Department for International Health Sciences; Institute for Social Medicine, Epidemiology and Health Economics; Charité - University Medical Center, Berlin, Germany.
Global Health. 2010 Oct 28;6:19. doi: 10.1186/1744-8603-6-19.
Current definitions of 'global health' lack specificity about the term 'global'. This debate presents and discusses existing definitions of 'global health' and a common problem inherent therein. It aims to provide a way forward towards an understanding of 'global health' while avoiding redundancy. The attention is concentrated on the dialectics of different concepts of 'global' in their application to malnutrition; HIV, tuberculosis & malaria; and maternal mortality. Further attention is payed to normative objectives attached to 'global health' definitions and to paradoxes involved in attempts to define the field.
The manuscript identifies denotations of 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic'. A fourth concept of 'global' as 'supraterritorial' is presented and defined as 'links between the social determinants of health anywhere in the world'. The rhetorical power of the denotations impacts considerably on the object of 'global health', exemplified in the context of malnutrition; HIV, tuberculosis & malaria; and maternal mortality. The 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic' house contradictions which can be overcome by the fourth concept of 'global' as 'supraterritorial'. The 'global-local-relationship' inherent in the proposed concept coheres with influential anthropological and sociological views despite the use of different terminology. At the same time, it may be assembled with other views on 'global' or amend apparently conflicting ones. The author argues for detaching normative objectives from 'global health' definitions to avoid so called 'entanglement-problems'. Instead, it is argued that the proposed concept constitutes an un-euphemistical approach to describe the inherently politicised field of 'global health'.
While global-as-worldwide and global-as-transcending-national-boundaries are misleading and produce redundancy with public and international health, global-as-supraterritorial provides 'new' objects for research, education and practice while avoiding redundancy. Linked with 'health' as a human right, this concept preserves the rhetorical power of the term 'global health' for more innovative forms of study, research and practice. The dialectic approach reveals that the contradictions involved in the different notions of the term 'global' are only of apparent nature and not exclusive, but have to be seen as complementary to each other if expected to be useful in the final step.
目前的“全球健康”定义缺乏对“全球”一词的具体说明。本次辩论提出并讨论了“全球健康”的现有定义以及其中所固有的一个共同问题。其目的是提供一种理解“全球健康”的方法，同时避免重复。重点关注不同“全球”概念在应用于营养不良、艾滋病毒、结核病和疟疾以及产妇死亡率方面的辩证关系。此外，还关注与“全球健康”定义相关的规范性目标以及定义该领域时所涉及的悖论。
本文确定了“全球”的外延意义，包括“全世界范围的”、“超越国界的”和“整体的”。提出并定义了第四个“全球”概念，即“全球范围内的联系”，指的是世界任何地方的健康决定因素之间的联系。外延意义的修辞力量对“全球健康”的对象产生了重大影响，这在营养不良、艾滋病毒、结核病和疟疾以及产妇死亡率的背景下得到了体现。作为“全世界范围的”、“超越国界的”和“整体的”的“全球”存在矛盾，这些矛盾可以通过第四个概念“全球范围内的联系”来克服。所提出的概念中固有的“全球-地方关系”与有影响力的人类学和社会学观点一致，尽管使用了不同的术语。同时，它可以与其他关于“全球”的观点结合使用，或者修正明显矛盾的观点。作者主张将规范性目标从“全球健康”定义中分离出来，以避免所谓的“纠缠问题”。相反，作者认为，所提出的概念构成了一种非委婉的方法，用于描述“全球健康”这一固有的政治化领域。
虽然“全球即全世界范围的”和“全球即超越国界的”是误导性的，并且与公共卫生和国际卫生产生了重复，但“全球即全球范围内的联系”为研究、教育和实践提供了“新”的对象，同时避免了重复。与“健康是一项人权”联系起来，这个概念保留了“全球健康”一词的修辞力量，为更具创新性的研究、研究和实践形式提供了支持。辩证方法表明，该术语“全球”的不同概念所涉及的矛盾只是表面的，而不是排他性的，但如果期望在最后一步有用，就必须将它们视为相互补充。
