Exclusive Commentary: Public Health—Simultaneously Global and Local

Public health has always been both global and local. Today the need to understand this is more urgent than ever. For example, until very recently, Ebola was addressed as local, thus it was ignored too long as a major global health risk.  Everyone now knows that Ebola can fly from your home to mine in hours. But, even for Ebola, do we have methods and systems for prevention and treatment that can be implemented locally, anywhere on the globe? The answer, right now, is no.

Public health and public focus is placed on high impact threats that receive extensive media coverage. Yet the everyday public health threats such as diabetes and heart disease, lack of safe drinking water and inadequate food and shelter cause more harm over time. They are most often dealt with by local public health programs but are rarely addressed systemically as global public health issues.

Public health will be stronger and more responsive if we recognize that we share, across the globe, a potpourri of public health issues ranging from chronic illness, infectious diseases and unhealthy lifestyles to basic sanitation, adequate food and shelter, and access to health care.  In each of these cases, global public health expresses itself locally and requires resolution at both local and global levels. Public health systems and general approaches to prevention and effective treatments can and should be developed globally, but effective implementation must be carried out locally.

The sources of and solutions to these problems are the same—politics and policy, economics, and education. We often compete across nations in these public health arenas when cooperation is needed to effectively address today’s major public health problems. As public health practitioners, researchers, and academics, we must develop concepts and measures that encompass both the global and local attributes of every public health issue.

Public health is in need of a new paradigm that incorporates both global and local components. These changes are needed in practice, professional education, and research.  Within this new paradigm one would see global/local solutions as systemic. The focus would be on cooperation rather than competition. New measures and concepts must be developed for research and new approaches to the advancement and reward system for academics would be focused on cooperation. A true global/local public health system must be centered on respect and social justice for all. It also must be focused on outcomes, not money.

That would be the true paradigm shift.

—G. Marie Swanson, PhD, MPH, is Professor Emerita, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona.