 32 whereas GH either is, or should be, more bidirectional. 1 45 84 In other cases, GH was described as comparable to IH, for example, when countries link GH efforts with development aid. 86 This is because the emphasis on delivering aid to poor countries reinforces an image of the world’s poor as needy subjects and, therefore, marks a continuation of IH and its sentiments under the guise of GH. 35

Finally, the field of TM was referenced to describe the evolutionary track of GH, particularly that GH is a modern-day product of the former. 20 25 57 69 75 84 A few authors critically pointed out that although GH has generally replaced TM and IH as terms embedded in histories of colonial power relations, many of the contemporary structures for governing and/or facilitating GH between countries today have remained largely the same, 25 48 54 62 suggesting that distinguishability between these terms too often occurs at the level of semantics.

Subtheme: GH is still vaguely defined

While GH was often described as a popular and well-established term, another key attribute repeated across the literature was its enduring vagueness. 23 25 26 31 33 43 45 48 52 62 74–77 81 86 Indeed, most papers commented on the term’s defiance of easy definition, its ambiguity and the lack of clarity regarding how people and organisations engaged in GH are using (or not using) the term to describe their interests. For example, Beaglehole and Bonita pointed out that research centres in low-income and middle-income countries are often engaged in GH issues but under other labels. 20 Some authors viewed the present lack of a clear and common definition as an obstacle endangering the coherence and maturation of the field. 33 35 45 For others, this indistinctness was thought to be precisely what gives GH such wide applicability, a certain degree of currency and political expediency. 45 76 81 86

A major concern cited was the lack of guidance for defining the term ‘global’ in GH. 26 34 43 48 75 As Bozorgmehr has outlined, the term is often used interchangeably within the GH community to mean ‘worldwide’, ‘everywhere’, ‘holistic’ and/or ‘issues that transcend national boundaries’. 48 This trend was noticeable within our review, as well. Engebretsen emphasised that GH ‘does not only allude to supranational dependency within the health field, but refers to a norm or vision for health with global ambitions’. 26 This view suggests that because the planet is populated by a multiplicity of positionings, perspectives and diverse world views, there can never be a truly a universal definition of ‘the global’ nor a global consensus around the definition of GH.

Finally, among studies that conducted original research into the definition of GH, several reported that study participants could not reach consensus on a definition. 52 74 75 77 Many thought it would be difficult if not impossible to arrive at a single, unified theoretical definition of GH, yet considered it important to formulate an operational definition of GH for guiding emerging activities related to GH. 23 45 77

This is the first study to systematically synthesise the literature defining GH and analyse the definitions found therein. All of the articles included in this study were published in peer-reviewed journals since 2009 indicating recent and steadfast interest in the topic of GH’s definition. This review examined GH definitions in the literature, and our thematic analysis focused on identifying recurrent themes across different definitions of GH.

Of the 78 articles included in this study, approximately one-third utilised empirical research methodologies to posit definitions of GH or else directly contribute towards the establishment of a common definition. Another one-third of papers summarised and discussed previously published definitions of GH (eg, reviews/overviews), while the remaining one-third suggested definitions of GH that were less grounded in analysis of empirical data than in the perspectives of its authors (eg, editorials, viewpoints). This systematic analysis indicated that the question of GH’s precise definition marks a point of controversy across fields of expertise. The variety of GH definitions posited by diverse experts in search of a common definition indicate that GH is multifaceted and polysemous.

In its broadest sense, GH can be defined as an area of research and practice committed to the application of overtly multidisciplinary, multisectoral and culturally sensitive approaches for reducing health disparities that transcend national borders. Indeed, it was most commonly defined across the literature in such general terms.

More specific definitions of GH were, of course, proposed by and considered valuable for many stakeholders in our review. Our analysis indicates that the precise definitions proposed by different experts were devised to serve particular functions. For example, narrow and concise definitions of GH were most frequently sought in the domains of governance and education, primarily for steering the development of policy frameworks and curricula, respectively. The imperative for an exact definition of GH in these subfields may be linked to bureaucratic demands for demarcating a technical term under which to classify specific activities, standardise certain functions, administer funds and direct workflow accordingly. It is also in this domain that authors most vociferously decried the absence of a unified and concise definition of GH, arguing this lack has led to ineffective initiatives, elusive methods for establishing accountability and instances of resource allocation based on ad hoc criteria—attractiveness to donors, public opinion, development agendum, foreign, economic or security policy priorities and so on—rather than via transparent mechanisms for adjudicating health need. 28 54 58 65 83 In contexts where health needs and upstream challenges were articulated, the lack of an agreed-upon definition oft impeded the policy process because stakeholders could not discern which GH issues among the multitude of different problems labelled as important were, in fact, the most pressing. 24 45 52 Because political indecision ramifies disproportionately for publics in countries where reliance on GH aid is a matter of life and death, establishing a clear definition of GH seems most crucial for the domain of governance.

We also found that detailed descriptions of GH’s specific conceptual and functional dimensions tended to reflect the specialisations or discipline-specific priorities of their authors. For example, definitions of GH stipulating the primacy of ‘cultural competency’ and ‘multidisciplinarity’ were more commonly proposed by interdisciplinary professionals in the literature on GH education than in journals of health policy, where definitions of GH were oriented more toward ‘security’ and ‘governance’ concerns. This suggests a correspondence between the subjective, experiential positions of the definers and the vocabulary they used to define or frame the need to define GH.

Unsurprisingly, we found that health professionals proposed the majority of definitions of GH in the literature. Additionally, the majority of publications and their authors were from higher income countries. Several authors in our review critically observed that GH has become institutionalised at a faster rate in higher income countries compared with lower and middle-income countries. 20 48 63 72 77 82 Their observations combined with our findings suggest that extant definitions of GH published in the literature or otherwise circulating in academic and professionalised spaces may unevenly reflect the interests and priorities of stakeholders from higher income countries. This suggests a need for greater diversity and inclusion in the debate on GH’s definition, as well as further reflexivity regarding who is defining GH, their means and motivations for doing so, and what these definitions put into action.

Interestingly, several articles published since 2019 have extended the debate on this topic of GH’s definition by directly engaging questions of geography and positionality: a recent commentary by King and Kolski defining GH ‘as public health somewhere else’ was met with pushback by those who argue that spatial definitions of GH are limited and limiting. 99–102

Limitations

To determine how GH is defined by experts in the literature, we ensured that the selection criteria developed for this study were broad enough to include a wide range of perspectives. Therefore, we included articles with varying degrees of evidentiary support, such as viewpoints, commentaries and editorials. Consequently, the results may be influenced by some of the primary researchers’ assumptions, projections, and biases. Backward citation tracking was used to add relevant articles to the review that had not been initially identified through database searching. This ensured that the review was exhaustive, however it also means that some conclusions drawn in the thematic analysis may have been influenced by this manual search strategy. By applying qualitative methods, this review provided a robust analysis of the thematic categories undergirding extant definitions of GH. A major limitation of this form of analysis is the extensive time required to develop and establish a code book and standardise the three coders’ use of the code book. However, this was deemed necessary to ensure consistency of judgement and intercoder reliability at each stage in the analysis. Another limitation of this study is that only articles written in English were included. To enhance the generalisability of results, future reviews should include data from non-English articles, especially if an inclusive, common definition of GH is to be achieved. Finally, this review was finalised prior to the emergence of the novel coronavirus. As such, future research should take into account new definitions of GH that emerge in light of the pandemic and lessons learnt.

