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Commentary
Is it about the ‘where’ or the ‘how’? Comment on Defining global health as public health somewhere else
  1. Sara Elisa Fischer1,
  2. Poorvaprabha Patil2,
  3. Chris Zielinski3,
  4. Lori Baxter4,
  5. Francisco Javier Bonilla-Escobar5,6,7,
  6. Shabina Hussain8,
  7. Claudia Lai9,
  8. Sarah Catherine Walpole10,
  9. Francis Ohanyido11,
  10. David Flood12,
  11. Ambrish Singh13,14,
  12. Najeeb Al-Shorbaji15
  1. 1Department of Government, Georgetown University, Washington, District of Columbia, USA
  2. 2Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  3. 3Centre for Global Health, University of Winchester, Winchester, Hampshire, UK
  4. 4Program Quality and Impact, Save the Children, Phnom Penh, Cambodia
  5. 5Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  6. 6Servicio de Oftalmologia, Grupo de Investigación en Salud Ocular, GISOC-UV, Universidad del Valle, Cali, Colombia
  7. 7SCISCO Foundation/ Fundación SCISCO, Science to serve the community, Cali, Colombia
  8. 8Mountlake Terrace, Washington, USA
  9. 9School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
  10. 10Infectious Diseases Department, Newcastle Hospitals, Newcastle upon Tyne, United Kingdom
  11. 11West African Academy of Public Health, Abuja, Nigeria
  12. 12Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
  13. 13Evidence League, Delhi, India
  14. 14Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  15. 15Jordan Library and Information Association, Amman, Jordan
  1. Correspondence to Sara Elisa Fischer; sf791{at}georgetown.edu

https://doi.org/10.1136/bmjgh-2020-002567

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    Summary box

    • The original commentary by King and Koski makes many important points, but we feel that the definition they provide, suggesting that the field is distinguished by the geographical relationship between practitioners and recipients, is too limiting.

    • We propose an alternative definition of global health as public health everywhere, which takes into account the ‘how’ as well as the ‘where’, and we urge readers to emphasise equity in addition to geography.

    • In our global health ecosystem, health problems, and the people who experience, prevent, solve and study them, are interconnected and cross national boundaries.

    • Good governance, increasing use of local expertise, locally appropriate sustainable technologies and knowledge exchange programmes across countries and communities can all play an important role in delivering public health everywhere.

    Introduction

    A recent commentary by King and Koski1 proffers a parsimonious definition of global health: as ‘public health somewhere else’ (emphasis in original). The authors describe how this definition highlights the underlying assumptions and normative issues that emerge when considering the practice of public health outside one’s home community. While we agree with many of the points made by the authors, we feel as though this was a missed opportunity to push the definition of global health forward applying systems thinking. This commentary first addresses the points of convergence and divergence with the original article’s main arguments. We then suggest why the definition presented does not do justice to the dynamism of global health. Finally, we conclude with a revised definition and discussion on what such a definition should encompass.

    Why practise somewhere else?

    The authors raise relevant and justifiable concerns regarding some common assumptions among global health practitioners. First, we agree that the oft-assumed ‘expertise gradient’ is problematic and maintains an ill-conceived notion of the foreign expert. This presumes that global health is practised by foreign experts in distant …

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