PubMed · 9092965
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T Godal. 1997-03-10. [Malaria].. https://pubmed.ncbi.nlm.nih.gov/9092965/
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Public health represents society's organised and publicly supported efforts to improve the health status of the entire population; its focus is on the reduction of health inequalities by optimising the underlying determinants of health and preventing disease. But public health is under threat and needs to be strengthened so that it is at the centre of human endeavour--locally, nationally, and worldwide.
To improve the performance of international health organisations, their essential functions must be agreed. This paper develops a framework to discuss these essential functions. Two groups are identified: core functions and supportive functions. Core functions transcend the sovereignty of any one nation state, and include promotion of international public goods (eg, research and development), and surveillance and control of international externalities (eg, environmental risks and spread of pathogens). Supportive functions deal with problems that take place within individual countries, but which may justify collective action at international level owing to shortcomings in national health systems-such as helping the dispossessed (eg, victims of human rights violations) and technical cooperation and development financing. Core functions serve all countries, whereas supportive functions assist countries with greater needs. Focus on essential functions appropriate to their mandate will better prepare international health organisations to define their roles, eg for WHO to focus on core functions and for the World Bank to focus on supportive ones.
40 years ago, activities in international health were the domain of WHO, governments (based on bilateral agreements), and non-governmental organisations. This has changed. Today, new players (such as the World Bank and, increasingly, the World Trade Organisation) have an influence on international health. As globalisation of trade and markets takes hold, new coalitions and alliances are forming to examine and deal with the direct and indirect consequences on health. This paper examines the changing context of cooperation in international health, and voices concerns about rising potential inequalities in health, both within and between countries. The question of how such changes will affect the actions of organisations working in international health is also addressed.