essay global health

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• BMJ Glob Health
• v.6(6); 2021

Defining global health: findings from a systematic review and thematic analysis of the literature

Melissa salm.

1 Anthropology, University of California Davis, Davis, California, USA

2 University of California Davis, Davis, California, USA

Mairead Minihane

Patricia conrad.

3 VM:PMI, University of California Davis, Davis, California, USA

Associated Data

No data are available. All data relevant to the study are included in the article or uploaded as supplementary information. n/a.

Introduction

Debate around a common definition of global health has seen extensive scholarly interest within the last two decades; however, consensus around a precise definition remains elusive. The objective of this study was to systematically review definitions of global health in the literature and offer grounded theoretical insights into what might be seen as relevant for establishing a common definition of global health.

A systematic review was conducted with qualitative synthesis of findings using peer-reviewed literature from key databases. Publications were identified by the keywords of ‘global health’ and ‘define’ or ‘definition’ or ‘defining’. Coding methods were used for qualitative analysis to identify recurring themes in definitions of global health published between 2009 and 2019.

The search resulted in 1363 publications, of which 78 were included. Qualitative analysis of the data generated four theoretical categories and associated subthemes delineating key aspects of global health. These included: (1) global health is a multiplex approach to worldwide health improvement taught and pursued at research institutions; (2) global health is an ethically oriented initiative that is guided by justice principles; (3) global health is a mode of governance that yields influence through problem identification, political decision-making, as well as the allocation and exchange of resources across borders and (4) global health is a vague yet versatile concept with multiple meanings, historical antecedents and an emergent future.

Extant definitions of global health can be categorised thematically to designate areas of importance for stakeholders and to organise future debates on its definition. Future contributions to this debate may consider shifting from questioning the abstract ‘what’ of global health towards more pragmatic and reflexive questions about ‘who’ defines global health and towards what ends.

Key questions

What is already known.

• Debate around a common definition of global health has seen extensive scholarly interest within the last two decades; despite the abundance of literature, ambiguity still persists around its precise definition.
• No systematic reviews with thematic analysis have been conducted to explore extant definitions of global health nor to contribute to a comprehensive definition of global health.

What are the new findings?

• We compile and thematically analyse extant definitions of global health and propose grounded theoretical insights into what might be seen as relevant for establishing a common definition of global health moving forward.
• The need for a clear and concise definition of global health has the highest stakes in the domain of global health policy governance.

What do the new findings imply?

• Stakeholders tend to define the ‘what’ of global health: its spaces, objects and practices. Our findings suggest that the debate around definition should shift to more pragmatic and reflexive questions regarding ‘who’ defines global health and towards what ends.

Debate around a common definition of global health (GH) has seen extensive scholarly interest within the last two decades. In 2009, a widely circulated paper by Koplan and colleagues aimed to establish ‘a common definition of global health’ as distinct from its derivations in public health (PH) and international health (IH). 1 They rooted the definition of PH in the mid-19th century social reform movements of Europe and the USA, the growth of biological and medical knowledge, and the discipline’s emphasis on population-level health management. Similarly, they traced the evolution of IH back to its colonial roots in hygiene and tropical medicine (TM) through to the mid-20th century with its geographic focus on developing countries. GH, they argued, would require a distinctive definition of its own to be ‘more than a rephrasing of a common definition of PH or a politically correct updating of international health’. Their intervention built on prior research noting confusion and overlap among the three terms and thus a need to carefully articulate the important differences between them. 2–5 Additional stakeholders have since elaborated varied definitions of GH, yet consensus around its precise definition remains elusive.

To determine how GH is presently defined and to identify whether a common conceptualisation has been established, we conducted a qualitative systematic literature review (SLR) of the GH literature between 2009 and 2019. SLRs are a methodology used ‘to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question’. 6 Unlike unsystematic narrative reviews, SLRs use formal, repeatable and transparent, procedures for identifying, evaluating and interpreting available research, thus ensuring robust coverage of the current literature while reducing the biased presentation of available evidence. 7–9 Medical researchers and policy-makers have long relied on SLRs because they integrate and critically evaluate current knowledge to support decisions about important issues. 10 However, very few SLRs exploring aspects of GH have yet been published, 11–13 and no SLRs focusing on extant definitions of GH have been conducted. This paper fills that gap by exploring the thematic components of extant definitions and thereby contributes towards a comprehensive definition of GH.

Aims and objectives

The aim of this review is: (a) to examine how GH has been defined in the literature between 2009 and 2019, (b) to systematically analyse the core thematic categories undergirding extant definitions of GH and (c) to offer grounded theoretical insights into what might be seen as relevant for establishing a common definition of GH.

Aiming to capture definitions of GH in literature between 2009 and 2019, our team conducted a systematic review of the peer-reviewed literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines ( figure 1 ). 14 The sequential steps of our review process included the following.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of citation analysis and systematic literature review. 14

Search strategy: identify papers and relevant databases

Search technique.

The terms ‘global health’ AND ‘define’ OR ‘definition’ OR ‘defining’ were queried when they appeared in the title, abstract or keyword of studies. Published studies were identified through comprehensive searches of electronic databases accessible through the authors’ university library system (Web of Science, Scopus, Embase, PubMed, EBSCO). Citation tracking through Google Scholar was also completed.

Study selection criteria

Articles published in international peer-reviewed journals, including conference papers, book chapters and editorial material, were reviewed. The studies included were written in English and published between 2009 and 2019. The year 2009 was chosen as a starting point because this is the year in which Koplan et al published ‘Towards a Common Definition of Global Health’. For this review, the team excluded news articles, theses, book reviews and published papers that were not written in English.

Assessment strategy: appraise which papers to include in review

The protocol-driven search strategy required that articles included in the review must: (a) contain the keywords ‘global health’ and ‘definition’ and/or ‘define’; (b) be in the English language and (c) be published between 2009 and 2019. The number of articles containing these keywords was recorded, and all the titles uncovered in the search were imported into Mendeley, a software for managing citations. Duplicates were identified and removed, after which abstracts were screened to assess eligibility against the inclusion criteria. Full-text articles were retrieved for those that met the inclusion criteria and three team members read a designated number of the articles selected for full review. To be included in the data extraction sheet, each article needed to: (a) focus on and explicitly name GH, (b) offer an original definition or description of GH and/or (c) cite an already-existing definition of GH. Articles that mentioned the query terms without any relation to these requirements (eg, did not provide a definition of GH or descriptive data to support interpretations of a GH definition) were excluded. Assessment for relevance and content was conducted by two investigators who reviewed all identified articles independently. Disagreements were resolved by consensus with a third investigator.

Synthesis strategy: extract the data

Based on the research goals, the team designed an initial coding template in Google Sheets as a method of documentation, with the following coding variables: author, title, typology, definition(s), conclusions and conceptual dimensions. To achieve a high level of reliability, the review team open-coded the same five articles, compared their coding experiences, and reconciled differences before adopting a final coding template and evenly dividing the remaining articles to be analysed. Extracted data included the type of study or research paradigm of each publication, the location and disciplinary affiliation of each study based on the contact information of the corresponding author, definitions and descriptions of GH and specialised dimensions of GH. Whenever articles contained more than one definition or description of GH, those items were organised line-by-line under the author on the data extraction sheet.

Analysis strategy: analyse the data

The team conducted thematic analysis of the data to understand how GH has been defined since 2009. Our approach to thematic analysis was based on the guidelines described by Thomas and Harden 15 and further informed by principles in grounded theory. 16 Our strategy consisted of three main stages: Initial Coding—remaining open to all possible emergent themes indicated by readings of the data; 16 17 Focused Coding—categorising the data inductively based on thematic similarity at the level of description 17 and finally, Theoretical Coding—integrating thematic categories into core theoretical constructs at a higher level of analysis. 18

In the first cycle, open descriptive codes were generated (eg, differences between PH and IH, GH education requirements, social justice values) directly from the definitions and descriptions of GH found in the articles. Individual sentences defining or describing GH were treated as unique line items on the data extraction sheet and coded accordingly in order to generate a range of ideas and information on which to build.

In the second cycle, a focused thematic analysis was carried out to identify general relationships and patterns among definitions in the literature and to confirm significant links between the openly coded data. Thematic phrases (eg, GH is multidisciplinary, GH promotes equity) were developed and reapplied to coded definitions on the data extraction sheet. Team members wrote and attached analytic memos to each coded datum—reflecting on emergent patterns and further ‘codeweaving’, 18 which is a term for charting possible relationships among the coded data. At this stage, additional coding techniques were utilised. Attribute coding was applied as a management technique for logging information about the characteristics of each publication. 19 Data segments coded in this manner were extracted from the main data extraction form and reassembled together in a separate Google Sheet for further analysis. The team also coded extracted definitions of GH by type: (a) original definition, (b) cited definition, (c) original description to track possible relationships between citational practices and developments in the conceptualisation and definition of GH.

In the third cycle, thematic phrases were ordered according to frequency then commonality and abstracted for overriding significance into theoretical categories. At this stage, the conceptual level of analysis was raised from description to a more abstract, theoretical level leading to a grounded theory. This resulted in the construction of four thematic categories, which are presented below with their supporting subthemes.

Patient and public involvement

Patients and public were not directly involved in this review; we used publicly available data for the analysis.

The search strategy retrieved bibliographic records for 1363 papers. The assessment strategy resulted in the elimination of 1237 papers after the removal of duplicates. Consequently, 78 papers were subjected to our strategies of synthesis (data extraction) and analysis.

Characteristics of study

A variety of studies were included in this review. The majority (27) were commentaries, viewpoints or debates. 1 20–48 Twenty-four were grouped as review/overview articles. 45–68 There were 25 original research articles, of which 13 used qualitative methods, 69–81 11 used mixed-methods 82–92 and one 93 used quantitative data from a survey to proffer definitions of GH. Two studies included in the review were book chapters. 94 95

The typologic, geographic and disciplinary distribution of the studies in this review are shown in table 1 . Most studies were authored in North America (40), 1 20–31 39–41 43 46 47 50 54–58 61 63 66 68 70 73 74 76–80 83 84 86 87 89–91 94 followed by European countries (29), 22 26 28 32 34–38 42 44 45 48 51 52 59 62 64 65 67 71 75 82 85 88 92 93 95 96 countries in Asia (2), 33 72 Latin America and the Caribbean (2), 60 81 and New Zealand (1). 20 Disciplinary fields represented in our sample included health (56), 20 22–27 30–32 34–40 42 43 45–51 54–56 58–61 63–69 72 74 75 77–79 82–84 86 88–91 93 95 law, social and cultural professions (19), 1 20 28 29 33 41 44 52 53 57 62 70 71 73 76 80 81 87 92 94 and education (2). 20 31

Summary of characteristics of retrieved publications

Attributes of definitions

All 78 studies under review defined, described and/or cited extant definitions of GH. The 34 papers shown in table 2 included descriptive definitions of GH that were formulated distinctly by its authors, that is, they were presented as original and without direct reference to other definitions.