Between 2009 and 2019, GH was most commonly defined in the literature in broad and general terms: as an area of research and practice committed to the application of multidisciplinary, multisectoral and culturally sensitive approaches for reducing health disparities that transcend national borders. More precise definitions exist to serve particular functions and tend to reflect the priorities of its definers. The four key themes that emerged from the present analysis are that GH is: (1) a multiplex approach to worldwide health improvement taught and researched through academic institutions; (2) an ethos that is guided by justice principles; (3) a mode of governance that yields influence through political decision-making, problem identification, the allocation and exchange of resources across borders and (4) a polysemous concept with historical antecedents and an emergent future. Findings from this thematic analysis have the potential to organise future conversations about which definition of GH is most common and/or most useful. Future discussions on the topic might shift from questioning the abstract ‘what’ of GH to more pragmatic and reflexive questions about ‘who’ defines GH and towards what ends.

Acknowledgments

Helpful comments by anonymous reviewers are acknowledged with thanks.

Handling editor: Seye Abimbola

Contributors: MS initiated and designed the project. MS, MA and MM contributed to the implementation of the research, to the collection of data, analysis of the results and to the writing of the manuscript. PC supervised the project and provided feedback on the manuscript.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement

Crosslisted as PSY 309

Research Methods in Global Health

Introduction to research methods through examination of a variety of methodological techniques in behavioral and social sciences and relevant to multidisciplinary GH research. Problem-based approach to practice identifying GH questions of interest, ways to operationalize and test them, including strengths and weaknesses of different approaches. Focus on discussing current GH issues, exploring questions and solutions, reading and evaluating published research and interpreting results. Skills include   identification of global health   problems, awareness   of contextual, behavioral,   and ethical     issues   involved, conceptualization of research questions, and designing a research study.

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MINOR: Elective

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Quantitative Methods in Global Health Research

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Quantitative research is the foundation for evidence-based global health practice and interventions. Preparing health research starts with a clear research question to initiate the study, careful planning using sound methodology as well as the development and management of the capacity and resources to complete the whole research cycle. Good planning will also ensure valid research outcomes. Quantitative research emphasizes a clear target population, proper sampling techniques, adequate sample size, detailed planning for data collection, and proper statistical analysis. This chapter provides an overview of quantitative research methods, explains relevant study designs, and presents considerations on all aspect of the research cycle along four phases: initiation, planning, data collection, and reporting phase.

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Ab Rahman, J. (2021). Quantitative Methods in Global Health Research. In: Haring, R., Kickbusch, I., Ganten, D., Moeti, M. (eds) Handbook of Global Health. Springer, Cham. https://doi.org/10.1007/978-3-030-05325-3_9-1

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Donald Thea

Zambia Infant Cohort Study: Brain Optimized to Survive and Thrive (ZICS-BOOST)

Children exposed to HIV in-utero but uninfected (CHEUs) number 14.8 million globally. In Zambia, an estimated 56,000 CHEUs are born annually, a staggering fraction of the national birth cohort. Multiple studies establish that CHEUs are more neurodevelopmentally vulnerable than HIV-unexposed peers. In Zambia, there are existing effective early childhood developmental (ECD) interventions that target other vulnerable populations, but never trialed specifically for CHEUs. GAP: Research is needed to evaluate the effectiveness of a scalable early childhood development (ECD) intervention for CHEUs. Zambia is scaling up ECD as part of its national strategy, but CHEUs are not currently targeted. There is need to better understand the scope and mechanism of HEU-related neurodevelopmental differences and what interventions are most effective. HYPOTHESIS #1: An ECD intervention delivered by community health workers via bi-weekly home visits will improve neurodevelopmental outcomes in CHEUs. HYPOTHESIS #2: CHEUs have significantly worse neurodevelopmental outcomes than unexposed peers at 24 months, mediated by preterm birth, disease stage or ARV exposure. METHODS: In order to observe differences in neurodevelopment between HIV-exposed and HIV-unexposed children, we will build upon an existing Zambian birth cohort by extending follow-up from 6 months to 2 years (n=450). Neurodevelopmental assessments will be measured by multiple context-validated tools at 12 and 24 months. In addition, a randomized control trial of a bi-weekly community health worker-delivered ECD intervention for CHEUs will be conducted to assess its impact on CHEU neurodevelopment. RESULTS: Pending. IMPACT: Despite growing evidence, HIV-exposure is not currently prioritized as a risk factor for poor development by policy makers or ECD programs. By capitalizing on the wealth of prenatal and infant data collected in our ‘parent’ study, we can investigate the mechanism that links HEU to neurodevelopment and test a potential therapy. Addressing developmental vulnerability in CHEUs is paramount to ensuring that future generations of children are school ready, and able to reach their full developmental potential.

Julie Herlihy

EVIDENCE: Evaluation to Inform Decisions using Economics and Epidemiology

EVIDENCE is a 5-year HIV/AIDS project funded by PEPFAR through USAID. With the project lead in South Africa, the Health Economics and Epidemiology Research Office (HE2RO), we conduct health economics and epidemiology evaluations and provide technical assistance in support of the goals of the South African National Strategic Plan for HIV, TB and STIs (NSP) and the PEPFAR Country Operational Plan. BU faculty and staff work closely with HE2RO on project evaluations, cost modeling, outcomes research, and financial management to improve guidelines, policies, programs, and resource allocation.

Economic Impact of HIV Policy Briefs

This project synthesises the evidence on the economic impact of HIV into a series of 17 policy briefs that can help decision-makers in ministries of finance and health in low- and middle-income countries (LMIC) decide on the future financing of their country’s HIV programme. The project incorporates a series of seminars with an academic and LMIC government staff audience aimed at refining the content and presentation of the briefs, the presentation of the evidence base to LMIC decision makers during a comprehensive workshop, and the publication of the briefs on a website and in peer-reviewed journals.

Gesine Meyer-Rath

infectious disease

Vaccine impact modelling consortium (vimc) 2.0  .

VIMC   is an international community of modelers providing high-quality estimates of the public health impact of vaccination to inform and improve decision making. This project contributes to the estimation of cervical cancer disease burden and human papillomavirus (HPV) vaccine impact in low- and middle-income countries. In addition, this project examines policy-relevant research questions for HPV vaccines in order to advance the research agenda in the field of vaccine impact modeling.

 Allison Portnoy

Low- and middle-income countries worldwide

INSECT: Implementing Novel Strategies for Education and Chagas Testing  

This project, funded by a CDC cooperative agreement, aims to increase Chagas knowledge in the medical community and to roll out screening programs for high-risk populations (such as women of childbearing age from endemic areas) nationwide.

Boston, Massachusetts

Chagas disease biorepository

We have developed a biorepository using biological samples from a cohort of Chagas disease patients at Boston Medical Center. The primary goal of the biorepository is to develop and maintain a large, geographically diverse collection of well-characterized samples to be used as a resource for future Chagas diagnostics research.

Incorporating Behavioral Feedback in the Infectious Disease Transmission Modeling

Transmission dynamic modeling is a powerful tool to understand the epidemiology of infectious diseases and evaluate the impact of control measures. However, the lack of empirical data on human behavior and its temporal variation has hindered the progress and application of these models. Therefore, this project aims to 1) understand how people experiencing acute infections change their social contact patterns over the course of their illness and 2) develop mechanistic models that incorporate these data to generate more reliable estimates of key transmission parameters and intervention impacts. Our project aims to provide policy makers and public health officials with more informed decision-making tools to develop interventions, ultimately leading to improved health outcomes.

Kayoko Shioda

United States

EPISTORM: Real-time Evaluation of Vaccine Effectiveness and Safety

Real-time monitoring of the effectiveness and safety of vaccines is essential for controlling infectious diseases. However, there are both practical and methodological hurdles. Our project aims to address two key challenges: 1) issues with linking public health data from different sources, and 2) analytic challenges associated with evaluating multi-dose vaccines, using causal inference techniques. Boston University has been selected to be part of the national network for outbreak and disease modeling led ( CDC Insight Net ), and this project will be conducted through this network.

