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PED20Supp. 4 10.1177/1757975913513116EditorialM. Pratt and M-C. Lamarre

Editorial The new world of global health Michael Pratt1 and Marie-Claude Lamarre2 Global health is often thought of as a discipline involving exotic diseases in faraway corners of the world. While this is at times true, the reality of global health today is that it often involves the same maladies, health behaviors, risk factors and social determinants of health that are found in the United States, France, and other wealthy countries. Heart disease, stroke, cancer, diabetes, and chronic lung disease have become the leading killers almost everywhere around the globe (1). The 2011 United Nations High Level Meeting on Non-Communicable Diseases (NCDs) brought this point forcefully home (2). The traditional view of global health also came with a traditional operating model. Money and expert technical assistance from high-income countries, global agencies, and non-governmental organizations (NGOs) were delivered to low and middle-income countries (LMIC) to solve their health problems for them, and in the best cases with them. This model had many notable successes such as smallpox eradication and control of cholera outbreaks. However, it was not uniformly characterized by building sustainable capacity within the targeted countries. Today, the rising burden of NCDs in LMIC requires different types of solutions and different approaches. The scale of the NCD epidemic and the complexity of its determinants do not lend themselves to episodic external solutions. Only by truly building capacity at home can LMIC stem the tide of NCDs. Of course, the same can be said for countries such as the United States where we have struggled with minimal success against rising rates of obesity and diabetes. In fact, success and failure in addressing NCDs can be found across all categories of countries and on all continents. We no longer live in a world where ‘North to South’ partnerships and learning are or should be the norm. However, frameworks for sharing experiences on disease prevention and health promotion are more easily discussed than achieved. A platform that allows multi-directional exchange of lessons learned, technical expertise, strategies, and policies is of

enormous value. What might such a platform look like? One version might look an awful lot like the cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the International Union for Health Promotion and Education (IUHPE). From 2002 to 2013 CDC and IUHPE worked together to address the challenges of global health promotion and disease prevention. A major goal of the cooperative agreement has been to increase public health capacity in LMIC through the development and implementation of health promotion strategies, collection, translation and dissemination of evidence-based knowledge and practice, infrastructure development, and empowerment of individuals and communities, valuing the assets they bring to improve health. Innovative new approaches to chronic disease prevention and health promotion have cropped up around the world and are spreading from regions and countries such as Brazil, Colombia, sub-Saharan Africa, and Cambodia to Europe, Australia, and North America to cite a few. In this special issue several examples are highlighted in which partnerships, networks, and global collaboration have facilitated this process by increasing the understanding of the underlying social causes of poor health (3), helping to build the case for action (4,5), focusing and delivering appropriate community interventions (6,7), and building the capacity in LMIC required to take action on NCDs (8,9). Appropriately, the work described in this special issue of Global Health Promotion and the authors of the papers come from Africa, Asia, and South America as well as Australia, Europe, and North America. An especially relevant example of global collaboration facilitated by the CDC IUHPE Cooperative Agreement – there were many others in a broad range of areas – comes from Latin America. The cooperative agreement was used as a platform to provide modest funding and logistic support to two regional networks – the Physical

1. Centers for Disease Control and Prevention. 2. International Union for Health Promotion and Education. Global Health Promotion 1757-9759; Vol 20 Supp. 4: 3­–5; 513116 Copyright © The Author(s) 2013, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975913513116 http://ghp.sagepub.com Downloaded from ped.sagepub.com by guest on March 25, 2015

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M. Pratt and M-C. Lamarre

Figure 1.  Consolidation of a global network for physical activity and public health courses with support from CDC and IUHPE. From ‘Capacity Building for the Promotion of Physical Activity’, a fact sheet produced by the University of los Andes, Bogota, Colombia, 2013.