How global health has been defined by academics since 2009

Several scholars engaged directly with the Koplan et al definition of GH 1 to stipulate definitions of their own. For example, some authors proposed amendments to Koplan et al that would place greater emphasis on inequity reduction and the need for collaboration, 20 particularly with institutional partners from developing countries. 73 Others were more critical of the broad yet weak conceptual idealism 86 of Koplan et al and recommended detaching normative objectives from its definition, 26 such as the value-laden concept of equity, which could compromise the definition’s technical neutrality by rendering it ideological. 91 Other authors sought to analytically clarify the meaning of ‘the global’ 26 in the definition provided by Koplan et al , distinguish it more clearly from IH 78 or dispute their distinction between GH and PH. 27 Indeed, the impact of the definition of GH proposed by Koplan et al has been substantial. It was variously adopted by the Consortium of Universities for Global Health, 47 the Canadian government, 23 Global Health for Family Medicine, 89 the German Academy of Sciences 75 and the Chinese Consortium of Universities for Global Health. 77

In general, GH was defined as a term, 37 51 95 and in particular, an umbrella term 49 75 or a concept; 69 and more broadly as a zone 76 or field 32 48 91 94 or area of research and practice, 1 56 as an achievable goal, 50 an approach, 48 82 a set of principles, 45 83 an organising framework for thinking and action 96 or a collection of problems. 35 94 GH was frequently contrasted to IH 32 35 68 69 94 95 and PH, 20 21 31 32 35 or else seen as indistinguishably from PH and IH. 27 Additionally, several papers explicitly specified and subsequently defined certain dimensions of GH, such as ‘global health governance’ (GHG), 32 33 35 38 42 51 52 58 69 80 81 87 ‘global health diplomacy’ (GHD), 24 28 95 ‘global health education’, 36 39 46–49 59 70 74 75 77 78 82 89 93 ‘global health security’, 26 41 76 88 92 97 98 ‘global health network’, 41 81 ‘global health actor’, 52 ‘global health ethics’, 69 ‘global health academics’ 64 67 and ‘global health social justice’ 61 (see table 3 ).

Frequently defined facets of ‘Global Health’ with exemplary definitions

Grounded theory approach based on thematic analysis

Definitions and descriptions of GH were aggregated into nine thematic codes reflecting the contents and scope of GH definitions, the functionality of those definitions and/or perceptions about defining GH. Codes were: (1) GH is a domain of research, healthcare and education, (2) GH is multifaceted (disciplinary, sectoral, cultural, national), (3) GH is rooted in a commitment to equity, (4) GH is a political field comprising power relations, (5) GH is problem-oriented, (6) GH transcends national borders, (7) GH is determined by globalisation and international interdependence, (8) conceptually, GH is either similar or dissimilar to PH, IH and TM and (9) GH is perceived as definitionally vague.

These codes were grouped selectively into higher analytical categories or theoretical statements as grounded in the literature: (1) GH is a multiplex approach to worldwide health improvement and form of expertise taught and researched through academic institutions, (2) GH is an ethos (ethical orientation and appeal) that is guided by justice principles, (3) GH is a mode of governance that yields degrees of national, international, transnational and supranational influence through political decision-making, problem identification, the allocation and exchange of resources across borders, (4) GH is a polysemous concept with many meanings and historical antecedents, and which has an emergent future ( table 4 ).

Defining global health with grounded theory analysis—table of themes, code categories and quotes from text

IH, international health; PH, public health; TM, tropical medicine.

Theme: global health is a multiplex approach to worldwide health improvement taught and pursued through research institutions

Subtheme: gh is a domain of research, healthcare, education.

GH was repeatedly defined as an active field of knowledge production that is composed of the following key elements: research, education, training and practice related to health improvement. 1 20 21 23 32 33 35 38 40 44–49 52 55–58 61 63–69 72 74 75 77 78 80 82 90–92 94 Few authors defined GH as a new, independent discipline within the broader domain of medical knowledge, 17 33 38 46 63 74 80 82 90 and some outlined discipline-specific competencies that were considered integral to the definition of GH, at least in curriculum development; for example: clinical literacy, 80 medical humanities, 82 cross-cultural sensitivity, 33 38 46 59 63 80 90 experiential learning 47 and critical thinking skills. 72 82 Several authors defined GH as a diffuse arena of scholarship that spans an array of academic disciplines, including anthropology, engineering, law, agriculture and healthcare administration. 44 56 59 63–65 78 91 94 Others defined GH explicitly as a ‘transdiscipline’ that seeks to transcend the restricted gaze of any single discipline and consequently integrate knowledge from a variety of sources. 67 94 Several authors explicitly defined GH as a necessarily collaborative field. 1 20 22 24 36 43 45 47 57 61 63 68 77 78 80 91

Subtheme: GH is multifaceted (disciplinary, sectoral, cultural, national)

The prefix ‘multi-’ was consistently applied in definitions of GH to describe a perspective that focuses on the multitude of interrelated factors, dimensions, values and features that underpin health as well as efforts to improve and study it. There was broad agreement that multidisciplinarity is a defining characteristic of GH. 1 23 25 32–34 36 38 40 45–47 49 52 55–57 59 60 64–69 72 75 77 78 80 82 91 However, there was some debate whether multiple disciplines are always needed and beneficial—and therefore essential—to the definition of GH. 23 One author argued that the multidisciplinary nature of GH is precisely what differentiates it from PH and IH. 68 Although some claimed that GH, with its focus on social and economic determinants, is inherently ‘predisposed to include aspects of the liberal arts and social sciences’, 75 others critically observed that most GH educational opportunities still cater predominantly to medical students, 32 35 48 72 which suggests that greater efforts will be required to achieve multidisciplinarity in the field moving forward.

There was a correspondence between GH definitions citing multidisciplinarity and cultural competency. 32 33 38 48 49 56 78 82 90 Curiously, multisectorality was less frequently mentioned than multidisciplinarity in definitions of GH, though it was referenced in some papers. 20 22 43 52 66 83 86 95

Theme: global health is an ethical initiative that is guided by justice principles

Subtheme: gh is rooted in values of equity and social justice.

Equity and social justice were the two most commonly and explicitly referenced values undergirding GH definitions and goals. Equity was repeatedly framed as a ‘main objective’ 60 and core component of GH research and practice. 23 25 43 46 48 53 66 67 77 78 84 However, it remains unclear whether the authors in our sample share the same meaning of equity. Velji and Bryant defined equity broadly as ‘ensuring equal opportunities and resources to enable all people to achieve their fullest health potential’. 66 Meanwhile, others rooted their conceptualisation of equity more specifically in the principles of social justice 30 61 69 88 89 or the human rights concept of equality, 54 62 67 83 86 which asserts that ‘all people are equal in regard to dignity and rights, regardless of their origin and all biological, social or other specific differences’. 59 This postwar sensibility echoes the 1978 Alma Ata Declaration of ‘health for all’, 20 24 as well as a traditional humanitarian ideal, even if now associated with principles grounded in national and global security. 24 54 88

Occasionally, the terms ‘equity’ and ‘equality’ were used interchangeably, suggesting they possess a commonly shared valence and reciprocal relationship despite slight differences in signification. Whereas equity refers to the provision of resources and opportunity based on specific needs, equality connotes providing the same level of resources and opportunities for all. 86 Nevertheless, other scholars questioned whether equity or equality should be included in official definitions of GH, at all, 27 48 75 insofar as what counts as ‘equitable’ for one country may be different for another. 26 32 48

Theme: global health is a form of governance that yields national, international, transnational and supranational influence through political decision-making, problem identification, the allocation and exchange of resources across borders

Subtheme: gh is a political field comprising power relations at multiple scales.

Numerous papers defined GH as embedded within a political field comprising power relations at multiple scales. 20 22–24 26 28 29 31–33 35 41 42 45 48 51–54 56 58 60 63 66 70 72 76 79 87 95 ‘Political field’ refers here to a sphere of influence and jurisdiction wherein institutions determine governing modalities (eg, laws, policies, instruments) to assure a range of activities, such as determining priorities, coordinating stakeholders, regulating funding mechanisms, establishing accountability, allocating resources and providing access to health services for the general public. ‘Power relations’ refers to the capacity of institutions, individuals, instruments and ideas to affect the actions of others; and ‘at multiple scales’ refers to levels of analysis (ie, worldwide, regional, national, local, etc.).

Within the literature on GHG and GH security, authors argued the need for a universal definition of GH to shape policy frameworks that ensure compliance with IH law. 32 45 51 88 95 Here, it is important to note that the ability to shape GH policy is, itself, an exercise in power: some GH actors, defined as ‘individuals or organizations that operate transnationally with a primary intent to improve health’, 56 are more capacitated than others to impact the formulation of policies and amount of attention and resources that certain GH issues receive. 32 41 45 52 95 For example, several papers discussed how ‘GH actors’ like the World Bank and the WHO shaped discussions around the response to Ebola, leading to refined definitions of GHG 35 87 88 and GH security. 41 Similarly, definitions of GH in line with the 2015 United Nations Millennium Development Goals, were also commonly referenced, 25 35 45 51 reflecting the influence of certain GH actors on the conceptualisation of GH.

