Elsevier

The Lancet

Volume 372, Issue 9654, 6–12 December 2008, Pages 1988-1996
The Lancet

Fast track — Health Policy
Global public health: a scorecard

https://doi.org/10.1016/S0140-6736(08)61558-5Get rights and content

Summary

Global health is attracting an unprecedented level of interest. In this paper, we summarise recent trends and identify the unfinished and new agendas in global public health. We propose a global public health scorecard as a simple way to assess progress and suggest actions by public health practitioners and their organisations for improving the effectiveness of public health. Although we find many recent positive developments in global health, the potential for global cooperation and progress is still largely untapped. Compared with other components of development, health improvement should easily foster global cooperation; strong advocacy and political will are keys to continuing progress. We view global public health as a barometer of more general development. Our responses to the current health challenges are at the forefront of the global struggle for survival.

Introduction

The midpoint for achieving the Millennium Development Goals (MDGs), the framework for health development, is a good time to review global progress in public health, especially in the context of unprecedented interest in matters of global health (panel 1).1 This article is based on the Cochrane Lecture delivered to the Society for Social Medicine, Southampton, Sept 17, 2008.

In this paper, and stimulated by Archie Cochrane's ability to synthesise and simplify complex health issues (panel 2),2 we explore the achievements of public health from a global perspective by summarising recent progress in global public health, identifying the unfinished and the new global agendas for public health, developing a scorecard for global public health to measure progress, and suggesting ways of improving the effectiveness of public health.

Section snippets

What is global public health?

Global public health is the collective action we take worldwide for improving health and health equity,3 aiming to bring the best available cost-effective and feasible interventions to all populations and selected high-risk groups. Essential collective actions for health improvement include disease prevention, health promotion, health protection, and the provision of health care. There are many frameworks for global public health: health security, foreign policy, economic development, charity,

Recent trends

A snapshot of global health status (panel 3) suggests that there is much to celebrate in global health progress, but also there are areas of concern. Figure 1 summarises global trends in life expectancy at birth, a simple index of progress, for the past half century. Substantial improvements are apparent, especially in low-income and middle-income countries with low mortality, such as China. The convergence between these countries and high-income countries is striking. So too is the fact that

The unfinished agenda: the MDGs

Recent encouraging trends in the control of infectious disease and reductions in child mortality have been driven, in part, by the MDGs (panel 1). Achievement of the three health MDGs by the target date of 2015 represents the unfinished agenda of global public health. Although progress is being made, for example, impressive poverty alleviation in China (but not in India), it is variable and is threatened by new crises, involving factors ranging from fuel to food; the number of people living in

The new agenda

The new agenda for global public health includes the rising burden of chronic non-communicable diseases, global environmental changes, and the underlying socioeconomic determinants of health. These issues are not yet firmly on the global agenda possibly because they were not part of the discussions taking place in the run up to the Millennium Declaration.20

A global scorecard for public health

Our first assessment of the state of global public health 10 years ago suggested that public health was at a crossroad.42 Despite substantial and unappreciated achievements over the second half of the 20th century, we were cautiously optimistic that public health practitioners were beginning to embrace the full breadth of the challenges that were then apparent.

We believe that this optimism was justified. Here we summarise, in the style of Cochrane, the current situation with a scorecard that

Improving the effectiveness of public health: next steps

The next steps in the development of the scorecard are the agreement on the criteria for a more formal measurement of status and progress, development of national scorecards for public health, which could feed into regional scorecards, and finally the development of a more sophisticated global scorecard based on the regional and national scorecards. WHO, in consultation with member states and non-governmental organisations such as the Institute for Health Metrics and Evaluation, could assume

Conclusion

Progress in global public health has been substantial in the past decade; this is not surprising given the level of interest from G8 countries, development agencies, and foundations. Most of the progress has been around specific issues, although the recent prominence of global environmental changes and the underlying determinants of health and health equity augur well for a broader public health approach to global health.4 The eradication of poverty and extreme hunger and the reduction in

References (70)

  • P Asaria et al.

    Population-wide interventions to prevent chronic diseases

    Lancet

    (2007)
  • SS Lim et al.

    Preventing chronic disease in high-risk individuals: health impact and costs

    Lancet

    (2007)
  • R Beaglehole et al.

    Prevention of chronic diseases: a call to action

    Lancet

    (2007)
  • A Haines et al.

    Policies for accelerating access to clean energy, imporivng healh, advancing development, and mitigating climate change

    Lancet

    (2007)
  • R Beaglehole et al.

    Public health at the crossroads: which way forward?

    Lancet

    (1998)
  • G Silberschmidt et al.

    Creating a committee C of the World Health Assembly

    Lancet

    (2008)
  • R Horton

    Health as an instrument of foreign policy

    Lancet

    (2007)
  • L Donaldson et al.

    Health is global: proposals for a UK Government-wide strategy

    Lancet

    (2007)
  • R Beaglehole et al.

    Improving the prevention and management of chronic disease in low- and middle-income countries: a priority for primary health care

    Lancet

    (2008)
  • LC Chen

    Philanthropic partnership for public health in India?

    Lancet

    (2006)
  • CJL Murray et al.

    Health metrics and evaluation: strengthening the science

    Lancet

    (2008)
  • MR Reich et al.

    Global action on health systems: a proposal for the Toyako G8 summit

    Lancet

    (2008)
  • D Woodward et al.

    Reducing poverty sustainably, in a carbon-constrained future

    Lancet

    (2008)
  • R MacDonald et al.

    Global health and the G8—is power just too sweet to share?

    Lancet

    (2008)
  • Health in the Millennium Development Goals

  • AL Cochrane

    Effectiveness and efficiency: random reflections on health services

    (1972)
  • World health statistics 2008

    (2008)
  • World population prospects: the 2006 revision

    (2007)
  • Murray CJL, Kulkarni SC, Michaud C, et al. Eight Americas: investigating mortality disparities across races, counties,...
  • CM Mathers et al.

    Projections of global mortality and burden of disease from 2002 to 2030

    PLoS Med

    (2006)
  • Mathers CD, Bonita R. Current global health status. In Beaglehole R, Bonita R, eds. Global public health, 2nd edn....
  • D Stuckler

    Population causes and consequences of leading chronic diseases: a comparative analysis of prevailing explanations

    The Millbank Quarterly

    (2008)
  • AIDS epidemic update: December 2007

    (2007)
  • New data show 1·4 billion live on less than US$1·25 a day, but progress against poverty remains strong

  • The Millennium Development Goals report

  • Cited by (0)

    View full text