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International Health

From the Chair | Robert E. Black

Robert BlackAs the world looks beyond the Millennium Development Goals of 2015, there is an active debate about future Sustainable Development Goals (SDG) with a longer time horizon. There must be continued focus on reducing mortality and improving health, although that is strangely being questioned. But it is clear that there are many areas deserving more attention, including universal health coverage, nutrition, sustainable agriculture, water availability and quality, land degradation, energy security, education, gender and poverty, and climate change. I am pleased that our department’s faculty have been leaders in some of these areas and are increasingly contributing in others, such as health coverage, air pollution and water.

The health systems research conference in Beijing, which featured so prominently many of our faculty, was a forum for discussion of universal health coverage as an SDG—in my mind a concept too oriented to medical care or payment for health services, rather than primary prevention or attention to the social determinants of health. As Richard Horton said in a comment in The Lancet following the conference: Shouldn’t we be focused on universal health, rather than health coverage?1

There is increasing attention to global environmental concerns, many of which need to be addressed urgently. However, there is less focus on the "built environment" than would seem due. Human-made settings increasingly dominate the planet. More than 70% of the populations of the Americas and Europe are urban. In Asia and Africa the populations are now 45% and 40% urban, respectively. These two regions are expected to have rapid increases in urbanization, accounting for 86% of the increase in urban populations and resulting in 4.5 billion people living in cities and towns in Asia and Africa by 2050. That date seems far away, but it is within the working lifetime of our students and younger faculty whose public health challenges will increasingly be urban ones.2

Injury causes substantial mortality and disability, and road safety is a critical issue in the built environment. Our International Injury Research Unit is playing a key role in the Bloomberg Global Road Safety Program, under the leadership of Prof. Adnan Hyder. The planned expansion of the work of the Unit into the urban environment with an interest in how to ensure safety and promote health will be led by our new faculty member, Asst. Prof. Kavi Bhalla. The contributions of the Unit have already been recognized by its status as a WHO Collaborating Center for Injuries, Violence and Accident Prevention, and it is gaining global recognition for its research and training activities. It is very much in keeping with the mission of our department that the Unit has a strong commitment to building capacity in low- and middle-income countries and is doing that successfully in over 15 countries. As with this example, our department will continue to reshape itself to meet current and future global needs.

1. Offline: The advantages of Universal Health. The Lancet. 2012. 380(9854): 1632. http://dx.doi.org/10.1016/S0140-6736(12)61932-1 

2. United Nations, Department of Economic and Social Affairs, Population Division: World Urbanization Prospects, the 2011 Revision: Press Release. New York, 2012. Released: 5 April 2012. http://esa.un.org/unpd/wup/index.htm