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Redefining global health and shifting the balance: the ARC-H principle
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  • Published on: 24 April 2024
    Pragmatism has its place in qualifying the use of 'global health'
    • Anisa J N Jafar, ST7 Emergency Medicine & Houghton Dunn Fellow Royal Manchester Children's Hospital & HCRI, University of Manchester, Manchester, UK
    • Other Contributors:
      • Anthony D Redmond, Emeritus Professor of International Emergency Medicine
      • Rob Mitchell, Consultant in Emergency Medicine
      • Shama D Patel, Assistant Professor in Emergency Medicine

    We would like to thank Professor Holst for taking the time to read and respond to our article. Indeed, in developing the piece, we read with great interest Professor Holst’s 2020 article on emergence, hegemonic trends and biomedical reductionism in global health. We acknowledge that global health is a broad and complex field, and ongoing discourse around terminology is welcome and encouraged.

    As Professor Holst himself states, “the predominant Global Health concept reflects the inherited hegemony of the Global North”.(1) With this is mind, we sought in our paper to articulate a practical interpretation of global health that emphasises the critical barriers to universal health coverage and optimal health outcomes. The challenges of access, resource and context limitation are global in nature, and do not relate exclusively to the provision of “humanitarian aid”. We agree with Professor Holst that addressing these issues requires trans-national solutions and multi-sectoral engagement.

    In articulating the ARC-H principle, we acknowledge that we have applied a “clinical-biomedical” frame. This reflects our work as emergency physicians who have borne witness to the direct and indirect consequences of access-, resource- and context-limited healthcare. Our interpretation is pragmatic, and deliberately serves to emphasise the expertise and lived experience of ARC-H populations.

    In no way do we seek to minimise the social, environmental, political and commer...

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    Conflict of Interest:
    All authors wrote the original article
  • Published on: 11 March 2024
    Sacrificing globalism on the altar of decolonisation
    • Jens Holst, Professor Fulda University of Applied Sciences

    Recently, in BMJ Global Health, Nasir Jafar and colleagues made another attempt to redefine 'global health'. They aim for 'greater clarity and precision' in a pragmatic and more inclusive sense, with the noble objective '‘to offload colonial vestiges present within the field and terminology of ‘global health’.‘ While this goal is undoubtedly right, important and overdue, the argument is alarmingly unconvincing and narrow. In their attempt to redefine, or rather reinterpret, global health, the authors make two important restrictions. Their proposal is based on an understanding of global health that is limited not only to a single country, but also to the field of humanitarian aid. Health emergencies and relief are only part of global health, so reducing the latter to humanitarian aid is absolutely unacceptable. It blatantly neglects both the meaning of "global" as "universal" and the complexity of global health as an explicitly political concept.

    The second, unacceptable limitation is the authors' narrowing of global health to healthcare and healthcare systems. It may be that a clinical-biomedical understanding dominates the theory and practice of global health, but the call for an a posteriori recognition of pragmatic development should not distract from the fact that global health is much more complex, encompassing the social, environmental, political and commercial determination of health, as well as inequalities...

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    Conflict of Interest:
    None declared.