Subtheme: GH is determined by globalisation and international interdependence

Numerous authors linked interdependence and accelerating globalisation (the process of integrating governments and markets, and of connecting people worldwide) with the need for a cohesive definition of GH, particularly to address issues of governance. 24 32 35 45 68 88 GHG and GHD were outlined as two influential subdomains in which the interconnections between globalisation, foreign policy and international relations were viewed as indispensable to definitions of GH. Two articles quoted David P Fidler’s definition of GHG as ‘the use of formal and informal institutions, rules, and processes by states, intergovernmental organizations, and nonstate actors to deal with challenges to health that require cross-border collective action to address effectively’. 35 58 Elsewhere, GHD was described as ‘bringing together the disciplines of public health, international affairs, management, law and economics and focuses on negotiations that shape and manage the global policy environment for health’. 95

Subtheme: GH issues transcend national borders

Across several papers, we observed a common refrain that GH ‘crosses borders’ and ‘transcends national boundaries’. 1 20 23 42 45 52 60 67 68 74 Authors frequently described GH concerns as those exceeding the jurisdictional reaches of any individual nation-state alone. 34 42 45 51 52 54 77 95 One paper claimed that GH is ‘transnational by definition’, 74 and others characterised GH problems as those experienced transnationally. 20 32 48 50 68

Studies focusing on GH research and training frequently referenced specific diseases and health risks that ‘transcend national borders’ alongside parallel recommendations to include an international component in the development of GH curricula. 16 48 49 63 74 93 While crossing national borders to research and promote health for all is widely perceived as an historical condition for GH 24 that has led to GH’s emergence as an academic discipline, 63 several scholars argued that GH should also focus on domestic health disparities 1 27 38 46 and for local issues to be simultaneously understood as universal or worldwide 48 74 75 to the extent they may occur anywhere 22 and are almost always impacted by global phenomena. 56

Subtheme: GH is problem-oriented

Medical anthropologists, Arthur Kleinman and Paul Farmer, described GH as a collection of problems rather than a distinct discipline. 35 94 Several authors in our review delineated GH problems through identification of specific diseases, such as HIV/AIDS, malaria, TB, Zika and Ebola. 24 29 30 35 45 83 Lee and Brumme noted that it has become common for experts to define GH problems by identifying their objects, namely diseases, population groups and locations. 58 Indeed, some authors outlined GH problems as the set of challenges ‘among those most neglected in developing countries’, 86 among them: emerging infectious diseases and maternal and child health; 43 65 diabetes, cardiovascular disease and other noncommunicable diseases in ‘local’ communities 25 63 and even neurological disorders among refugees arriving in Europe. 93 How these types of object-based definitions of GH problems come to shape GH agendum is important to note.

Clark made a compelling argument against the definition of GH problems in terms of specific diseases, writing that such ‘medicalisation’ may ‘prove detrimental for how the world responds and resources actions designed to alleviate poor health and poverty, redress inequities, and save lives’. 72 Brada also argued against defining GH problems geographically and instead urged experts to consider how the processes by which GH and its quintessential spaces, namely ‘resource-limited’ and ‘resource-poor settings’, are actively constituted, reinforced and contested. 70 Several authors similarly suggested that focusing on the social, political, economic and cultural forces contributing to health inequity and diseases of poverty better captured the scope of GH problems than naming any particular set of diseases or places in the world. 33 43 56 58 69 72 73 86 92

Lack of consensus regarding what counts as a ‘true’ GH problem was linked to the lack of a clear and concise definition of GH. Indeed, several scholars argued that the current inability to define GH made it difficult for stakeholders to define precisely what the ‘problem’ is. 44 45 48 86 Furthermore, the diagnosis of GH problems determined what types of GH ‘solutions’ were proposed in response. For example, when GH problems were defined as universally shared and transnational, then cross-border solutions were developed; when GH issues were framed epidemiologically in terms of distributed risk, then actions targeting specific determinants and burdens were proposed. 1 20 23 67 68 92 When GH problems were framed as threats to inter/national security, strategies were formulated to protect borders, economies, health systems and to improve surveillance mechanisms. 41 45 54 76 80 88 When the problem of inequality drove definitions of GH, recommendations to alleviate poverty, food insecurity, poor sanitation, etc. were proposed. 32 53 60 72

Although Kuhlmann suggested that GH tends to over-prioritise problem-identification to the detriment of critical solution-oriented work, 31 our analysis suggests that the type, scope and quality of solutions proposed are contingent on the elaboration of problems. Similarly, Campbell wrote, ‘Unlike a science or an art, the field of global health is very much about providing solutions to current problems. As such, it would be short-sighted not to consider the causes of global health problems in order to better formulate the solutions. The causes ought to be included in a comprehensive and complete definition of the field’. 23

Theme: global health is a polysemous concept with historical antecedents and an emergent future

Subtheme: gh is conceptually dis/similar to ph, ih and tm.

GH was consistently traced back to and compared with PH, IH and TM. 1 20 27 32–34 43 57 69 71 75 84 86 88 Disagreement or confusion regarding the degrees of similarity and difference between these domains seemed to stem from a shared understanding that GH, in fact, evolved to a varying degree from each of these fields and does not, therefore, denote a clear-cut break with nor full-blown departure from any of them. 84 94

Several authors argued that the scope and scale of GH is distinct from PH. 1 20 32 69 71 Some argued that ‘public health is equated primarily with population-wide interventions; global health is concerned with all strategies for health improvement,’ including clinical care; 20 and that ‘public health acknowledges the state as a dominant actor, (while) global health recognizes the rise of other actors like international institutions’. 35 GH was also seen as placing a greater emphasis on multidisciplinarity and promoting a more expansive conceptualisation of ‘health’, itself, compared with PH. 69 Beyond the prevention of and response to biomedicalised health risks at the population level, Rowson defined GH as oriented towards the ‘underlying determinants of those problems, which are social, political and economic in nature.’ 32 It is questionable, however, to assume similar notions of health have not also been pursued in PH. Meanwhile, opposing views found GH and PH conceptually indistinguishable, 27 43 86 either as terms that could be used interchangeably, 95 or else as coconstitutive of one another, such that PH could be understood as a descriptive component of GH. 33 86

Differences between GH and IH echoed those drawn between GH and PH. For example, GH was characterised as more attentive to multidisciplinarity, while IH was said to implement a more limited biomedical approach to healthcare and health research. 1 69 95 Undergirding a major point of distinction between GH and IH was the belief that IH focuses on health problems in developing countries 1 22 32 43 45 48 54 83 86 93 and relies on ‘the flow of resources and knowledge from the developed to the developing world’, 32 whereas GH either is, or should be, more bidirectional. 1 45 84 In other cases, GH was described as comparable to IH, for example, when countries link GH efforts with development aid. 86 This is because the emphasis on delivering aid to poor countries reinforces an image of the world’s poor as needy subjects and, therefore, marks a continuation of IH and its sentiments under the guise of GH. 35

Finally, the field of TM was referenced to describe the evolutionary track of GH, particularly that GH is a modern-day product of the former. 20 25 57 69 75 84 A few authors critically pointed out that although GH has generally replaced TM and IH as terms embedded in histories of colonial power relations, many of the contemporary structures for governing and/or facilitating GH between countries today have remained largely the same, 25 48 54 62 suggesting that distinguishability between these terms too often occurs at the level of semantics.

Subtheme: GH is still vaguely defined

While GH was often described as a popular and well-established term, another key attribute repeated across the literature was its enduring vagueness. 23 25 26 31 33 43 45 48 52 62 74–77 81 86 Indeed, most papers commented on the term’s defiance of easy definition, its ambiguity and the lack of clarity regarding how people and organisations engaged in GH are using (or not using) the term to describe their interests. For example, Beaglehole and Bonita pointed out that research centres in low-income and middle-income countries are often engaged in GH issues but under other labels. 20 Some authors viewed the present lack of a clear and common definition as an obstacle endangering the coherence and maturation of the field. 33 35 45 For others, this indistinctness was thought to be precisely what gives GH such wide applicability, a certain degree of currency and political expediency. 45 76 81 86

A major concern cited was the lack of guidance for defining the term ‘global’ in GH. 26 34 43 48 75 As Bozorgmehr has outlined, the term is often used interchangeably within the GH community to mean ‘worldwide’, ‘everywhere’, ‘holistic’ and/or ‘issues that transcend national boundaries’. 48 This trend was noticeable within our review, as well. Engebretsen emphasised that GH ‘does not only allude to supranational dependency within the health field, but refers to a norm or vision for health with global ambitions’. 26 This view suggests that because the planet is populated by a multiplicity of positionings, perspectives and diverse world views, there can never be a truly a universal definition of ‘the global’ nor a global consensus around the definition of GH.

Finally, among studies that conducted original research into the definition of GH, several reported that study participants could not reach consensus on a definition. 52 74 75 77 Many thought it would be difficult if not impossible to arrive at a single, unified theoretical definition of GH, yet considered it important to formulate an operational definition of GH for guiding emerging activities related to GH. 23 45 77

This is the first study to systematically synthesise the literature defining GH and analyse the definitions found therein. All of the articles included in this study were published in peer-reviewed journals since 2009 indicating recent and steadfast interest in the topic of GH’s definition. This review examined GH definitions in the literature, and our thematic analysis focused on identifying recurrent themes across different definitions of GH.

Of the 78 articles included in this study, approximately one-third utilised empirical research methodologies to posit definitions of GH or else directly contribute towards the establishment of a common definition. Another one-third of papers summarised and discussed previously published definitions of GH (eg, reviews/overviews), while the remaining one-third suggested definitions of GH that were less grounded in analysis of empirical data than in the perspectives of its authors (eg, editorials, viewpoints). This systematic analysis indicated that the question of GH’s precise definition marks a point of controversy across fields of expertise. The variety of GH definitions posited by diverse experts in search of a common definition indicate that GH is multifaceted and polysemous.

In its broadest sense, GH can be defined as an area of research and practice committed to the application of overtly multidisciplinary, multisectoral and culturally sensitive approaches for reducing health disparities that transcend national borders. Indeed, it was most commonly defined across the literature in such general terms.

More specific definitions of GH were, of course, proposed by and considered valuable for many stakeholders in our review. Our analysis indicates that the precise definitions proposed by different experts were devised to serve particular functions. For example, narrow and concise definitions of GH were most frequently sought in the domains of governance and education, primarily for steering the development of policy frameworks and curricula, respectively. The imperative for an exact definition of GH in these subfields may be linked to bureaucratic demands for demarcating a technical term under which to classify specific activities, standardise certain functions, administer funds and direct workflow accordingly. It is also in this domain that authors most vociferously decried the absence of a unified and concise definition of GH, arguing this lack has led to ineffective initiatives, elusive methods for establishing accountability and instances of resource allocation based on ad hoc criteria—attractiveness to donors, public opinion, development agendum, foreign, economic or security policy priorities and so on—rather than via transparent mechanisms for adjudicating health need. 28 54 58 65 83 In contexts where health needs and upstream challenges were articulated, the lack of an agreed-upon definition oft impeded the policy process because stakeholders could not discern which GH issues among the multitude of different problems labelled as important were, in fact, the most pressing. 24 45 52 Because political indecision ramifies disproportionately for publics in countries where reliance on GH aid is a matter of life and death, establishing a clear definition of GH seems most crucial for the domain of governance.

