A Parisian summer exploring global health

This intense programme, generously supported by the Circle U. European University Alliance, provided a platform to explore new ideas, think about alternative ways of doing things, and to collaborate with PhD students.

Unpacking health: metrics, economics and history

We started the week by asking "What is health?". This seemingly simple question unravelled into a complex exploration of definition and measurement. We grappled with the World Health Organization’s (WHO) definition of health, recognising it as a multidimensional concept encompassing physical, mental and social wellbeing. However, measuring these different areas presents a significant challenge. While physical health might be easier to quantify, mental and social health are far more complex.

The motivation behind measuring health is multifaceted: it allows us to identify specific population needs, estimate health improvement or deterioration, and compare different groups. We discussed various metrics, including the Quality Adjusted Life Year (QALY) and the Disability Adjusted Life Year (DALY).

Next, we learned about the efforts of figures like Brian Abel-Smith, who explored ways of "Paying for Health Services," and Archibald Cochrane, who championed combining clinical and economic cost-effectiveness in health system reforms. The 1993 World Bank report marked a significant turning point, advocating for direct government investment in health, tying health system development to economic growth.

The discussions around limited resources versus unlimited wants brought to light the inescapable reality of rationing in healthcare. Concepts like ‘utilitarianism’, ‘prioritarianism’ and ‘fair innings’ were introduced as ethical frameworks to justify the allocation of scarce resources, emphasising the critical choices that underpin healthcare decisions. We explored how factors like a father's education can profoundly impact a child's health, underscoring the deep-seated nature of health inequalities.

Global health challenges: from elimination to resistance

We were presented a compelling case study on Hepatitis C Virus elimination, demonstrating the journey from global public health agenda to local implementation. Interventions like mass screening, decentralised access to treatment, and nurse-led outreach clinics illustrated practical approaches to improving treatment coverage.

We then addressed the pressing issue of antimicrobial resistance, framing it as a failing infrastructure. We explored how factors like self-medication, incomplete diagnoses and poverty contribute to drug resistance, particularly in regions like East Africa, where non-prescription practices for sexually transmitted infections (STIs) are prevalent.

Beyond the biomedical: commercial determinants and decolonisation

A crucial and thought-provoking segment of the programme focused on the how commercial interests can affect people’s health (called commercial determinants of health, or CDH). We discussed how powerful businesses influence health and equity, often by using practices and pathways that oversimplify complex problems. Major risk factors for non-communicable diseases, such as tobacco use, unhealthy diets, and lack of physical activity, are often exacerbated by commercial interests.

The discussions on global mental health further challenged conventional approaches. We explored the limitations of universal diagnostic criteria in capturing the diversity of human experience, raising the critical question of whether global mental health, in its current form, can be perceived as a "colonial enterprise”. This led to a powerful call for acknowledging "other ways of knowing, being and doing" and prioritising the needs and perspectives of those living with mental health conditions in the Global South.

Perhaps one of the most impactful sessions critically examined the colonial roots of global health and the potential for new technologies to re-colonise the Global South. We meticulously traced the historical links between colonialism, medicine and concepts like "civilisation", revealing how practices like vaccinations and the establishment of hospitals were often intertwined with political and economic subjugation. The shift from "tropical medicine" to "global health" was presented not as a clean break, but as a continuity of power dynamics.

We then extended this critical lens to the digital age, warning of digital colonisation through economic impact, online advertising and the extraction of big data. The concentration of patents and intellectual property in the Global North, coupled with the reliance on cloud services and the rise of remote workers from the Global South, creates new forms of dependency and exploitation.

Environmental health and the way forward

Finally, we considered the dimension of environmental health. We discussed how factors like air, water and soil quality, chemical exposure, biodiversity loss, and climate change profoundly impact human health. The "plastic paradox" served as a stark example of how innovations designed to make our lives easier can lead to widespread pollution.

The call for integrating chemical exposure into non-communicable disease risk factors, and the need for local to global action to prevent, control and mitigate pollution, were clear takeaways. The idea of "planetary health" emerged as a holistic approach, recognising the interconnectedness of human health and the health of the planet.

My time at the Summer School was truly transformative. It provided a rich tapestry of perspectives on health economics, history and public health, while continuously emphasising the importance of learning how to be together and collaborate.