Cryptococcal Meningitis Screening in South Africa

Cryptococcal meningitis (CM) is a fungal infection that causes infection in the brain and spinal cord. CM is a leading cause of AIDS-related deaths globally, mainly among patients with low CD4 cell counts. Through screening HIV patients with low CD4 cells counts for cryptococcal antigen (CrAg), it is possible to identify CrAg-positive patients before they develop meningitis. Treating these patients with antifungal medications can then substantially reduce risks of progression to CM and death. Through support from the CDC Foundation (May 2015 – June 2021), the purpose of this program of research has been to evaluate costs and effectiveness of alternative CrAg screening strategies and CM treatment regimens.

Using Behavioral Economics to Improve the Uptake of and Persistence on Pre-exposure Prophylaxis in Men Who Have Sex With Men to Prevent HIV Infection

South Africa’s HIV incidence remains high, in particular amongst populations such as men who have sex with men (MSM) who may be at increased risk. HIV pre-exposure prophylaxis (PrEP) is considered key to reducing incidence in these populations, yet pilot studies show sub optimal uptake and poor persistence amongst those most at risk. This research will focus on understanding why PrEP uptake and persistence amongst MSM in South Africa is low and how the delivery of PrEP to this population could be altered to encourage those most at risk to start treatment using behavioral insights.

Impact of Undernutrition on Immunity Elicited by Vaccines in the Gambia

Moderate and severe undernutrition are highly prevalent in several resource-limited countries. There is conflicting evidence on the impact of undernutrition on the immunity elicited by childhood vaccines, as well as the specific supplements that could be used to overcome vaccine hypo-responses associated with undernutrition. In a pilot project in The Gambia, we are comparing antibody vaccine responses against a panel of EPI vaccines of children with severe wasting and stunting with well-nourished children. Furthermore, through a metabolomics assay, we will assess whether specific amino acid deficiencies are associated with decreased responses in undernourished children.

IPV (intimate partner violence)

Testing the effectiveness of an evidence-based transdiagnostic cognitive behavioral therapy approach for improving hiv treatment outcomes among violence-affected and virally unsuppressed women in south africa.

This study will evaluate the impact of the Common Elements Treatment Approach (CETA), an evidence-based intervention comprised of cognitive-behavioral therapy elements, at improving HIV treatment outcomes among women with HIV who have experienced intimate partner violence (IPV) and have an unsuppressed viral load on HIV treatment. To evaluate CETA, we will conduct a randomized controlled trial of HIV-infected women, with or without their partners, who have experienced IPV and have an unsuppressed viral load to test the effect of CETA in increasing viral suppression and reducing violence.

The Intransigence of Malaria in Malawi: Understanding Hidden Reservoirs, Successful Vectors and Prevention Failures

Under the aegis of the Malawi International Center of Excellence of Malaria Research (ICEMR) program, several cohort studies have been conducted focused on studying malaria control measures and understanding why measures such as bed nets have failed to control malaria in Malawi. Examples of these studies are the one led by Dr. Valim aiming to identify the transmission reservoir group(s) for malaria in Malawi and to assess the impact of current interventions on these human reservoirs. Another study conducted under the aegis of ICEMR aims to assess the effectiveness of the RTS,S malaria vaccine in conjunction with other malaria prophylactic measures.

Maternal and Child Health

Global network for women’s and children’s health research.

The Global Network conducts observational studies and clinical trials in 8 locations in low and middle income countries in Asia, Africa and Central America. The goals of the research are (1) to evaluate whether low-cost, sustainable interventions improve maternal and child health; and (2) build local research capacity and infrastructure. Whenever possible common protocols are implemented in all 8 locations. The Boston University site works with the Lata Medical Research Foundation in Nagpur, India. The grant funds several studies.

Synbiotics for the Early Prevention of Severe Infections in Infants (SEPSIS)

SEPSIS, a collaboration between icddrb (Dhaka), Hospital for Sick Kids (Toronto), and BU consists of a few related studies including an observational cohort of severe infections and the intestinal microbiome in young infants in Dhaka, Bangladesh and a phase II randomized, placebo-controlled trial of the efficacy, safety, and tolerability of neonatal administration of Lactobacillus plantarum ATCC 202195 with or without fructooligosaccharide for one or seven days

Antimicrobial Resistance

A-plus trial: multi-site efficacy and safety trial of intrapartum azithromycin in lmics – amr sub-study and effect of azithromycin on the developing microbiome ..

The Global Network is conducting a trial to evaluate whether Azithromycin given during labor reduces maternal and neonatal infections and mortality. This grant supports studying the effect of azithromycin on development of antimicrobial resistance and the gut and airway microbiome.

Sequencing of Klebsiella pneumoniae isolates from Zambia

Bloodstream isolates (K. pneumoniae and E. coli) from the Sepsis Prevention in Neonates in Zambia study are being sequenced to determine serotypes and antibiotic resistance characteristics.

Non-communicable Diseases

World health organization. global ncd reporting mechanism..

Veronika Wirtz & Peter Rockers

In 2021, the World Health Organization introduced the Global Diabetes Compact, targeting equitable and affordable access to diabetes care, particularly in low- and middle-income countries. Acknowledging the support from the private sector, WHO formulated a list of 31 asks to prioritize expansion of access to essential insulin and related health technologies. Boston University is now supporting WHO in developing a Global Reporting Mechanism (GRM) to encourage the reporting and tracking of industry commitments aligned with the 31 WHO Asks.

Noncommunicable Disease Management in South Africa: Insights from the National Health Laboratory Services (NHLS) Multi-morbidity Cohort.

The K01 Award (K01DK116929) addresses the growing challenge of Type 2 Diabetes Mellitus (T2DM), focusing on care disparities and treatment efficacy, particularly among populations living with and without HIV in low- and middle-income countries. Central to this project is the innovative application of a probabilistic record-linking algorithm to develop a patient cohort from the National Health Laboratory Services (NHLS) database in South Africa, which contains over 68 million laboratory records from more than 30 million individuals and covers conditions like HIV, tuberculosis, diabetes, kidney disease, and cardiovascular disorders from April 1, 2004, to March 31, 2017.

The creation of the NHLS Multi-morbidity Cohort has facilitated in-depth analysis of data including anonymized patient identifiers, demographics, test specifics, and geographic information. This cohort is instrumental for the project’s aims to examine examining the T2DM care cascade in populations with and without HIV, evaluate the Integrated Chronic Disease Management (ICDM) model’s impact on diabetes care using quasi-experimental methods, studying chronic kidney disease progression , and evaluating compliance with national diabetes guidelines . These efforts aim to enhance understanding and improve management of noncommunicable diseases in South Africa.

Alana Brennan

World Bank Global compendium of primary care service delivery models for non-communicable diseases

(link to report should be available in June 2024)

Addressing the challenges within non-communicable disease programs and primary healthcare centers, the World Bank embarked on a project to gather a comprehensive collection of primary care service delivery models for non-communicable diseases. This initiative highlighted the critical need for a cohesive approach to primary healthcare, which includes the promotion, prevention, and management of non-communicable diseases, aiming to improve care across the entire spectrum, from reducing risk factors to managing chronic conditions at the primary care level effectively. The project’s goal was to develop an online, action-oriented collection for the World Bank, filled with innovative design solutions and digital enhancements to boost access, efficiency, effectiveness, and the quality of care for non-communicable diseases. This collection intended to present a wide array of primary healthcare models designed for chronic conditions, supporting countries in their shift towards integrated, chronic care services and moving away from a reliance on acute, episodic care.