We also found that detailed descriptions of GH’s specific conceptual and functional dimensions tended to reflect the specialisations or discipline-specific priorities of their authors. For example, definitions of GH stipulating the primacy of ‘cultural competency’ and ‘multidisciplinarity’ were more commonly proposed by interdisciplinary professionals in the literature on GH education than in journals of health policy, where definitions of GH were oriented more toward ‘security’ and ‘governance’ concerns. This suggests a correspondence between the subjective, experiential positions of the definers and the vocabulary they used to define or frame the need to define GH.

Unsurprisingly, we found that health professionals proposed the majority of definitions of GH in the literature. Additionally, the majority of publications and their authors were from higher income countries. Several authors in our review critically observed that GH has become institutionalised at a faster rate in higher income countries compared with lower and middle-income countries. 20 48 63 72 77 82 Their observations combined with our findings suggest that extant definitions of GH published in the literature or otherwise circulating in academic and professionalised spaces may unevenly reflect the interests and priorities of stakeholders from higher income countries. This suggests a need for greater diversity and inclusion in the debate on GH’s definition, as well as further reflexivity regarding who is defining GH, their means and motivations for doing so, and what these definitions put into action.

Interestingly, several articles published since 2019 have extended the debate on this topic of GH’s definition by directly engaging questions of geography and positionality: a recent commentary by King and Kolski defining GH ‘as public health somewhere else’ was met with pushback by those who argue that spatial definitions of GH are limited and limiting. 99–102

Limitations

To determine how GH is defined by experts in the literature, we ensured that the selection criteria developed for this study were broad enough to include a wide range of perspectives. Therefore, we included articles with varying degrees of evidentiary support, such as viewpoints, commentaries and editorials. Consequently, the results may be influenced by some of the primary researchers’ assumptions, projections, and biases. Backward citation tracking was used to add relevant articles to the review that had not been initially identified through database searching. This ensured that the review was exhaustive, however it also means that some conclusions drawn in the thematic analysis may have been influenced by this manual search strategy. By applying qualitative methods, this review provided a robust analysis of the thematic categories undergirding extant definitions of GH. A major limitation of this form of analysis is the extensive time required to develop and establish a code book and standardise the three coders’ use of the code book. However, this was deemed necessary to ensure consistency of judgement and intercoder reliability at each stage in the analysis. Another limitation of this study is that only articles written in English were included. To enhance the generalisability of results, future reviews should include data from non-English articles, especially if an inclusive, common definition of GH is to be achieved. Finally, this review was finalised prior to the emergence of the novel coronavirus. As such, future research should take into account new definitions of GH that emerge in light of the pandemic and lessons learnt.

Between 2009 and 2019, GH was most commonly defined in the literature in broad and general terms: as an area of research and practice committed to the application of multidisciplinary, multisectoral and culturally sensitive approaches for reducing health disparities that transcend national borders. More precise definitions exist to serve particular functions and tend to reflect the priorities of its definers. The four key themes that emerged from the present analysis are that GH is: (1) a multiplex approach to worldwide health improvement taught and researched through academic institutions; (2) an ethos that is guided by justice principles; (3) a mode of governance that yields influence through political decision-making, problem identification, the allocation and exchange of resources across borders and (4) a polysemous concept with historical antecedents and an emergent future. Findings from this thematic analysis have the potential to organise future conversations about which definition of GH is most common and/or most useful. Future discussions on the topic might shift from questioning the abstract ‘what’ of GH to more pragmatic and reflexive questions about ‘who’ defines GH and towards what ends.

Acknowledgments

Helpful comments by anonymous reviewers are acknowledged with thanks.

Handling editor: Seye Abimbola

Contributors: MS initiated and designed the project. MS, MA and MM contributed to the implementation of the research, to the collection of data, analysis of the results and to the writing of the manuscript. PC supervised the project and provided feedback on the manuscript.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement

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Global Health Care, Essay Example

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Introduction

Global health care is a challenging phenomenon that supports the development of new perspectives and approaches to solving global health concerns, including nutrition, infectious disease, cancer, and chronic illness. It is important to address global health as a driving force in international healthcare expenditures because it represents an opportunity for clinicians throughout the world to collaborate and to address global health concerns to achieve favorable outcomes. Global healthcare in the modern era includes the utilization of technology to support different population groups and to address different challenges as related to global health problems that impact millions of people in different ways. These challenges demonstrate the importance of large-scale efforts to eradicate disease, to prevent illness, and to manage disease effectively through comprehensive strategies that encourage communication and collaboration across boundaries.

Global health care incorporates a number of critical factors into play so that people throughout the world are given a chance to live and to lead a higher quality of life. The World Health Organization (WHO) is of particular relevance because this organization supports global health initiatives and large-scale impact projects throughout the world (Sundewall et.al, 2009). The WHO recognizes the importance of developing strategies to address global health concerns by pooling resources in order to ensure that many population groups are positively impacted by these initiatives (Sundewall et.al, 2009). The WHO also collaborates with government bodies throughout the world to address specific concerns that are relevant to different population groups, such as infectious diseases, many of which ravage populations in a significant manner (Fineberg and Hunter, 2013). In this context, it is observed that global health has a significant impact on populations and their ability to thrive, given the high mortality rates of some diseases in less developed nations (Fineberg and Hunter, 2013). Therefore, it is expected that there will be additional frameworks in place to accommodate the needs of populations and the resources that are required to achieve favorable outcomes (Fineberg and Hunter, 2013).

In addition to the WHO, there are many other international organizations that support global health and disease in different ways. For example, The United Nations Children’s Fund (UNICEF) supports large-scale global health efforts to support the world’s children (imva.org, 2013). UNICEF works in conjunction with many governments and other sources of funding in order to accomplish its objectives related to child health and wellbeing (imva.org, 2013). UNICEF spends significant funds on many focus areas, including the preservation of child health, nutrition, emergency support, and sanitation in conjunction with local water supplies (imva.org, 2013). In addition, the United States Agency for International Development (USAID) provides support in many areas, including a primary focus on healthcare in developing nations (imva.org, 2013).

Leininger’s Culture Care Theory is essential in satisfying the objectives of global health because it supports an understanding of the issues related to cultural diversity and how they impact healthcare practices throughout the world (Current Nursing, 2012). This theory embodies many of the differences that exist in modern healthcare practices and supports a greater understanding of the issues that are most relevant on a global scale (Current Nursing, 2012). This theory is applicable because it represents a call to action to consider cultural differences when providing care and treatment to different population groups, but not at the expense of the quality of care that is provided (Current Nursing, 2012). In many countries, the provision of care is largely dependent on cultural diversity and customs, which is essential to a thriving healthcare system; however, diversity must also incorporate the concept of providing maximum care for an individual in need of treatment (Current Nursing, 2012).

Professional nursing is highly relevant to global health because nurses address some of the most critical challenges in providing care and expanding access to treatment for millions of people throughout the world. However, it is also important for nurses working with global health initiatives to recognize the importance of these directives and to consider ways to improve quality of care without compromising principles or other factors in the process. These efforts will ensure that nurses maximize their knowledge and understanding of global health and its scope in order to achieve positive outcomes for people in desperate need of healthcare services throughout the world. Nurses must collaborate with small and large-scale organizations regarding global health issues so that population needs are targeted and are specific. These efforts will ensure that patients are treated in areas where healthcare access is severely limited.

Global health represents a significant set of challenges for clinicians throughout the world. It is important to recognize these concerns and to take the steps that are necessary to provide patients with the best possible outcomes to achieve optimal health. The scope of global health concerns is significant; therefore, it is important to address these concerns and to take the steps that are necessary to collaborate and promote initiatives to fight global health problems. When these objectives are achieved using the knowledge and expertise of nurses, it is likely that there will be many opportunities to treat patients and to educate them regarding positive health. With the assistance of large global organizations, nurses play an important role in shaping outcomes for women throughout the world.

Current Nursing (2012). Transcultural nursing. Retrieved from http://currentnursing.com/nursing_theory/transcultural_nursing.html

Fineberg, H.V., and Hunter, D. J. (2013). A global view of health – an unfolding series. T he New England Journal of Medicine, 368(1), 78-79.

Imva.org (2013). Bilateral agencies. Retrieved from http://www.imva.org/Pages/orgfrm.htm

Sundewall, J., Chansa, C., Tomson, G., Forsberg, B.C., and Mudenda, D. (2009). Global health initiatives and country health systems. The Lancet, 374, 1237.

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• Open access
• Published: 07 April 2020

What is global health? Key concepts and clarification of misperceptions

Report of the 2019 GHRP editorial meeting

• Xinguang Chen 1 , 2 ,
• Hao Li 1 , 3 ,
• Don Eliseo Lucero-Prisno III 4 ,
• Abu S. Abdullah 5 , 6 ,
• Jiayan Huang 7 ,
• Charlotte Laurence 8 ,
• Xiaohui Liang 1 , 3 ,
• Zhenyu Ma 9 ,
• Zongfu Mao 1 , 3 ,
• Ran Ren 10 ,
• Shaolong Wu 11 ,
• Nan Wang 1 , 3 ,
• Peigang Wang 1 , 3 ,
• Tingting Wang 1 , 3 ,
• Hong Yan 3 &
• Yuliang Zou 3  

Global Health Research and Policy volume  5 , Article number:  14 ( 2020 ) Cite this article

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The call for “W orking Together to Build a Community of Shared Future for Mankind” requires us to improve people’s health across the globe, while global health development entails a satisfactory answer to a fundamental question: “What is global health?” To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, in-depth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word “global” in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multi-country and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of “international health” by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of the Belt and Road Initiative proposed by China.

