Global public health starts at home: upstream approaches to global health training

Abstract

The interconnectedness of today's globalised world brings with it challenges and inequality in the health of populations. But all too often health professionals' training focuses on downstream individual intervention approaches (eg, smoking cessation, diet improvement), at the expense of upstream determinants (eg, food marketing, trade agreements). A crop of global health degrees has emerged aimed at explaining and understanding diseases of global importance. However, these courses are largely taught from a position of assumed power in which those from the wealthy nations have greater leverage than their counterparts from low-income and middle-income countries (LMICs). We set out to challenge the philosophies and approaches for action that are taught in global health training courses, which have been slow to tackle more foundational issues. Highlighting trade agreements and the political economy of health as examples, we stress the need for a greater emphasis on intervening in the upstream social, economic, and commercial determinants of health. Although we recognise that the terms “global north” and “global south” are an oversimplification of the global distribution of power and resources that do not comprehensively capture the heterogeneity of the global south, we merely use these terms to scaffold discussion on power asymmetries and dynamics that influence health.