The project culminated in a comprehensive matrix featuring 158 models, alongside 60 concise two-page case reports and 15 detailed five-page case reports. These documents collectively highlight a diverse range of primary care service delivery models for non-communicable diseases, spanning various geographic regions and income categories. Sub-Saharan Africa was prominently featured, accounting for 26.6% of the models, with East Asia and the Pacific at 22.8%, and South Asia at 20.2%. Most of these models were found in upper-middle-income and lower-middle-income countries, making up 45.6% and 42.4% of the implementations, respectively. Diabetes stood out as the most common focus, being the target of 50.0% of the models, followed by hypertension at 41.8% and mental health disorders at 38.0%. The main strategies highlighted in these models were task-shifting/task-sharing (40.5%), the integration of new services or conditions (35.4%), and educational or training initiatives (33.5%). The implementation settings varied, with mixed areas being the most common at 41.8%, and rural and urban areas following at 24.7% and 22.1%, respectively. The scale of implementation predominantly ranged from small to medium, accounting for 55.1% of the models, but there were also notable instances of large-scale and national-scale projects at 20.2% and 10.1%, respectively, highlighting the extensive reach and potential impact of these initiatives.

Alana Brennan, Nancy Scott , Sydney Rosen

low-and middle-income countries

Opportunistic screening for hypertension and type 2 diabetes mellitus using COVID-19 infrastructure

South Africa continues to grapple with a substantial burden of non-communicable diseases, particularly type 2 diabetes and hypertension. However, these conditions are often underdiagnosed and poorly managed, further exacerbated by the strained primary healthcare system and the disruptive impact of the COVID-19 pandemic. Integrating non-communicable disease screening with large-scale healthcare initiatives, such as COVID-19 testing and vaccination campaigns, offers a potential solution, especially in low- and middle-income countries. We investigated the feasibility and effectiveness of this integration in two separate cohorts.

Study 1: Integration of point-of-care screening for type 2 diabetes mellitus and hypertension with COVID-19 rapid antigen screening in Johannesburg, South Africa

In a prospective cohort study at the Germiston taxi rank in Johannesburg, South Africa, we assessed the integration of screenings for type 2 diabetes mellitus and hypertension with rapid antigen tests for COVID-19. The study involved 1,169 participants and included measurements of blood glucose, blood pressure, waist circumference, smoking status, height, and weight. Participants showing elevated blood glucose levels (fasting levels equal to or greater than 7.0 or random levels equal to or greater than 11.1 millimoles per liter) and/or elevated blood pressure readings (diastolic pressure equal to or greater than 90 and systolic pressure equal to or greater than 140 millimeters of mercury) were directed to receive clinical follow-up. Our results indicated an overall diabetes prevalence of 7.1%, incorporating both previously diagnosed individuals and those newly identified with elevated blood glucose measurements. We also observed a hypertension prevalence of 27.9%, which included both known cases and new detections of elevated blood pressure during the study. However, the rates of connecting these individuals to subsequent medical care were low, with only 30.0% of those with elevated blood glucose and 16.3% with elevated blood pressure engaging in follow-up care. This opportunistic approach to screening helped identify potential new diagnoses in 22% of participants, yet it also underscored the necessity for better strategies to ensure these individuals receive the necessary ongoing care, highlighting the critical need for additional research to determine the feasibility and effectiveness of such integrated screening programs on a larger scale.

Study 2: Integration of point-of-care screening for type 2 diabetes mellitus and hypertension into the COVID-19 vaccine programme in Johannesburg, South Africa

In a prospective cohort study at four health facilities in Johannesburg, South Africa, we screened 1,376 participants for hypertension and type 2 diabetes mellitus during COVID-19 vaccination campaigns. This integration aimed to address the significant problem of undiagnosed conditions in a strained healthcare system. We measured blood glucose, blood pressure, waist circumference, smoking status, height, and weight, referring individuals with elevated blood glucose (fasting levels equal to or greater than 7.0 or random levels equal to or greater than 11.1 millimoles per liter) and/or blood pressure (diastolic pressure equal to or greater than 90 and systolic pressure equal to or greater than 140 millimeters of mercury) for further medical evaluation. Our findings showed a 4.1% prevalence of diabetes, combining known cases and new detections of elevated blood glucose levels. The hypertension prevalence was 19.4%, including both existing and newly identified cases of elevated blood pressure. Notably, 46.1% of participants exhibited waist circumferences indicative of metabolic syndrome, more frequently observed in females. Additionally, 7.8% of the screened individuals were potentially newly diagnosed with diabetes or hypertension, emphasizing the importance of integrated screening initiatives. Approximately half of the individuals with newly identified risk factors successfully sought follow-up care within a month, highlighting the effectiveness of using routine healthcare interactions for extensive screenings, particularly vital in settings with limited resources, and underscoring the need to improve linkage to care for efficient management of non-communicable diseases.

Alana Brennan, Gesine Myer-Rath

Assessing the effects of HIV disease on dysglycemia in a cohort of tuberculosis patients in South Africa’s Western Cape

Our planned research will focus on compare rates of dysglycemia (both hyperglycemia and hypoglycemia) in people living with HIV (PLWH) and HIV-uninfected persons receiving tuberculosis (TB) treatment using pilot data from the The Impact of Alcohol Consumption on TB Treatment Outcomes (TRUST) Study . HbA1c’s were only collected at enrollment the TRUST. As such, we will collect blood samples to measure HbA1c and blood glucose levels at patients 18-month study visit. This will allow us to assess changes in blood glucose levels from study enrollment by HIV status. Second, we will assess the role stress and inflammation play in relation to blood sugar levels in PLWH and HIV-uninfected individuals. Research suggests that the hosts immune response to active TB and/or HIV disease results in a prolonged state of systemic inflammation which can have negative metabolic effects. We will collect samples to measure markers of stress and inflammation at the 18-month study visit when all patients will be one year post TB treatment completion and when transient hyperglycemia due to TB infection should be resolved. This will be preliminary data to assess if there are differences in these specific stress and inflammatory markers post TB treatment amongst PLWH and HIV-uninfected individuals and potentially identify underlying mechanism(s) causing abnormal blood sugar levels.

Programme Evaluation of Timor-Leste PEN-HEARTS Intervention

This project will evaluate early implementation in Timor-Leste of PEN-HEARTS, a community-based intervention supported by the WHO designed to improve health outcomes among individuals with non-communicable diseases such as diabetes. Building on a similar evaluation in Bhutan, a BU team of faculty and students will design and implement the evaluation with WHO and Ministry of Health officials in Timor-Leste. The evaluation will use mixed methods and involve data collection in both intervention and comparison sites in four districts of Timor-Leste.

Timor-Leste

Pharmaceutical Policy

Medicines, technologies, and pharmaceutical services.

The Medicines, Technologies and Pharmaceutical Services (MTaPS) project aims to strengthen pharmaceutical systems in low and middle income countries. Boston University is a core partner of the USAID funded MTaPS project led by Management Sciences for Health. The objectives are (1) to generate evidence on the development, implementation and strengthening of data management that can support decision-making in pharmaceutical systems; (2) to develop, implement and evaluation accountability mechanisms in pharmaceutical systems.

Veronika Wirtz

Tuberculosis

Methods to estimate the impact of interventions on the transmission and incidence of tuberculosis.

The major goals of this project are to develop models that can be used to monitor the success of TB interventions. This project is a collaboration with Dr. Helen Jenkins and Dr. Leo Martinez and is led by Dr. Laura White of the BUSPH Department of Biostatistics

Intensified patient-finding intervention to increase the detection of children with tuberculosis

Children with tuberculosis are vastly under detected and under diagnosed. An intensified patient-finding intervention using systematic verbal screening at health facilities was undertaken in two locations to increase the detection of children who may be at high risk for tuberculosis disease. These projects aim to identify gaps along the pediatric tuberculosis care cascade; understand age-specific clinical presentation and risk factors for tuberculosis disease, extrapulmonary presentations, and poor treatment outcomes; refine clinical algorithms to expedite decision-making for treatment initiation; and explore other topics related to pediatric tuberculosis epidemiology.