“Promoting Health For All” can be considered as the mission of global health for collective efforts to build “a Community of Shared Future for Mankind” first proposed by President Xi Jinping of China in 2013. The concept of global health continues to evolve along with the rapid development in global health research, education, policymaking, and practice. It has been promoted on various platforms for exchange, including conferences, workshops and academic journals. Within the Editorial Board of Global Health Research and Policy (GHRP), many members expressed their own points of view and often disagreed with each other with regard to the concept of global health. Substantial discrepancies in the definition of global health will not only affect the daily work of the Editorial Board of GHRP, but also impede the development of global health sciences.

To promote a better understanding of the term “ global health” , we convened a special session in the 2019 GHRP Editorial Board Meeting on the 7th of July at Wuhan University, China. The session started with a review of previous work on the concept of global health by researchers from different institutions across the globe, followed by free brainstorms, questions-answers and open discussion. Individual participants raised many questions and generously shared their thoughts and understanding of the term global health. The session was ended with a summary co-led by Dr. Xinguang Chen and Dr. Hao Li. Post-meeting efforts were thus organized to further synthesize the opinions and comments gathered during the meeting and post-meeting development through emails, telephone calls and in-person communications. With all these efforts together, concensus have been met on several key concepts and a number of confusions have been clarified regarding global health. In this editorial, we report the main results and conclusions.

A brief history

Our current understanding of the concept of global health is based on information in the literature in the past seven to eight decades. Global health as a scientific term first appeared in the literature in the 1940s [ 1 ]. It was subsequently used by the World Health Organization (WHO) as guidance and theoretical foundation [ 2 , 3 , 4 ]. Few scholars discussed the concept of global health until the 1990s, and the number of papers on this topic has risen rapidly in the subsequent decade [ 5 ] when global health was promoted under the Global Health Initiative - a global health plan signed by the U.S. President Barack Obama [ 6 ]. As a key part of the national strategy in economic globalization, security and international policies, global health in the United States has promoted collaborations across countries to deal with challenging medical and health issues through federal funding, development aids, capacity building, education, scientific research, policymaking and implementation.

Based on his experience working with Professor Zongfu Mao, the lead Editors-in-Chief, who established the Global Health Institute at Wuhan University in 2011 and launched the GHRP in 2016, Dr. Chen presented his own thoughts surrounding the definition of global health to the 2019 GHRP Editorial Board Meeting. Briefly, Dr. Chen defined global health with a three-dimensional perspective.

First, global health can be considered as a guiding principle, a branch of health sciences, and a specialized discipline within the broader arena of public health and medicine [ 5 ]. As many researchers posit, global health first serves as a guiding principle for people who would like to contribute to the health of all people across the globe [ 5 , 7 , 8 ].

Second, Dr. Chen’s conceptualization of global health is consistent with the opinions of many other scholars. Global health as a branch of sciences focuses primarily on the medical and health issues with global impact or can be effectively addressed through global solutions [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Therefore, the goal of global health science is to understand global medical and health issues and develop global solutions and implications [ 7 , 9 , 15 , 17 , 18 , 19 ].

Third, according to Dr. Chen, to develop global health as a branch of science in the fields of public health and medicine, a specialized discipline must be established, including educational institutions, research entities, and academic societies. Only with such infrastructure, can the professionals and students in the global health field receive academic training, conduct global health research, exchange and disseminate research findings, and promote global health practices [ 5 , 15 , 20 , 21 , 22 , 23 ].

Developmentally and historically, we have learned and will continue to learn global health from the WHO [ 1 , 4 , 24 , 25 ]. WHO’s projects are often ambitious, involving multiple countries, or even global in scope. Through research and action projects, the WHO has established a solid knowledge base, relevant theories, models, methodologies, valuable data, and lots of experiences that can be directly used in developing global health [ 26 , 27 , 28 , 29 ]. Typical examples include WHO’s efforts for global HIV/AIDS control [ 13 , 30 , 31 , 32 ], and the Primary Healthcare Programs to promote Health For All [ 33 , 34 ].

The definition of Global Health

From published studies in the international literature and our experiences in research, training, teaching and practice, our meeting reached a consensus-global health is a newly established branch of health sciences, growing out from medicine, public health and international health, with much input from the WHO. What makes global health different from them is that (1) global health deals with only medical and health issues with global impact [ 35 , 5 , 36 , 10 , 14 , 2 ] the main task of global health is to seek for global solutions to the issues with global health impact [ 7 , 18 , 37 ]; and (3) the ultimate goal is to use the power of academic research and science to promote health for all, and to improve health equity and reduce health disparities [ 7 , 14 , 15 , 18 , 38 ]. Therefore, global health targets populations in all countries and involves all sectors beyond medical and health systems, although global health research and practice can be conducted locally [ 39 ].

As a branch of medical and health sciences, global health has three fundamental tasks: (1) to master the spatio-temporal patterns of a medical and/or health issue across the globe to gain a better understanding of the issue and to assess its global impact [ 40 , 41 , 42 , 43 ]; (2) to investigate the determinants and influential factors associated with medical and health issues that are known to have global impact [ 15 , 40 , 41 , 42 , 43 ]; and (3) to establish evidence-based global solutions, including strategies, frameworks, governances, policies, regulations and laws [ 14 , 15 , 28 , 38 , 44 , 45 , 46 , 47 ].

Like public health, medicine, and other branches of sciences, global health should have three basic functions : The first function is to generate new knowledge and theories about global health issues, influential factors, and develop global solutions. The second function is to distribute the knowledge through education, training, publication and other forms of knowledge sharing. The last function is to apply the global health knowledge, theories, and intervention strategies in practice to solve global health problems.

Understanding the word “global”

Confusion in understanding the term ‘global health’ has largely resulted from our understanding of the word “global”. There are few discrepancies when the word ‘global’ is used in other settings such as in geography. In there, the world global physically pertains to the Earth we live on, including all people and all countries in the world. However, discrepancies appear when the word “global” is combined with the word “health” to form the term “global health”. Following the word “global” literately, an institution, a research project, or an article can be considered as global only if it encompasses all people and all countries in the world. If we follow this understanding, few of the work we are doing now belong to global health; even the work by WHO are for member countries only, not for all people and all countries in the world. But most studies published in various global health journals, including those in our GHRP, are conducted at a local or international level. How could this global health happen?

The argument presented above leads to another conceptualization: Global health means health for a very large group of people in a very large geographic area such as the Western Pacific, Africa, Asia, Europe, and Latin America. Along with this line of understanding, an institution, a research project or an article involving multi-countries and places can be considered as global, including those conducted in countries involved in China’s Belt and Road Initiative (BRI) [ 26 , 48 , 49 , 50 , 51 ]. They are considered as global because they meet our definitions of global health which focus on medical and health issues with global impact or look for global solutions to a medical or health issue [ 5 , 7 , 22 ].

One step further, the word ‘global’ can be considered as a concept of goal-setting in global health. Typical examples of this understanding are the goals established for a global health institution, for faculty specialized in global health, and for students who major or minor in global health. Although few of the global health institutions, scholars and students have conducted or are going to conduct research studies with a global sample or delivered interventions to all people in all countries, all of them share a common goal: Preventing diseases and promoting health for all people in the world. For example, preventing HIV transmission within Wuhan would not necessarily be a global health project; but the same project can be considered as global if it is guided by a global perspective, analyzed with methods with global link such as phylogenetic analysis [ 52 , 53 ], and the goal is to contribute to global implications to end HIV/AIDS epidemic.

The concept of global impact

Global impact is a key concept for global health. Different from other public health and medical disciplines, global health can address any issue that has a global impact on the health of human kind, including health system problems that have already affected or will affect a large number of people or countries across the globe. Three illustrative examples are (1) the SARS epidemic that occurred in several areas in Hong Kong could spread globally in a short period [ 11 ] to cause many medical and public health challenges [ 54 , 55 ]; (2) the global epidemic of HIV/AIDS [ 13 ]; and the novel coronavirus epidemic first broke out in December 2019 in Wuhan and quickly spread to many countries in the world [ 56 ].

Along with rapid and unevenly paced globalization, economic growth, and technological development, more and more medical and health issues with global impact emerge. Typical examples include growing health disparities, migration-related medical and health issues, issues related to internet abuse, the spread of sedentary lifestyles and lack of physical activity, obesity, increasing rates of substance abuse, depression, suicide and many other emerging mental health issues, and so on [ 10 , 23 , 36 , 42 , 57 , 58 , 59 , 60 ]. GHRP is expecting to receive and publish more studies targeting these issues guided by a global health perspective and supports more researchers to look for global solutions to these issues.

The concept of global solution

Another concept parallel to global impact is global solution . What do we mean by global solutions? Different from the conventional understanding in public health and medicine, global health selectively targets issues with global impact. Such issues often can only be effectively solved at the macro level through cross-cultural, international, and/or even global collaboration and cooperation among different entities and stakeholders. Furthermore, as long as the problem is solved, it will benefit a large number of population. We term this type of interventions as a global solution. For example, the 90–90-90 strategy promoted by the WHO is a global solution to end the HIV/AIDS epidemic [ 61 , 62 ]; the measures used to end the SARS epidemic is a global solution [ 11 ]; and the ongoing measures to control influenza [ 63 , 64 ] and malaria [ 45 , 65 ], and the measures taken by China, WHO and many countries in the world to control the new coronaviral epidemic started in China are also great examples of global solutions [ 66 ].

Global solutions are also needed for many emerging health problems, including cardiovascular diseases, sedentary lifestyle, obesity, internet abuse, drug abuse, tobacco smoking, suicide, and other problems [ 29 , 44 ]. As described earlier, global solutions are not often a medical intervention or a procedure for individual patients but frameworks, policies, strategies, laws and regulations. Using social media to deliver interventions represents a promising approach in establishment of global solutions, given its power to penetrate physical barriers and can reach a large body of audience quickly.

Types of Global Health researches

One challenge to GHRP editors (and authors alike) is how to judge whether a research study is global? Based on the new definition of global health we proposed as described above, two types of studies are considered as global and will receive further reviews for publication consideration. Type I includes projects or studies that involve multiple countries with diverse backgrounds or cover a large diverse populations residing in a broad geographical area. Type II includes projects or studies guided by a global perspective, although they may use data from a local population or a local territory. Relative to Type I, we anticipate more Type II project and studies in the field of global health. Type I study is easy to assess, but caution is needed to assess if a project or a study is Type II. Therefore, we propose the following three points for consideration: (1) if the targeted issues are of global health impact, (2) if the research is attempted to understand an issue with a global perspective, and (3) if the research purpose is to seek for a global solution.