Activity Network of the Americas (PANA, or the acronym in Spanish and Portuguese RAFA) and the Americas Chronic Disease Surveillance Network (AMNET). RAFA was launched with support from CDC and the Pan American Health Organization (PAHO) in 2001, and IUHPE starting in 2002. RAFA has catalyzed regional public health action on physical activity since then (10). RAFA and the CDC IUHPE Cooperative

Agreement served as an incubator out of which grew a model for physical activity and public health training courses that started in Brazil and now has a global span (Figure 1). Capacity building has also been a focus for AMNET. Public health systems in Latin America are wrestling with how to effectively address NCDs with limited resources while maintaining critical existing public health programs. Through the cooperative

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agreement AMNET has developed a distancebased NCD epidemiology and practice curriculum specifically for local health departments that are especially challenged by the double burden of infectious and chronic diseases, and limited staff and budget. CDC IUHPE support helped RAFA and AMNET bring together ministry of health staff, local public health professionals, and university researchers. While this mix introduces complexity into the networks, it also produces a rich environment for creative problem solving and advancing new dimensions of public health in Latin America with minimal resources. The need to maximize limited resources, provide high-quality training at low cost, and mobilize partnerships to move public health in new directions is obviously not limited to Latin America (11). RAFA served as a model for the rebirth of a European Physical Activity Network (HEPA – Health Enhancing Physical Activity), and the AMNET NCD curriculum and partnership model are being adapted for use in the US Pacific Territories that face very similar challenges to those of small public health jurisdictions in Latin America. As this special issue and editorial demonstrate, partnerships and networks are a key part of exchanging information, strategies and experiences for global health. Importantly, they usually do so in a way that emphasizes equity, shared governance, and the value of all members of the networks. However, networks and partnerships require maintenance and support to flourish. The benefits to any one member are rarely sufficient for that organization to ‘foot the bill’ for the network as a whole. For the last decade the CDC IUHPE Cooperative Agreement has provided a platform to sustain networks that have advanced public health in LMIC. The burden of NCDs in LMIC will continue to be a focus of global health in the coming years, and catalyzing shared approaches to meeting this challenge will be an important task for all organizations committed to improving global health. The findings and conclusions in this report are those of the authors and do not necessarily represent

the official position of the US Centers for Disease Control and Prevention. References 1. Lozano R, Naghavi M, Foreman K, Lim S, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095–2128. 2. Alleyne G, Stuckler D, Alwan A. The hope and the promise of the UN Resolution on non-communicable diseases. Global Health 2010; 6: 15. 3. Blanchard C, Narle G, Gibbs M, Ruddock C, Grady M, Brookes C, et al. Improving policy and practice to promote equity and social justice – a qualitative comparative analysis building on key learnings from a twinning exchange between England and the US. Glob Health Promot. 2013; 20(Suppl 4): 45–56. 4. Shilton T, Champagne B, Blanchard C, Ibarra Avila ML, Kasemsup V. Towards a global framework for capacity-building for non-communicable disease advocacy in low- and middle-income countries. Glob Health Promot. 2013; 20(Suppl 4): 6–19. 5. Blanchard C, Shilton T, Bull F. Global Advocacy for Physical Activity (GAPA): global leadership towards a raised profile. Glob Health Promot. 2013; 20(Suppl 4): 113–121. 6. Amuyunzu-Nyamongo M, Owuor JO, Blanchard C. The Consortium for NCD Prevention and Control in SubSaharan Africa (CNCD-Africa): from concept to practice. Glob Health Promot. 2013; 20(Suppl 4): 97–103. 7. Raffo V, Bliss T, Shotten M, Sleet D, Blanchard C. Case Study: the Argentina Road Safety Project. Lessons learned from the Decade of Action for Road Safety 2011 – 2020. Glob Health Promot. 2013; 20(Suppl 4): 20–36. 8. McQueen DV, Pratt M, Blanchard C. Commentary on a meeting entitled: Building Global Capacity for NonCommunicable Diseases (NCD) Prevention: Defining Direction and Roles. Glob Health Promot. 2013; 20(Suppl 4): 93–96. 9. Finck Barboza C, Monteiro SM, Barradas SC, Sarmiento OL, Rios P, Ramirez A, et al. Physical activity, nutrition and behavior change in Latin America: a systematic review. Glob Health Promot. 2013; 20(Suppl 4): 65–81. 10. Matsudo SM, Matsudo VR. Coalitions and networks: facilitating global physical activity promotion. IUHPE Promo Educ. 2006; 8:133–138. 11. Ali MK, Rabadán-Diehl C, Flanigan J, Blanchard C, Narayan KMV, Engelgau M. Systems and capacity to address noncommunicable diseases in low- and middleincome countries. Sci Transl Med. 2013; 5: 181cm4.

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The new world of global health.

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