Meredith Brooks

Pakistan and Bangladesh

SAIA-TB: Using the Systems Analysis and Improvement Approach to Prevent TB in rural South Africa

Description: South Africa estimates 80% of their population has TB infection, and 14% of the population lives with HIV, with an estimated 5-15% of South Africans at high risk of developing TB disease from recent infection or immunocompromised status. Therefore, utilization of routinely collected data to optimize the comprehensive TB care cascade – screening, evaluation, diagnosing, linkage to care, treatment, and TB-free survival – is important to assess at the clinic level to improve clinic flow and patient outcomes. This study—funded by NINR/NIH—will leverage an evidence-based implementation science strategy, the Systems Analysis and Improvement Approach (SAIA), and recent TB cascade analyses piloted in the proposed site, to adapt and evaluate the effectiveness of SAIA-TB using a stepped wedge crossover cluster randomized trial across 12 clinics in rural Eastern Cape, South Africa.

Improving Childhood Tuberculosis Treatment Outcomes and Post-TB Lung Functioning and Quality of Life in Rural South Africa

Description: We will assess the TB care cascade in children, expanding it to include a child-specific definition of post-TB lung disease (PTLD), among children in a high TB/HIV burden setting in Eastern Cape South Africa, and identify risk-factors for completing each step of the newly expanded TB care cascade. Additionally, we will collect rich data regarding nutritional status, air pollutant exposure, lung capacity, and quality of life to estimate their effect on TB disease outcomes and PTLD in children. Funded by the Charles H. Hood Foundation.

Household Contact Tuberculosis Preventive Therapy Programs in Rural Eastern Cape, South Africa (KWIT-TB)

Description: We will assess the geospatial components, including access to care and population-level characteristics to gaps in the TB preventive therapy care cascade.

Adaptive Design to Aid in the Planning of community-based Tuberculosis screening services (ADAPT-TB)

Description: Community-based screening via mobile units can close gaps in missed diagnoses by bringing screening services into communities, making screening more convenient for individuals with limited access to appropriate services. Questions remain, however, about how to efficiently operate these mobile units. Leveraging longstanding relationships in Lima, Peru, including existing collaborations involving mobile screening units, I will collect data from health facilities and mobile screening units to [Aim 1] establish spatial and temporal trends of the local tuberculosis burden and [Aim 2] build neighborhood-level models reflecting local risk of tuberculosis. I will then [Aim 3] develop a baseline decision model via a restless multi-armed bandit framework to make data-driven decisions about where, when, and how long to place the mobile units in the community. The overall goal is to optimize the real-time movement of these units throughout a community to increase the detection of individuals with TB and allocate resources more efficiently. Funded by a Carlin Foundation Award for Public Health Innovation and a Population Health Data Science (PHDS) Seed Funding Award.

Optimizing tuberculosis elimination initiatives for high-risk populations

Certain populations are at increased risk of tuberculosis infection and progression to tuberculosis disease. In Mexicali, Mexico, we are assessing the impact of novel diagnostics for tuberculosis infection testing in three high-risk populations–people who use drugs, household contacts of people with tuberculosis, and people confined to a penitentiary setting–to inform tailored algorithms for tuberculosis testing and initiation of tuberculosis preventive treatment. We also assess gaps identified along the tuberculosis comprehensive care cascade to guide local tuberculosis prevention and management guidelines.

Tuberculosis in teens: a geospatial approach to predict community transmission

Description: Adolescents are a unique population that have been routinely neglected from tuberculosis guidelines. However, due to their ability to spread tuberculosis and their high number of social contacts, adolescents may be a key node fueling cycles of local community tuberculosis transmission in high incidence settings. Through a K01 Award from NIAID, NIH, we use geospatial and genotypic analyses to complete the following objectives: (1) To characterize the spatial heterogeneity of tuberculosis transmission events in adolescents. (2) To predict the spatial distribution of tuberculosis transmission events in adolescents. (3) To estimate and compare, through simulation, the impact of adolescent-tailored screening and treatment interventions on reducing community tuberculosis transmission.

Predictors of Resistance Emergence Evaluation in MDR-TB Patients on Treatment.

Dr. Horsburgh and Dr. Tim Sterling of Vanderbilt are leading a prospective cohort study of patients with MDR-TB. The aims of the study are to determine if decreased TB drug levels predispose to the development of additional drug resistance on treatment and to develop early indicators of such emergence of resistance.

US, India, Brazil

RePORT India Consortium

The major goal of this project is to collaborate with partners in India in clinical studies of tuberculosis infection and disease.

Akshay Gupte

Transmission of Tuberculosis among illicit drug use linkages

The goal of this project is to assess the risk for TB transmission between persons who smoke drugs. This is a prospective cohort study of persons with and without drug use in South Africa.

Karen Jacobson

US, South Africa

Prevention Policy Modeling Lab

The Goal of this Project is to develop cost-effectiveness models for TB prevention. This project is a collaboration with Dr. Nick Menzies at Harvard School of Public Health and Dr. Josh Solomon at Stanford School of Medicine.

DRAMATIC Phase 2 Duration Randomized MDR-TB Treatment Trial

The major goal of this project is to identify a shorter, less toxic treatment for MDR-TB.  This project is a collaboration with Dr. Payam Nahid at University of California, San Francisco. It is randomizing patients with fluoroquinolone-susceptible MDR-TB in Vietnam and the Philippines to four different durations of a 5-drug regimen.

US, Vietnam, the Philippines

Phenotype, Progression and Immune Correlates of Post-Tuberculosis Lung Disease

Pulmonary tuberculosis (PTB) is associated with lung injury which can persist despite successful therapy. Lung sequelae of treated PTB are increasingly recognized as an independent risk factor for chronic obstructive pulmonary disease (COPD) and, an important contributor of excess morbidity and mortality. This project aims to: 1) characterize the early natural history of post-TB lung disease (PTLD) and provide rationale for long-term monitoring and bronchodilator therapy in affected cases, 2) characterize the functional and morphological phenotype of PTLD by serial pulmonary function testing and multi-detector computed tomography, 3) identify immune profiles measured during early, late and post-therapy associated with PTLD.

RePORT-India Lung Health Study

Pulmonary tuberculosis (PTB) is the most common form of TB disease and is characterized by granuloma formation, necrosis, and cavitation in the lung tissue. This lung injury in PTB may affect tuberculosis treatment outcomes. Granulomatous lesions, fibrosis, and cavitation impair drug penetration in affected lung tissue and may lead to persistent foci of bacterial replication and drug resistance. The overall goal of this project is to identify clinical and imaging markers of lung injury that are associated with unfavorable treatment outcomes in PTB.

Multiomic signatures of Lung Injury in Tuberculosis

Pulmonary tuberculosis (PTB) is associated with lung injury which can persist despite successful therapy. Lung sequelae of treated PTB are increasingly recognized as an independent risk factor for chronic obstructive pulmonary disease (COPD) and, an important contributor of excess morbidity and mortality. Furthermore, PTB is characterized by granuloma formation, necrosis, and cavitation in the lung tissue which can impair drug penetration in affected lung tissue leading to persistent foci of bacterial replication, drug resistance and poor treatment outcomes. The overall goal of this study is to explore host metabolomic and genetic signatures associated with lung injury in PTB patients with and without diabetes and HIV.

Point-of-care Questionnaire and mHealth Assisted Diagnosis of Post-TB Lung Disease

Pulmonary tuberculosis (PTB) is associated with lung injury which can persist despite successful therapy. Lung sequelae of treated PTB are increasingly recognized as an independent risk factor for chronic obstructive pulmonary disease (COPD) and, an important contributor of excess morbidity and mortality. Spirometry is the gold standard for diagnosing lung function defects, however it is technically challenging and expensive to perform, and may not be available at the point-of-care in many TB-endemic settings. The overall goal of this project is to develop and validate a questionnaire-based screening algorithm, assisted by machine learning analysis of cough sounds and lung auscultation data, to identify individuals with a high probability of having Post-TB Lung Disease for referral and confirmatory testing.