An illustrative example of Type I studies is the epidemic and control of SARS in Hong Kong [ 11 , 67 ]. Although started locally, SARS presents a global threat; while controlling the epidemic requires international and global collaboration, including measures to confine the infected and measures to block the transmission paths and measures to protect vulnerable populations, not simply the provisions of vaccines and medicines. HIV/AIDS presents another example of Type I project. The impact of HIV/AIDS is global. Any HIV/AIDS studies regardless of their scope will be global as long as it contributes to the global efforts to end the HIV/AIDS epidemic by 2030 [ 61 , 62 ]. Lastly, an investigation of cardiovascular diseases (CVD) in a country, in Nepal for example, can be considered as global if the study is framed from a global perspective [ 44 ].

The discussion presented above suggests that in addition to scope, the purpose of a project or study can determine if it is global. A pharmaceutical company can target all people in the world to develop a new drug. The research would be considered as global if the purpose is to improve the medical and health conditions of the global population. However, it would not be considered as global if the purpose is purely to pursue profit. A research study on a medical or health problem among rural-to-urban migrants in China [ 57 , 58 , 60 ] can be considered as global if the researchers frame the study with a global perspective and include an objective to inform other countries in the world to deal with the same or similar issues.

Think globally and act locally

The catchphrase “think globally and act locally” presents another guiding principle for global health and can be used to help determine whether a medical or public health research project or a study is global. First, thinking globally and acting locally means to learn from each other in understanding and solving local health problems with the broadest perspective possible. Taking traffic accidents as an example, traffic accidents increase rapidly in many countries undergoing rapid economic growth [ 68 , 69 ]. There are two approaches to the problem: (1) locally focused approach: conducting research studies locally to identify influential factors and to seek for solutions based on local research findings; or (2) a globally focused approach: conducting the same research with a global perspective by learning from other countries with successful solutions to issues related traffic accidents [ 70 ].

Second, thinking globally and acting locally means adopting solutions that haven been proven effective in other comparable settings. It may greatly increase the efficiency to solve many global health issues if we approach these issues with a globally focused perspective. For example, vector-borne diseases are very prevalent among people living in many countries in Africa and Latin America, such as malaria, dengue, and chikungunya [ 45 , 71 , 72 ]. We would be able to control these epidemics by directly adopting the successful strategy of massive use of bed nets that has been proven to be effective and cost-saving [ 73 ]. Unfortunately, this strategy is included only as “simple alternative measures” in the so-called global vector-borne disease control in these countries, while most resources are channeled towards more advanced technologies and vaccinations [ 16 , 19 , 74 ].

Third, thinking globally and acting locally means learning from each other at different levels. At the individual level, people in high income countries can learn from those in low- and mid-income countries (LMICs) to be physically more active, such as playing Taiji, Yoga, etc.; while people in LMICs can learn from those in high income countries to improve their hygiene, life styles, personal health management, etc. At the population level, communities, organizations, governments, and countries can learn from each other in understanding their own medical and health problems and healthcare systems, and to seek solutions for these problems. For example, China can learn from the United States to deal with health issues of rural to urban migrants [ 75 ]; and the United States can learn from China to build three-tier health care systems to deliver primary care and prevention measures to improve health equality.

Lastly, thinking globally and acting locally means opportunities to conduct global health research and to be able to exchange research findings and experiences across the globe; even without traveling to another country. For example, international immigrants and international students present a unique opportunity for global health research in a local city [ 5 , 76 ]. To be global, literature search and review remains the most important approach for us to learn from each other besides conducting collaborative work with the like-minded researchers across countries; rapid development in big data and machine learning provide another powerful approach for global health research. Institutions and programs for global health provides a formal venue for such learning and exchange opportunities.

Reframing a local research study as global

The purpose of this article is to promote global health through research and publication. Anyone who reads this paper up to this point might already be able to have a clear idea on how to reframe his/her own research project or article to be of global nature. There is no doubt that a research project is global if it involves multiple countries with investigators of diverse backgrounds from different countries. However, if a research project targets a local population with investigators from only one or two local institutions, can such project be considered as global?

Our answer to this question is “yes” even if a research study is conducted locally, if the researcher (1) can demonstrate that the issue to be studied or being studied has a global impact, or (2) eventually looks for a global solution although supported with local data. For example, the study of increased traffic accidents in a city in Pakistan can be considered as global if the researchers frame the problem from a global perspective and/or adopt global solutions by learning from other countries. On the other hand, a statistical report of traffic accidents or an epidemiological investigation of factors related to the traffic accidents at the local level will not be considered as global. Studies conducted in a local hospital on drug resistance to antibiotics and associated cost are global if expected findings can inform other countries to prevent abuse of antibiotics [ 77 ]. Lastly, studies supported by international health programs can be packaged as global simply by broadening the vision from international to global.

Is Global Health a new bottle with old wine?

Another challenge question many scholars often ask is: “What new things can global health bring to public health and medicine?” The essence of this question is whether global health is simply a collection of existing medical and health problems packaged with a new title? From our previous discussion, many readers may already have their own answer to this question that this is not true. However, we would like to emphasize a few points. First, global health is not equal to public health, medicine or both, but a newly emerged sub-discipline within the public health-medicine arena. Global health is not for all medical and health problems but for the problems with global impact and with the purpose of seeking global solutions. In other words, global health focuses primarily on mega medical and health problems that transcend geographical, cultural, and national boundaries and seeks broad solutions, including frameworks, partnerships and cooperation, policies, laws and regulations that can be implemented through governments, social media, communities, and other large and broad reaching mechanisms.

Second, global health needs many visions, methods, strategies, approaches, and frameworks that are not conventionally used in public health and medicine [ 5 , 18 , 22 , 34 ]. They will enable global health researchers to locate and investigate those medical and health issues with global impact, gain new knowledge about them, develop new strategies to solve them, and train health workers to deliver the developed strategies. Consequently, geography, history, culture, sociology, governance, and laws that are optional for medicine and public health are essential for global health. Lastly, it is fundamental to have a global perspective for anyone in global health, but this could be optional for other medical and health scientists [ 40 , 41 ].

Global Health, international health, and public health

As previously discussed, global health has been linked to several other related disciplines, particularly public health, international health, and medicine [ 3 , 5 , 7 , 18 , 22 ]. To our understanding, global health can be considered as an application of medical and public health sciences together with other disciplines (1) in tackling those issues with global impact and (2) in the effort to seek global solutions. Thus, global health treats public health sciences and medicine as their foundations, and will selectively use theories, knowledge, techniques, therapeutics and prevention measures from public health, medicine, and other disciplines to understand and solve global health problems.

There are also clear boundaries between global health, public health and medicine with regard to the target population. Medicine targets patient populations, public health targets health populations in general, while global health targets the global population. We have to admit that there are obvious overlaps between global health, public health and medicine, particularly between global health and international health. It is worth noting that global health can be considered as an extension of international health with regard to the scope and purposes. International health focuses on the health of participating countries with intention to affect non-participating countries, while global health directly states that its goal is to promote health and prevent and treat diseases for all people in all countries across the globe. Thus, global health can be considered as developed from, and eventually replace international health.

Challenges and opportunities for China to contribute to Global Health

To pursue A Community with a Shared Future for Mankind , China’s BRI , currently involving more than 150 countries across the globe, creates a great opportunity for Chinese scholars to contribute to global health. China has a lot to learn from other countries in advancing its medical and health technologies and to optimize its own healthcare system, and to reduce health disparities among the 56 ethnic groups of its people. China can also gain knowledge from other countries to construct healthy lifestyles and avoid unhealthy behaviors as Chinese people become more affluent. Adequate materials and money may be able to promote physical health in China; but it will be challenging for Chinese people to avoid mental health problems currently highly prevalent in many rich and developed countries.

To develop global health, we cannot ignore the opportunities along with the BRI for Chinese scholars to share China’s lessons and successful experience with other countries. China has made a lot of achievements in public health and medicine before and after the Open Door Policy [ 49 , 78 ]. Typical examples include the ups and downs of the 3-Tier Healthcare Systems, the Policy of Prevention First, and the Policy of Putting Rural Health as the Priority, the Massive Patriotic Hygiene Movement with emphasis on simple technology and broad community participation, the Free Healthcare System for urban and the Cooperative Healthcare System for rural residents. There are many aspects of these initiatives that other countries can emulate including the implementation of public health programs covering a huge population base unprecedented in many other countries.

There are challenges for Chinese scholars to share China’s experiences with others as encountered in practice. First of all, China is politically very stable while many other countries have to change their national leadership periodically. Changes in leadership may result in changes in the delivery of evidence- based intervention programs/projects, although the changes may not be evidence-based but politically oriented. For example, the 3-Tier Healthcare System that worked in China [ 79 , 80 ] may not work in other countries and places without modifications to suit for the settings where there is a lack of local organizational systems. Culturally, promotion of common values among the public is unique in China, thus interventions that are effective among Chinese population may not work in countries and places where individualism dominates. For example, vaccination program as a global solution against infectious diseases showed great success in China, but not in the United States as indicated by the 2019 measles outbreak [ 81 ].

China can also learn from countries and international agencies such as the United Kingdom, the United States, the World Health Organization, and the United Nations to successfully and effectively provide assistance to LMICs. As China develops, it will increasingly take on the role of a donor country. Therefore, it is important for Chinese scholars to learn from all countries in the world and to work together for a Community of Shared Future for Mankind during the great course to develop global health.

Promotion of global health is an essential part of the Working Together  to Build a Community of Shared Future for Mankind. In this editorial, we summarized our discussions in the 2019 GHRP Editorial Board Meeting regarding the concept of global health. The goal is to enhance consensus among the board members as well as researchers, practitioners, educators and students in the global health community. We welcome comments, suggestions and critiques that may help further our understanding of the concept. We would like to keep the concept of global health open and let it evolve along with our research, teaching, policy and practice in global health.

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We would like to thank those who had provided their comments for the improvement of the manuscript.

The work is funded by the journal development funds of Wuhan University.

