What does global health mean at the beginning of the 21st century? What is it aiming to do? What does it mean in terms of practice and the way that we understand things?

A lot of the time when we think about health and healthcare policy, we imagine that it happens at the national or domestic level. A country makes its own healthcare policy and expects that this will impact the health of its citizens. More recently, however, due to increased globalisation, we’ve come to realise that people’s health outcomes are affected by different things happening around the world.

A lot of people use “global health” as a euphemism for “health in developing countries”. This is not a good use of the term. We need to focus more on the idea of the transnational aspects of health and to understand that there are transnational actors now that never existed before.

In the 1950s, following the set-up of the United Nations in 1945, the only transnational entities were nation-states. Those were the only entities that were recognised across national borders and which had legal standing. Today, we have many more entities such as international NGOs that are incredibly powerful and spread across many countries. We have enormous transnational corporations that are more powerful and have access to more resources than many countries. We also have profoundly influential individuals such as philanthropists who can move countries and international institutions. And we have political organisations spanning multiple countries and movements. All these entities have a role to play in the causation and distribution of disease in different countries, and in being able to regulate and address these problems.

To only focus on this euphemistic notion of global health as “health in other places” (usually distant, poor countries) is both a profound misunderstanding and a lost opportunity. What we really need to be thinking about is global health at this new level of transnational interactions, and how that influences health inequalities in countries.

The ethics that come with this rising prevalence of infectious diseases within and across countries is at a very nascent stage. That’s because all our ethics before have been about chronic diseases, doctor-patient relationships and how we deal with different health policies and health inequalities.

The rise of infectious diseases transforms our ethics because infectious diseases are spread through social interactions. It’s not about a disease randomly affecting people but about how individuals interact with one another. At a very fundamental level, infectious diseases raise questions about how we treat one another in a more ethical way so that we can protect everyone’s health.

There are also profound ethical challenges. Who is going to control infectious diseases and how? What sort of resources do they have? Is the solution going to be a therapy or a vaccine? Who will produce those therapies and vaccines and who will be able to access them? Will international institutions be able to co-operate in order to contain an epidemic, think about solutions such as vaccines and therapies and make sure everyone has access to them? None of these are scientific questions. They are deeply political and concern ethical choices that countries have to make.

If we look around the world, not every country has had the same experience with the spread of COVID within its borders. Some countries have succeeded in controlling it. Others, including those we thought would be the best-performing countries, have failed. In a way, it’s a natural experiment in which we have exposed the world to COVID to see how countries would respond. What we know is that how COVID has spread within countries is very much determined by the policies that were implemented by national governments and their experts, and by the values that were expressed or neglected in those policies. All of those things together shape the course that the epidemic has taken across different societies. There is no way to call this a natural disaster when it’s very clear that the social, political and economic system determines how the epidemic has spread within your country.