Definition

The international health service is a system of health institutions that provide health services to people living in different regions, continents, or around the world. The essential function of the international health service is to produce international public goods that transcend the borders of any given nation.

Basic Characteristics

Challenges of Globalization

Globalization is the process of increasing economic, political, and social interdependence, and global integration, which occurs as capital, traded goods, people, concepts, images, ideas, and values diffuse across national boundaries (Taylor 2002).

Globalization has eroded national borders, making countries increasingly dependent on international trade. Even in the field of health, we are witnessing the worldwide distribution of both infective and non‐communicable diseases, so that countries are facing similar health problems. Furthermore, global environmental threats pose a challenge to human health; e. g. ozone layer depletion has led to an increase in the incidence of skin cancer; and land degradation, air and water pollution, and the greenhouse effect are indirectly affecting health through various environmental alterations. Among the most powerful global forces are liberalization of trade, especially of harmful legal products such as tobacco, which has resulted in an increase in tobacco‐related deaths worldwide; international transfer of illegal drugs (heroin, cocaine); and diffusion of medical technologies (which may have adverse health effects). Finally, numerous health problems occur as a consequence of population migrations, either due to war, environmental crisis, or economic collapse, and the increasing number of people traveling internationally every year contributes to the international spread of various diseases (Frenk et al. 1997).

As a consequence of globalization, governments of both developed and developing countries are turning to international cooperation to attain national public health objectives and improve the health status of their populations. The implementation of international laws can provide a legal foundation for international health commitments, financial and technical assistance, information exchange, scientific research, and surveillance worldwide ( global health policy).

Global Trade in Health Services

Global trade in health services is the union of several global processes occurring in globalization that impact on health services (UNCTAD 1997; Chanda 2001; European Commission 2001). Global trade in health services is manifested in several ways.

First, it is reflected in the growing cross-border delivery of health services, both via traditional mail channels, and by electronic services or  telehealth. The main idea of  telemedicine was to provide health care to remote populations and to improve the quality of diagnosis and treatment, but the lack of supporting technology and infrastructure at present makes it ineffective in many developing countries.

Another global phenomenon is movement of personnel and consumers from one country to another. Consumers are moving to the countries that provide the best, safest, or cheapest service for diagnosis and treatment. Health care providers are moving around the world, seeking the best education, employment, or career opportunities. This global trade of people, services, and foreign investments has induced the establishment of many collaborative arrangements in health care – hospitals, clinics, and diagnostic and treatment centers, which can provide expensive and specialized medical services. Theoretically, this kind of trade should have improved health systems, but it might result in the development of a dual market, consisting of expensive health centers providing higher‐quality health services to wealthy nationals and foreigners, and much lower quality, resource‐constrained centers providing health services to the poor. The implications of global movement of health care providers can be both positive and negative. On one hand, transient mobility of health care providers certainly promotes exchange of knowledge among professionals, and upgrades skills and standards in the country of interest. However, a permanent outflow of health care providers presents a significant loss for the source country, both in the loss of highly trained personnel and loss of the public resources invested in their training (Chanda 2001).

Nevertheless, globalization is not to blame for all of these problems. It is the poor infrastructure, low standards, poor employment opportunities, loose health system, and low-quality health services in the source countries that cause global movement of consumers and health care providers. It is equally clear that, for many countries, some components of globalization, such as trade liberalization and technology transfer, could increase efficiency, welfare, and health. In general, a gradual and selective investment in human and physical resources in the health sector, implementation of health policies, and strengthening of health systems is a highly preferable path of globalization of developing countries (Cornia 2001).

Just as national health systems are facing reforms in the light of globalization, the world health system must reinvent itself to meet the challenges of the future. The essential function of international health services is to produce international public goods that transcend the borders of any given nation. Those functions, referring to prevention, diagnosis, and treatment of diseases of global importance, are listed in the Health information section (health information).

History of International Organizations

The first efforts to establish international health cooperation date from the mid-19th century, and the First International Sanitary Conference held in Paris in 1851. It was the first international convention organized in Europe to deal with the arrival and spread of pestilent diseases, particularly cholera, which was epidemic at that time. In 1902, the International Sanitary Bureau was established. This was the predecessor of the current Pan American Health Organization , an agency of the League of Nations, which was founded in Geneva in 1919. In 1945, three physicians, Drs. Szeming Sze of China, Karl Evang of Norway, and Geraldo de Paula Souza of Brazil, proposed the formulation of a single health organization that would address the health needs of the world's people. Their joint declaration to establish an international health organization was approved when the constitution of the World Health Organization (WHO) was adopted in 1946. April 7th 1948 was the date of implementation of the constitutional act of the WHO and has been celebrated as World Health Day ever since.

International Health Services Today

The WHO, through its six autonomous Regional Offices, is the leader in defining health goals in various regions of the world. In 1980, the Regional Office for Europe adopted a long-term European strategy “Health for All”, which was expanded in 1998 into the policy named “Health21 – health for all in the 21st century” (WHO 1998). The two main aims of this policy – health promotion and protection, and reduction of diseases – are to be fulfilled through twenty-one targets for health. Some of these targets are focused on health systems, their gradual orientation towards better health gain, equity and cost‐effectiveness, and the implementation of new policies and strategies based on the health for all principles. Equity, equality and solidarity in health development between and within countries are also supported. Other targets are more individual and oriented toward strengthening health throughout the life cycle; improving the physical, economic, social and cultural environment; and reducing diseases and injuries.