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Xinguang Chen, Hao Li, Xiaohui Liang, Zongfu Mao, Nan Wang, Peigang Wang & Tingting Wang

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Chen XG wrote the manuscript. LI H organized the meeting, collecting the comments and editing the manuscript. Lucero-Prisno DE integrated all the comments together. Abdullah AS, Huang JY, Laurence C, Liang XH, Ma ZY, Ren R, Wu SL, Wang N, Wang PG and Wang Tt all participated in the discussion and comments of this manuscript. Laurence C and Liang XH both provided language editing. The author(s) read and approved the final manuscript

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Chen, X., Li, H., Lucero-Prisno, D.E. et al. What is global health? Key concepts and clarification of misperceptions. glob health res policy 5 , 14 (2020). https://doi.org/10.1186/s41256-020-00142-7

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The health impacts of globalisation: a conceptual framework

• Maud MTE Huynen 1 ,
• Pim Martens 1 , 2 , 3 &
• Henk BM Hilderink 4  

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This paper describes a conceptual framework for the health implications of globalisation. The framework is developed by first identifying the main determinants of population health and the main features of the globalisation process. The resulting conceptual model explicitly visualises that globalisation affects the institutional, economic, social-cultural and ecological determinants of population health, and that the globalisation process mainly operates at the contextual level, while influencing health through its more distal and proximal determinants. The developed framework provides valuable insights in how to organise the complexity involved in studying the health effects resulting from globalisation. It could, therefore, give a meaningful contribution to further empirical research by serving as a 'think-model' and provides a basis for the development of future scenarios on health.

Introduction

Good health for all populations has become an accepted international goal and we can state that there have been broad gains in life expectancy over the past century. But health inequalities between rich and poor persist, while the prospects for future health depend increasingly on the relative new processes of globalisation. In the past globalisation has often been seen as a more or less economic process. Nowadays it is increasingly perceived as a more comprehensive phenomenon, which is shaped by a multitude of factors and events that are reshaping our society rapidly. This paper describes a conceptual framework for the effects of globalisation on population health. The framework has two functions: serving as 'think-model', and providing a basis for the development of future scenarios on health.

Two recent and comprehensive frameworks concerning globalisation and health are the ones developed by Woodward et al. [ 1 ], and by Labonte and Togerson [ 2 ]. The effects that are identified by Woodward et al. [ 1 ] as most critical for health are mainly mediated by economic factors. Labonte and Torgerson [ 2 ] primarily focus on the effects of economic globalisation and international governance. In our view, however, the pathways from globalisation to health are more complex. Therefore, a conceptual framework for the health effects of the globalisation process requires a more holistic approach and should be rooted in a broad conception of both population health and globalisation. The presented framework is developed in the following three steps: 1) defining the concept of population health and identifying its main determinants, 2) defining the concept of globalisation and identifying its main features and 3) constructing the conceptual model for globalisation and population health.

Population health

As the world around us is becoming progressively interconnected and complex, human health is increasingly perceived as the integrated outcome of its ecological, social-cultural, economic and institutional determinants. Therefore, it can be seen as an important high-level integrating index that reflects the state-and, in the long term, the sustainability-of our natural and socio-economic environments [ 3 ]. This paper primarily focuses on the physical aspects of population health like mortality and physical morbidity.

Our identification of the most important factors influencing health is primarily based on a comprehensive analysis of a diverse selection of existing health models (see Huynen et al [ 4 ] for more details). We argue that the nature of the determinants and their level of causality can be combined into a basic framework that conceptualises the complex multi-causality of population health. In order to differentiate between health determinants of different nature, we will make the traditional distinction between social-cultural, economic, environmental and institutional factors. These factors operate at different hierarchical levels of causality, because they have different positions in the causal chain. The chain of events leading to a certain health outcome includes both proximal and distal causes; proximal factors act directly to cause disease or health gains, and distal determinants are further back in the causal chain and act via (a number of) intermediary causes [ 5 ]. In addition, we also distinguish contextual determinants. These can be seen as the macro-level conditions shaping the distal and proximal health determinants; they form the context in which the distal and proximal factors operate and develop.

Subsequently, a further analysis of the selected health models and an intensive literature study resulted in a wide-ranging overview of the health determinants that can be fitted within this framework (Figure 1 and Table 1 ). We must keep in mind, however, that determinants within and between different domains and levels interact along complex and dynamic pathways to 'produce' health at the population level. Additionally, health in itself can also influence its multi-level, multi-nature determinants; for example, ill health can have a negative impact on economic development.

Multi-nature and multi-level framework for population health.

Globalisation

There is more and more agreement on the fact that globalisation is an extremely complex phenomenon; it is the interactive co-evolution of multiple technological, cultural, economic, institutional, social and environmental trends at all conceivable spatiotemporal scales. Hence, Rennen and Martens [ 6 ] define contemporary globalisation as an intensification of cross-national cultural, economic, political, social and technological interactions that lead to the establishment of transnational structures and the global integration of cultural, economic, environmental, political and social processes on global, supranational, national, regional and local levels. Although somewhat complex, this definition is in line with the view on globalisation in terms of deterritorialisation and explicitly acknowledges the multiple dimensions involved.

However, the identification of all possible health effects of the globalisation process goes far beyond the current capacity of our mental ability to capture the dynamics of our global system; due to our ignorance and interdeterminacy of the global system that may be out of reach forever [ 7 ]. In order to focus our conceptual framework, we distinguish-with the broader definition of globalisation in mind-the following important features of the globalisation process: (the need for) new global governance structures, global markets, global communication and diffusion of information, global mobility, cross-cultural interaction, and global environmental changes (Table 2 ) (see Huynen et al. [ 4 ] for more details).

Conceptual model for globalisation and health

We have identified (the need for) global governance structures, global markets, global communication and the diffusion of information, global mobility, cross-cultural interaction, and global environmental changes as important features of globalisation. Based on Figure 1 and Table 1 , it can be concluded that these features all operate at the contextual level of health determination and influence distal factors such as health(-related) policies, economic development, trade, social interactions, knowledge, and the provision of ecosystem goods and services. In turn, these changes in distal factors have the potential to affect the proximal health determinants and, consequently, health. Our conceptual framework for globalisation and health links the above-mentioned features of the globalisation process with the identified health determinants. This exercise results in Figure 2 .

Conceptual framework for globalisation and population health.

Figure 3 , subsequently, shows that within the developed framework, several links between the specific features of globalisation and health can be derived. These important links between globalisation and health are discussed in the following sections. It is important to note that Figure 3 primarily focuses on the relationships in the direction from globalisation to health. This does not mean, however, that globalisation is an autonomous process: globalisation is influenced by many developments at the other levels, although these associations are not included in the Figure for reasons of simplification. In addition, the only feedback that is included in Figure 3 concerns the institutional response. One also has to keep in mind that determinants within the distal level and within the proximal level also interact with each other, adding complexity to our model (see Huynen et al. 4 for more details and examples of important intralevel relationships).

Conceptual model for globalisation and population health.

Globalisation and distal health determinants

Figure 3 shows that the processes of globalisation can have an impact on all identified distal determinants (Figure 3 ; arrows 1–4). Below, the implications of the globalisation process on these distal determinants will be discussed in more detail.

Health(-related) policies

Global governance structures are gaining more and more importance in formulating health(-related) policies (Figure 3 ; arrow 1). According to Dodgson et al. [ 8 ], the most important organisations in global health governance are the World Health Organization (WHO) and the World Bank (WB). The latter plays an important role in the field of global health governance as it acknowledges the importance of good health for economic development and focuses on reaching the Millennium Development Goals [ 9 ]. The WB also influenced health(-related) policies together with the International Monetary Funds (IMF) through the Structural Adjustment Programmes (SAPs) (e.g. see Hong [ 10 ]). In order to give a more central role to pro-poor growth considerations in providing assistance to low-income countries, the IMF and WB introduced the Poverty Reduction Strategy approach in 1999 [ 11 ]. In addition, the policies of the World Trade Organization (WTO) are also increasingly influencing population health [ 10 , 12 – 14 ]. Fidler [ 15 ] argues that 'from the international legal perspective, the centre of power for global health governance has shifted from WHO to the WTO'. Opinions differ with regard to whether the WTO agreements provide sufficient possibilities to protect the population from the adverse (health) effects of free trade or not [ 16 ]. In 2002, the WTO ruled that the French ban on the import of all products containing asbestos was legal on health grounds, despite protests from Canada [ 17 , 18 ]. However, protecting citizens against health risks remains difficult, as health standards often need to be supported by sound scientific evidence before trade can be restricted (see e.g. the WTO ruling against the European trade barrier concerning hormone-treated meat [ 19 , 20 ]).

Another important development is the growing number of public-private partnerships for health, as governments increasingly attract private sector companies to undertake tasks that were formerly the responsibility of the public sector. At the global level, public-private partnerships are more and more perceived as a possible new form of global governance [ 12 ] and could have important implications for health polices, but also for health-related policies.

Economic development

Opinions differ with regard to the economic benefits of economic globalisation (Figure 3 ; arrow 2). On the one side, 'optimists' argue that global markets facilitate economic growth and economic security, which would benefit health. They base themselves on the results of several studies that argue that inequities between and within countries have decreased due to globalisation (e.g. see Frankel [ 21 ], Ben David [ 22 ], Dollar and Kraay [ 23 ]). Additionally, it is argued that although other nations or households might become richer, absolute poverty is reduced and that this is beneficial for the health of the poor [ 24 ]. On the other side, 'pessimists' are worried about the health effects of the exclusion of nations and persons from the global market. They argue that the risk of exclusion from the growth dynamics of economic globalisation is significant in the developing world [ 25 ]. In fact, notwithstanding some spectacular growth rates in the 1980's, especially in east Asia, incomes per capita declined in almost 70 countries during the same period [ 26 ]. Many worry about what will happen to the countries that cannot participate in the global market as successful as others.

Due to the establishment of global markets and a global trading system, there has been a continuing increase in world trade (Figure 3 ; arrow 2). According to the WTO, total trade multiplied by a factor 14 between 1950 and 1997 [ 27 ]. Today all countries trade internationally and they trade significant proportions of their national income; around 20 percent of world output is being traded. The array of products being traded is wide-ranging; from primary commodities to manufactured goods. Besides goods, services are increasingly being traded as well [ 28 ]. In addition to legal trade transactions, illegal drug trade is also globalising, as it circumvents national and international authority and takes advantage of the global finance systems, new information technologies and transportation.