Effectiveness of Anti-Fibrotic Therapy for Preventing Pulmonary Impairment in COVID-19

COVID-19 is associated with persistent pulmonary impairment despite successful management of acute disease. Of particular interest is pulmonary fibrosis, with several studies reporting reduced FVC, DLCO and anterior reticulation on chest CT. The overall goal of this project is to conduct a retrospective analysis of medical records to measure the association between receipt of antifibrotic therapy (Pirfenidone and/or Nintedanib) and lung impairment following hospital discharge among adults with COVID-19.

Veterans health

Bridging the care continuum for vulnerable veterans across va and community care (bridgecc) queri program.

Led by investigators at the Bedford VA, this project is implementing three evidence-based practices (EBPs) that aim to improve coordinated care between VA and non-VA providers to improve the health of veterans. The EBPs focus on 1) homeless overdose prevention expansion; 2) maintaining independence and sobriety through systems integration and outreach; and 3) post-incarceration engagement to increase social support. Dr. Sabin is guiding the costing components for each EBP.

Read our research on: Gun Policy | International Conflict | Election 2024

Regions & Countries

Global health, as obesity rates rise in the u.s. and worldwide, new weight-loss drugs surge in popularity.

Last year, Ozempic, Rybelsus and Wegovy had combined sales of about $21.1 billion globally – up 89% since 2022.

Key findings about COVID-19 restrictions that affected religious groups around the world in 2020

Our study analyzes 198 countries and territories and is based on policies and events in 2020, the most recent year for which data is available.

How COVID-19 Restrictions Affected Religious Groups Around the World in 2020

Nearly a quarter of countries used force to prevent religious gatherings during the pandemic; other government restrictions and social hostilities related to religion remained fairly stable.

How Global Public Opinion of China Has Shifted in the Xi Era

The Chinese Communist Party is preparing for its 20th National Congress, an event likely to result in an unprecedented third term for President Xi Jinping. Since Xi took office in 2013, opinion of China in the U.S. and other advanced economies has turned more negative. How did it get to be this way?

Partisanship Colors Views of COVID-19 Handling Across Advanced Economies

A median of 68% across 19 countries think their country has done a good job dealing with the coronavirus outbreak, with majorities saying this in every country surveyed except Japan. However, most also believe the pandemic has created greater divisions in their societies and exposed weaknesses in their political systems – and these view are especially common in the U.S.

Americans see different global threats facing the country now than in March 2020

Many U.S. adults describe cyberattacks from other countries (71%) and the spread of misinformation online (70%) as major threats to the U.S.

What Makes Life Meaningful? Views From 17 Advanced Economies

Family is preeminent for most publics but work, material well-being and health also play a key role.

How the political typology groups compare

Pew Research Center’s political typology sorts Americans into cohesive, like-minded groups based on their values, beliefs, and views about politics and the political system. Use this tool to compare the groups on some key topics and their demographics.

Citizens in Advanced Economies Want Significant Changes to Their Political Systems

Dissatisfaction with the functioning of democracy is linked to concerns about the economy, the pandemic and social divisions.

Germany and Merkel Receive High Marks Internationally in Chancellor’s Last Year in Office

Germany’s pandemic response and its role in the EU are also rated positively.

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About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

📕 Studying HQ

Exploring research topics on global health nursing: a comprehensive guide for nursing students, carla johnson.

• September 6, 2023
• Essay Topics and Ideas

Global health nursing is an evolving and crucial field that extends the principles of nursing care beyond borders, cultures, and socio-economic disparities. For nursing students, delving into global health nursing opens up a world of opportunities to make a significant impact on healthcare worldwide. This article aims to provide nursing students with valuable research topics on global health nursing, including PICOT questions, evidence-based practice (EBP) project ideas, nursing capstone project ideas, research paper topics, and research questions to inspire their academic and professional journey in this field.

What You'll Learn

Global Health Nursing: An Overview

Global health nursing is a specialized area of nursing practice that focuses on promoting health equity and addressing healthcare disparities on a global scale. It involves providing care, conducting research, and implementing interventions that improve the health outcomes of individuals and communities in resource-limited settings, as well as in underserved populations within high-income countries.

PICOT Questions in Global Health Nursing

• P: Children in low-income countries with limited access to clean water and sanitation facilities; I: Implementation of hygiene education programs; C: Absence of hygiene education programs; O: Reduction in waterborne diseases; T: 12 months. In resource-limited settings, can the implementation of hygiene education programs significantly reduce the incidence of waterborne diseases among children over a 12-month period?
• P: Pregnant women in rural communities with limited access to prenatal care; I: Introduction of mobile prenatal clinics; C: Traditional prenatal care models; O: Improvement in maternal and neonatal health outcomes; T: 24 months. In underserved rural areas, does the implementation of mobile prenatal clinics improve maternal and neonatal health outcomes compared to traditional prenatal care models over a 24-month period?
• P: Elderly patients in long-term care facilities; I: Integration of telemedicine for routine health assessments; C: Conventional in-person healthcare services; O: Enhanced access to healthcare and reduction in hospitalizations; T: 6 months. Among elderly patients in long-term care facilities, does the integration of telemedicine for routine health assessments enhance access to healthcare and reduce hospitalizations when compared to conventional in-person healthcare services over a 6-month period?
• P: HIV-positive adolescents in urban slums; I: Implementation of peer-led educational programs; C: Absence of peer-led educational programs; O: Improvement in HIV treatment adherence rates; T: 12 months. In urban slums, can the implementation of peer-led educational programs significantly improve HIV treatment adherence rates among HIV-positive adolescents over a 12-month period?
• P: Communities in disaster-prone regions; I: Development of disaster preparedness initiatives; C: Lack of disaster preparedness initiatives; O: Reduction in disaster-related morbidity and mortality; T: 36 months. Do disaster preparedness initiatives in disaster-prone regions significantly reduce disaster-related morbidity and mortality over a 36-month period compared to areas without such initiatives?
• P: Refugees with limited access to mental health services; I: Implementation of culturally sensitive counseling programs; C: Standard mental health services ; O: Improvement in mental health outcomes; T: 18 months. Among refugees with limited access to mental health services, does implementing culturally sensitive counseling programs lead to improved mental health outcomes compared to standard mental health services over an 18-month period?
• P: Indigenous communities with high rates of preventable diseases; I: Introduction of community health worker programs; C: Absence of community health worker programs; O: Reduction in preventable disease incidence; T: 24 months. In indigenous communities with high rates of preventable diseases, can the introduction of community health worker programs lead to a significant reduction in preventable disease incidence over a 24-month period compared to communities without such programs?
• P: Low-income pregnant women with limited access to antenatal car e; I: Implementation of transportation support for clinic visits; C: No transportation support; O: Increased utilization of antenatal care services; T: 9 months. Among low-income pregnant women with limited access to antenatal care, does the implementation of transportation support for clinic visits lead to increased utilization of antenatal care services over a 9-month period compared to those without transportation support?
• P: Patients in a post-disaster relief camp; I: Deployment of rapid response medical teams; C: Delayed medical response; O: Reduction in post-disaster mortality; T: 3 months. In post-disaster relief camps, does the deployment of rapid response medical teams lead to a significant reduction in post-disaster mortality over a 3-month period compared to delayed medical response?
• P: Adolescent girls in remote areas with limited access to education; I: Implementation of mobile education initiatives; C: Traditional in-person education; O: Improvement in educational attainment; T: 12 months. Among adolescent girls in remote areas with limited access to education, does implementing mobile education initiatives lead to improved educational attainment compared to traditional in-person education over a 12-month period?