The WHO is dedicated to many international health programs:

  • Global Strategy on Diet, Physical Activity and Health , which was developed and adopted in the 2004 World Health Assembly – it was recognized that a few largely preventable risk factors account for most of the world's disease burden. This strategy intends to provide significant change in diet habits and physical activity levels worldwide.

  • Diabetes Action Now is a joint program of the WHO and the International Diabetes Federation. The overall goal is to raise awareness about diabetes and its complications, particularly in low- and middle‐income countries, and to stimulate effective measures for the surveillance, prevention, and control of diabetes.

  • The WHO Mental Health Policy Project is a comprehensive strategy to improve the mental health of the population using existing resources to achieve maximal benefits, to provide effective services to those in need, and to assist reintegration of people with mental disorders into community life.

  • The Countrywide Integrated Noncommunicable Diseases Intervention (CINDI) program was established in the European Region. It presently includes 27 participant countries. It was developed with the aim of reducing modifiable risk factors, such as smoking and high blood pressure, by integrating health promotion and disease prevention.

  • The Global School Health Initiative was established to increase the number of schools that can truly be called “Health-Promoting Schools”. The aim is to mobilize and strengthen health promotion and education activities at the local, national, regional, and global levels. The Initiative is designed to improve the health of students, school personnel, families, and other members of the community through schools.

  • The Healthy Cities Project was developed to support the solving of local problems in various communities. Whether the primary reason people convene involves children, environmental concerns, homelessness, safety, education, or other issues, the approach is to establish a collaboration among citizens and people from business, the government, and other sectors of society who recognize that their interconnection can be used to impact on the well-being of the entire community.

Critiques on the Work of International Health Organizations

Analysts criticize international health agencies for their bureaucracy, lack of coordination, and waste of resources, often leading to increased inequities and inequalities in health care (inequity in health, inequality in health) for the world's most vulnerable populations, instead of improving health. Furthermore, international health agencies are said to be neglecting the new global health challenges, not only new emerging diseases and health risks, but also issues regarding the development of new medical technologies, interventions and research, the design and implementation of information systems, the status and reforms of national health systems, consumers' health protection, etc. (Antezana 1997; Frenk 1997).

Given the rising trends in globalization, it is inevitable that a question on equity in access to health services occurs. It is often true that cost‐effective public health interventions do not reach the populations who need them. International agencies are constantly putting new conditions on governance, making their support dependent on implementation of patents, legislation, sanitary and veterinary norms, social clauses, etc.

Another critical failing in the work of international agencies is the implementation of health interventions in a way that is inadequate or unsuitable according to the epidemiological profile of the population. Due to the short-term funding of public health programs and rapid staff turnover in governments, donors and international agencies, and technical assistance groups, health interventions often have low coverage and do not contribute to the building of sustainable health systems (Victora et al. 2004).

Role of International Health Organizations in the 21st Century

Bearing all this in mind, the proposed role of the WHO in the 21st century is to (Antezana 1997):

  • Be the world's health conscience: be an advocate for health, advance global health equity, and identify policies and practices that are beneficial or harmful for health,

  • Provide leadership to a global alliance for health,

  • Provide technical cooperation, with special attention being given to the poorest countries and communities,

  • Establish global ethical and scientific norms and standards,

  • Perform global surveillance and establish early warning systems for transnational threats to health,

  • Initialize, undertake, and control global eradication, elimination, or control of selected diseases,

  • Promote innovation in science and technology for health,

  • Mobilize and be an advocate for resources for the poorest countries and communities.

European Community and Health Care

The activities of the European Community include a contribution to the attainment of a high level of health protection . The right to “Health Care” is described in the “Charter of Fundamental Rights of the European Union ”, agreed in Nice in 2000. This Right is defined as “Everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices”. The EU Committee on Health is very much concerned with the health systems of Member States, especially the flow of services, financing, quality of services, and education and training of professionals. Another important issue, yet not thoroughly developed, regulated, and implemented is cross-border health care. The EU Legislation and the Delivery of Services to Patients coordinates and regulates the delivery of health services between Member States (European Commission 2001).

Conclusion

Globalization, environmental changes, economic development, population explosion, urbanization, and changes in health care systems have increased the need for international health services. Some developing health systems are unable to provide even basic health services and they would certainly benefit from preventive health, public health care, and education as a means of addressing current health threats. In such cases, international health organizations play an important role in supporting governments, national health systems, communities, and individuals in promoting health and preventing disease, or providing educational, technical, or organizational assistance in diagnostics, treatment, and rehabilitation of diseases.

Cross-References

Consumer

Equality

Equity

EU Legislation and the Delivery of Services to Patients

Global Health Policy

Globalization

Global Trade in Health Services

Health Information

Health Systems

Inequality in Health

Inequity in Health

Telehealth

Telemedicine