Evidence-Based Practice (EBP) Project Ideas on Global Health Nursing

• Assessing the effectiveness of vaccination campaigns in preventing infectious diseases in underserved communities.
• Implementing telehealth programs to improve access to mental health services in remote areas.
• Evaluating the impact of community health worker interventions on maternal and child health outcomes.
• Investigating the barriers to HIV testing and treatment adherence among vulnerable populations.
• Assessing the effectiveness of health education programs in reducing non-communicable diseases in low-resource settings.
• Examining the role of nurses in disaster preparedness and response efforts.
• Developing culturally competent training programs for healthcare providers working with diverse populations.
• Investigating the factors influencing healthcare-seeking behaviors among refugees.
• Evaluating the impact of mobile clinics on healthcare access in rural communities.
• Assessing the quality of healthcare services in refugee camps.

Nursing Capstone Project Ideas on Global Health Nursing

• Designing a global health nursing curriculum for nursing schools.
• Developing a disaster preparedness plan for a vulnerable community.
• Creating a telemedicine program for a remote healthcare facility.
• Implementing a hygiene education program in a low-income school.
• Evaluating the impact of a community health worker initiative on health outcomes.
• Developing a cultural competency training module for healthcare providers.
• Designing a maternal and child health intervention for an underserved population.
• Conducting a needs assessment for healthcare services in a refugee camp.
• Developing a healthcare access program for rural communities .
• Creating a mental health support program for adolescent refugees.

Nursing Research Topics on Global Health Nursing

• The role of global health nursing in achieving the Sustainable Development Goals.
• Challenges and opportunities in providing nursing care in humanitarian settings.
• Cultural competence and its significance in global health nursing practice.
• The impact of climate change on global health nursing.
• Nursing workforce migration and its effects on healthcare in resource-limited countries.
• Ethics and ethical dilemmas in global health nursing.
• The role of technology in improving healthcare access in underserved areas.
• Maternal and child health disparities in low-income countries.
• Non-communicable diseases and their burden in low-resource settings.
• Mental health stigma in diverse cultural contexts.

Nursing Research Questions on Global Health Nursing

• How does cultural competence among nurses affect healthcare outcomes in global health settings?
• What are the key challenges faced by nurses working in disaster relief operations?
• How can telehealth interventions improve healthcare access in underserved communities?
• What factors contribute to the successful implementation of community health worker programs in low-resource settings?
• What are the ethical considerations when providing nursing care in humanitarian crises?
• How does climate change impact the health of vulnerable populations in global health nursing?
• What are the barriers to healthcare-seeking behavior among refugees in host countries?
• How can technology be leveraged to enhance healthcare delivery in remote areas?
• What strategies can be employed to reduce maternal and child health disparities in low-income countries?
• What interventions are effective in reducing mental health stigma in culturally diverse contexts?

Essay Topic Ideas & Examples on Global Health Nursing

• Explore the diverse roles nurses play in addressing global health issues and discuss the challenges and rewards they encounter.
• Analyze healthcare disparities in underserved populations worldwide and propose strategies for reducing these disparities.
• Examine the significance of cultural competence in nursing practice and provide real-life examples of its impact on patient care.
• Discuss the ethical dilemmas nurses face in humanitarian crises and explore the decision-making processes involved.
• Evaluate the role of telehealth in global health nursing and its potential to expand healthcare access in remote areas.

Global health nursing is a dynamic and vital field that allows nursing students to make a meaningful difference in the lives of individuals and communities worldwide. As you embark on your journey in global health nursing, remember that your passion and dedication can contribute to reducing health disparities, improving healthcare access, and promoting health equity on a global scale. Whether you choose to pursue PICOT questions, EBP projects, capstone projects, research papers, or essays in this field, your efforts can bring about positive change. We encourage you to explore these topics and ideas to inspire your academic and professional endeavors. If you need assistance with your writing assignments, don’t hesitate to seek our writing services to support your success in global health nursing. Together, we can create a healthier world for all.

• Why is global health nursing important? Global health nursing is important because it addresses healthcare disparities, promotes health equity, and provides healthcare to underserved populations worldwide, contributing to better health outcomes for all.
• Why is global health important? Global health is crucial because it recognizes that health challenges transcend national borders, emphasizing the interconnectedness of health worldwide. It seeks to improve health globally and ensure that all individuals have access to healthcare and live healthy lives.
• What is the role of globalization in healthcare? Globalization in healthcare refers to the interconnectedness and interdependence of healthcare systems, professionals, and patients across borders. It facilitates the sharing of medical knowledge, technology, and resources, which can lead to improved healthcare access and outcomes.
• Which concept describes healthcare globalization? Healthcare globalization is often described as the process of healthcare systems, services, and practices becoming increasingly integrated and interconnected globally.

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Health Policy

Pursuing policies that improve the public health, including health economics, health services, advocacy, and preparedness

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 Explore the latest public health research and insights about health policy.

Summer Institute in Data to Policy

Registration now open for courses in strategic leadership, youth engagement, policy analysis, resource management, and evaluation of programs and/or research.

The Omnipresence of PFAS—and What We Can Do About Them

PFAS—also known as “forever chemicals”—are everywhere, but we don’t yet know the extent of their damage to the environment, or our health.

Student Spotlight: Glendedora Dolce

For graduate students who are passionate about putting research and policy recommendations into action, the Johns Hopkins Health Policy Institute (HPI) is an invaluable experience. Among the Spring 2024 HPI Fellows is Glendedora Dolce, now in her second year as a Health and Public Policy doctoral student. Glendora's research aims to prevent injuries, illnesses, and health disparities as it pertains to child passenger safety.

HOPE Challenge: Heart of the Matter Recap

In observance of American Heart Month, HPM’s Hopkins Center for Health Disparities Solutions (HCHDS) hosted discussions with leading policy and medical experts about equity in cardiovascular health and how to advance policies that can positively change the health destinies of marginalized communities in the U.S. today and for generations to come.

Health Policy Analysis Webinar Series Brings Together Global Health Policy Scholars

The health policy analysis webinar series was launched in April 2020 with the aim of holding research and policy discussions around global health policy issues.

HPM Faculty Member Jeromie Ballreich, PhD, MHS, testifies before House Ways and Means Committee

On Tuesday, February 6, Jeromie Ballreich, PhD, testified before the House Ways and Means Committee, addressing the critical issue of chronic drug shortages in the United States. He highlighted the complexity of factors contributing to shortages and proposed four policy solution sets for Congress to consider.

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Health Policy Faculty Experts

 Looking for prominent public health experts in the field of health policy? They’re here at the Bloomberg School of Public Health.

Joshua M. Sharfstein

Joshua Sharfstein, MD, works to develop and promote public health strategies, healthcare payment approaches, and regulatory policies that advance health and equity.

Rajiv N. Rimal

Rajiv N. Rimal, PhD, MA, works globally on social and behavior change interventions with a focus on women and children’s nutrition and well-being. He adopts a social norms-based approach to address health inequities in low- and middle-income countries.

Gerard Anderson

Gerard Anderson, PhD, works with policymakers to control health care spending.

Albert Wu, MD, MPH, studies the impact of safety problems on patients and health care workers.

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Upcoming Events

Addressing health care's carbon footprint: a conversation with u.s. health and human services secretary xavier becerra, special conversation with former u.s. surgeon general dr. antonia novello, project learning in the context of wicked problems: a 40-year case study of health systems strengthening in uttar pradesh, india, global health symposium: funding restructuring and resource distribution in global health, global health symposium day 2: student poster presentations.

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Global health security news, resources and funding for global health researchers

Fogarty and NIH are committed to improving global health security by building the capacity of countries to address public health threats, health emergencies and infectious disease outbreaks.

Scientists world-wide must work together to stop epidemics early and at the source. Programs supported by Fogarty develop infectious disease research capacity, provide training in countries with little or no infrastructure, and link scientists to a global network of experts. The training provided to health care workers, doctors and researchers requires a relatively modest investment, but could provide the tools countries need to halt disease outbreaks in their tracks, possibly preventing the need for large-scale emergency efforts like the ones assembled to fight recent Ebola and Zika virus outbreaks.

The National Institute of Allergy and Infectious Diseases (NIAID) leads NIH infectious disease research , included research related to biodefense and emerging infectious diseases .

Recent News

• Coronavirus news, funding and resources for global health researchers compiled by Fogarty
• Joint Update by the Department of State and the Department of Health and Human Services on Negotiations Toward a Pandemic Accord HHS Factsheet, March 29, 2024
• Designing a new antibiotic to combat drug resistance NIH Research Matters , March 12, 2024
• The risk of mpox importation and subsequent outbreak potential in Chinese mainland: a retrospective statistical modelling study , co-authored by Fogarty’s Kaiyuan Sun Infectious Diseases of Poverty , February 29, 2024
• Synchrony of Bird Migration with Global Dispersal of Avian Influenza Reveals Exposed Bird Orders , co-authored by Fogarty’s Nidia Trovão Nature Communications , February 6, 2024
• Comparative evolution of influenza A virus H1 and H3 head and stalk domains across host species , co-authored by Fogarty’s Nidia Trovão and Joshua Cherry mBio , January 16, 2024

NIH News and Resources

• National Institute of Allergy and Infectious Diseases (NIAID) on biodefense and emerging infectious diseases
• NIH Public Health Emergency and Disaster Research Response (DR2) - a pilot program developed by the National Institute of Environmental Health Sciences (NIEHS) in collaboration with the National Library of Medicine (NLM)

Other US Government Resources

• White House
• National Biodefense Strategy and Implementation Plan for Countering Biological Threats, Enhancing Pandemic Preparedness, and Achieving Global Health Security [PDF] , published October 2022
• United States Government Global Health Security Strategy 2021 [PDF] , published October 2021
• Department of Health and Human Services
• About the Global Health Security Agenda from HHS
• Global Health Security Agenda , a partnership of nations, international organizations and non-governmental stakeholders
• Public health emergency information from the HHS Assistant Secretary for Preparedness and Response
• Centers for Disease Control and Prevention (CDC)
• CDC and the Global Health Security Agenda
• Emerging Infectious Diseases from CDC
• National Center for Emerging and Zoonotic Infectious Diseases at CDC
• Office of Public Health Preparedness and Response at CDC
• Department of Homeland Security National Biodefense Analysis and Countermeasures Center
• Department of State information on International Health and Biodefense
• Federal Emergency Management Agency (FEMA) Ready.gov

Other Online Resources

• Coalition for Epidemic Preparedness Innovations (CEPI)
• World Health Organization (WHO):
• Emergency and disaster risk management for health
• Strengthening health security by implementing the International Health Regulations (IHR)

Updated April 16, 2024

Spotlight on Global Health Research

Students and trainees present a broad range of projects in global health at annual showcase.

“Global Health Research Day is a wonderful opportunity to showcase the amazing work that our students and trainees are doing around the world in collaboration with Brown faculty and their international partners,” Adam Levine, MD, MPH, director of Brown’s Global Health Initiative, says. “It’s also an opportunity to bring together global health researchers and teachers from across BioMed to help build new interdisciplinary collaborations.”

Seth F. Berkley ’78 MD’81, P’27MD’31, senior adviser to the Brown University Pandemic Center and longtime leader in worldwide efforts to expand vaccination access, spoke about issues of scale and equity in global health at this year’s keynote address. Mukesh K. Jain, MD, dean of medicine and biological sciences, and Levine presented the inaugural Susan Cu-Uvin Global Health Leadership Award to Professor of Obstetrics and Gynecology Susan Cu-Uvin, director of the Providence/Boston Center for AIDS Research Leadership Committee.

“With 15 million HIV-exposed but unaffected children globally, and 1.5 million HEU children born annually, there is a great global health importance in prioritizing research for this vulnerable group in order to recognize the risk factors and then develop interventions to mitigate them,” Dogon says.

Giovanna De Luca, MD, MS, a global emergency medicine fellow, explains her study, Emergency Department Visits by Pediatric Refugees in the State of Rhode Island. The research reviewed charts conducted between April 2015 and July 2023 from Lifespan hospital emergency departments. It identified 483 visits from refugee patients under 18 years old, who spoke 22 different languages. The study demonstrated the complexities with demographics, linguistics, and geographic factors that influence health care patterns.

Research by Akshay Amesur ’24 MD’28, titled Dose for Development, focused on factors that have limited pharmaceutical innovation in India and China, two key low- and middle-income countries and the world’s largest pharmaceutical manufacturers. Amesur showed that political economy and academic infrastructure were the strongest determinants of pharmaceutical innovation, and that government intervention must take on risks with funding research and development expenditures and incentives to foster advancements in drug innovation.

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Biodiversity is key to the mental health benefits of nature

New research from King's College London has found that spaces with a diverse range of natural features are associated with stronger improvements in our mental wellbeing compared to spaces with less natural diversity.

Published in Scientific Reports and funded by the National Institute for Health and Care Research (NIHR) and Wellcome, this citizen science study used the smartphone application Urban Mind to collect real-time reports on mental wellbeing and natural diversity from nearly 2000 participants.

Researchers found that environments with a larger number of natural features, such as trees, birds, plants and waterways, were associated with greater mental wellbeing than environments with fewer features, and that these benefits can last for up to eight hours.

Further analysis found that nearly a quarter of the positive impact of nature on mental health could be explained by the diversity of features present. These findings highlight that policies and practices that support richness of nature and species are beneficial both for environment and for public mental health.

Lead author Ryan Hammoud, Research Assistant at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, said:

"To our knowledge, this is the first study examining the mental health impact of everyday encounters with different levels of natural diversity in real-life contexts. Our results highlight that by protecting and promoting natural diversity we can maximise the benefits of nature for mental wellbeing. In practice, this means moving away from heavily curated monocultural pockets and parks of mown grass, which are typically associated with low biodiversity, towards spaces which mirror the biodiversity of natural ecosystems. By showing how natural diversity boosts our mental wellbeing, we provide a compelling basis for how to create greener and healthier urban spaces."

The study took place between April 2018 and September 2023, with 1,998 participants completing over 41,000 assessments. Each participant was asked to complete three assessments per day over a period of 14 days, entering information about their environment and answering a series of questions about their mental health. Natural diversity was defined by how many out of four natural features -trees, plants, birds and water -- were present within the participant's surrounding environment.

Data were collected using the Urban Mind app, developed by King's College London, landscape architects J&L Gibbons and arts foundation Nomad Projects. The Urban Mind project is funded by a Wellcome Climate Impacts Award to Professor Andrea Mechelli, the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre and the NIHR Applied Research Collaboration South London.

Senior author Andrea Mechelli, Professor of Early Intervention in Mental Health at the IoPPN, said:

"In the context of climate change, we are witnessing a rapid decline in biodiversity in the UK as well as globally. Our results suggest that biodiversity is critical not only for the health of our natural environments but also for the mental wellbeing of the people who live in these environments. It is time to recognise that biodiversity brings co-benefits for planetary and human health and needs to be considered vital infrastructure within our cities."

'Smartphone-based ecological momentary assessment reveals an incremental association between natural diversity and mental wellbeing' by Hammoud, R. et al. is published in Scientific Reports. DOI : 10.1038/s41598-024-55940-7

• Mental Health
• Child Psychology
• Evolutionary Biology
• Endangered Plants
• Biodiversity
• Rainforests
• Groundwater
• Chloroplast
• Origin of life
• Conservation ethic
• Natural gas
• Conservation biology

Story Source:

Materials provided by King's College London . Note: Content may be edited for style and length.

Journal Reference :

• Ryan Hammoud, Stefania Tognin, Michael Smythe, Johanna Gibbons, Neil Davidson, Ioannis Bakolis, Andrea Mechelli. Smartphone-based ecological momentary assessment reveals an incremental association between natural diversity and mental wellbeing . Scientific Reports , 2024; 14 (1) DOI: 10.1038/s41598-024-55940-7

Cite This Page :

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