Social interactions: migration

Due to the changes in the infrastructures of transportation and communication, human migration has increased at unprecedented rates (Figure 3 ; arrow 3) [ 28 ]. According to Held et al. [ 28 ] tourism is one of the most obvious forms of cultural globalisation and it illustrates the increasing time-space compression of current societies. However, travel for business and pleasure constitutes only a fraction of total human movement. Other examples of people migrating are missionaries, merchant marines, students, pilgrims, militaries, migrant workers and Peace Corps workers [ 28 , 29 ]. Besides these forms of voluntary migration, resettlement by refugees is also an important issue. However, since the late 1970s, the concerns regarding the economic, political, social and environmental consequences of migration has been growing and many governments are moving towards more restrictive immigration policies [ 30 ].

Social interactions: conflicts

The tragic terrorist attacks in New York and Washington D.C. in September 2001 fuelled the already ongoing discussions on the link between globalisation and conflicts. Globalisation can decrease the risk on tensions and conflicts, as societies become more and more dependent on each other due the worldwide increase in global communication, global mobility and cross-cultural interactions (Figure 3 ; arrow 3). Others argue that the resistance to globalisation has resulted in religious fundamentalism and to worldwide tensions and intolerance [ 31 ]. In addition, the intralevel relationships at the distal level play a very important role, because many developments in other distal factors that have been associated with the globalisation process are also believed to increase the risk on conflicts. In other words, the globalisation-induced risk on conflict is often mediated by changes in other factors at the distal level [ 4 ].

Social interactions: social equity and social networks

Cultural globalisation (global communication, global mobility, cross-cultural interaction) can also influence cultural norms and values about social solidarity and social equity (Figure 3 ; arrow 3). It is feared that the self-interested individualism of the marketplace spills over into cultural norms and values resulting in increasing social exclusion and social inequity. Exclusion involves disintegration from common cultural processes, lack of participation in social activities, alienation from decision-making and civic participation and barriers to employment and material sources [ 32 ]. Alternatively, a socially integrated individual has many social connections, in the form of both intimate social contacts as well as more distal connections [ 33 ]. On the other hand, however, the geographical scale of social networks is increasing due to global communications and global media. The women's movement, the peace movement, organized religion and the environmental movement are good examples of such transnational social networks. Besides these more formal networks, informal social networks are also gaining importance, as like-minded people are now able to interact at distance through, for example, the Internet. In addition, the global diffusion of radio and television plays an important role in establishing such global networks [ 28 ]. The digital divide between poor and rich, however, can result in social exclusion from the global civil society.

The knowledge capital within a population is increasingly affected by developments in global communication and global mobility (Figure 3 : arrow 3). The term 'globalisation of education' suggests getting education into every nook and cranny of the globe. Millions of people now acquire part of their knowledge from transworld textbooks, due to the supraterritoriality in publishing. Because of new technologies, most colleges and universities are able to work together with academics from different countries, students have ample opportunities to study abroad and 'virtual campuses' have been developed. The diffusion of new technologies has enabled researchers to gather and process data in no time resulting in increased amounts of empirical data [ 34 ]. New technologies have even broadened the character of literacy. Scholte [ 34 ] argues that 'in many line of work the ability to use computer applications has become as important as the ability to read and write with pen and paper. In addition, television, film and computer graphics have greatly enlarged the visual dimensions of communication. Many people today 'read' the globalised world without a book'. Overall, it is expected that the above-discussed developments will also improve health training and health education (e.g. see Feachem [ 24 ] and Lee [ 35 ]).

Ecosystem goods and services

Global environmental changes can have profound effects on the provision of ecosystem goods and services to mankind (Figure 3 ; arrow 4). The Intergovernmental Panel on Climate Change (IPCC) [ 36 ] concludes that it is expected that climate change can result in significant ecosystem disruptions and threatens substantial damage to the earth's natural systems. In addition, several authors have addressed the link between biodiversity and ecosystem functioning and it is agued that maintaining a certain level of biodiversity is necessary for the proper provision of ecosystem goods and services [ 37 – 40 ]. However, it is still unclear which ecosystem functions are primarily important to sustain our physical health. Basically, the following types of 'health functions' can be distinguished. First, ecosystems provide us with basic human needs like food, clean air, clean water and clean soils. Second, they prevent the spread of diseases through biological control. Finally, ecosystems provide us with medical and genetic resources, which are necessary to prevent or cure diseases [ 41 ].

Globalisation and proximal health determinants

Figure 3 shows that the impact of globalisation on each proximal health determinant is mediated by changes in several distal factors (Figure 3 ; arrows 5–12). The most important relationships will be discussed in more detail below. It is important to note that health policies and health-related policies can have an influence on all proximal factors (Figure 3 ; arrow 5).

Health services

Health services are increasingly influenced by globalisation-induced changes in health care policy (Figure 3 ; arrow 5), economic development and trade (Figure 3 : arrow 6), and knowledge (Figure 3 ; arrow 7), but also by migration (3: arrow 7). Although the WHO aims to assist governments to strengthen health services, government involvement in health care policies has been decreasing and, subsequently, medical institutions are more and more confronted with the neoliberal economic model. Health is increasingly perceived as a private good leaving the law of the market to determine whose health is profitable for investment and whose health is not [ 10 ]. According to Collins [ 42 ] populations of transitional economies are no longer protected by a centralized health sector that provides universal access to everyone and some groups are even denied the most basic medical services. The U.S. and several Latin American countries have witnessed a decline in the accessibility of health care following the privatisation of health services [ 43 ].

The increasing trade in health services can have profound implications for provision of proper health care. Although it is perceived as to improve the consumer's choice, some developments are believed to have long-term dangers, such as establishing a two-tier health system, movement of health professionals from the public sector to the private sector, inequitable access to health care and the undermining of national health systems [ 10 , 12 ]. The illegal trading of drugs and the provision of access to controlled drugs via the Internet are potential health risks [ 44 ]. In addition, the globalisation process can also result in a 'brain-drain' in the health sector as a result of labour migration from developing to developed regions.

However, increased economic growth is generally believed to enhance improvements in health care. Increased (technological) knowledge resulting from the diffusion of information can further improve the treatment and prevention of all kinds of illnesses and diseases.

Social environment

The central mechanism that links personal affiliations to health is 'social support,' the transfer from one person to another of instrumental, emotional and informational assistance [ 45 ]. Social networks and social integration are closely related to social support [ 46 ] and, as a result, globalisation-induced changes in social cohesion, integration and interaction can influence the degree of social support in a population (Figure 3 ; arrow 9). This link is, for example, demonstrated by Reeves [ 47 ], who discussed that social interactions through the Internet influenced the coping ability of HIV-positive individuals through promoting empowerment, augmenting social support and facilitating helping others. Alternatively, social exclusion is negatively associated with social support.

Another important factor in the social environment is violence, which often is the result of the complex interplay of many factors (Figure 3 ; arrows 5, 8 and 9). The WHO [ 48 ] argues that globalisation gives rise to obstacles as well as benefits for violence prevention. It induces changes in protective factors like social cohesion and solidarity, knowledge and education levels, and global violence prevention activities such as the implementation of international law and treaties designed to reduce violence (e.g. social protection). On the other hand, it also influences important risk factors associated with violence such as social exclusion, income inequality, collective conflict, and trade in alcohol, drugs or firearms.

Due to the widespread flow of people, information and ideas, lifestyles also spread throughout the world. It is already widely acknowledged and demonstrated that several modern behavioural factors such as an unhealthy diet, physical inactivity, smoking, alcohol misuse and the use of illicit drugs are having a profound impact on human health [ 49 – 52 ] (Table 3 ). Individuals respond to the range of healthy as well as unhealthy lifestyle options and choices available in a community [ 53 ], which are in turn determined by global trade (Figure 3 ; arrow 8), economic development (Figure 3 ; arrow 8) and social interactions (Figure 3 ; arrow 9).

Although the major chronic diseases are not transmittable via an infectious agent, the behaviours that predispose to these diseases can be communicated by advertising, product marketing and social interactions [ 54 ]. Global trade and marketing developments drive, for example, the nutrition transition towards diets with high proportions of salt, saturated fat and sugars [ 51 , 53 ]. Another example is the worldwide spread of tobacco consumption as transnational tobacco companies take advantage of the potential for growth in developing countries [ 51 , 55 ]. Additionally, the scale of cigarette smuggling poses a considerable global threat to the efforts to control tobacco consumption [ 44 ]. Illegal trade in illicit drugs poses similar problems. At the same time, the alcohol industry is almost as globalised as the tobacco industry [ 56 ].

However, health education can play a role in promoting healthy lifestyles by improving an individual's knowledge about the health effects of different lifestyle options (Figure 3 ; arrow 9). Besides health education, (global) policies can also directly discourage unhealthy behaviour by means of economic incentives (e.g. charging excise on tobacco) or other legislation (Figure 3 ; arrow 5).

Physical environment: infectious diseases pathogens

The spread of infectious diseases is probably one of the most mentioned health effects of globalisation and past disease outbreaks have been linked to factors that are related to the globalisation process (see e.g. Newcomb [ 57 ]). The recent outbreak of the Severe Acute Respiratory Syndrome (SARS) demonstrates the potential of new infectious diseases to spread rapidly in today's world, increasing the risk of a global pandemic. The combination of movement of goods (Figure 3 ; arrow 10) and people (Figure 3 ; arrow 11), and profound changes affecting ecosystem goods and services (Figure 3 ; arrow 12) all contribute to increased risk of disease spread [ 57 ]. For example, the globalisation of food production, trade and consumption has been associated with the increased spread and transmission of food born diseases [ 57 , 58 ]. Diseases like HIV/AIDS or hepatitis B can also spread through trade in infected biological products (e.g. blood) [ 44 ].

Enhanced knowledge and new technologies will improve the surveillance of infectious diseases and monitoring of antibiotic resistance [ 24 , 35 ] (Figure 3 ; arrow 11). Globalisation potentially increases the speed of responses in some cases. Wilson [ 29 ] states that responding to disease emergence requires a global perspective-both conceptually and geographically-as the current global situation favours the outbreak and rapid spread of infectious disease. As a result, the policies and actions undertaking by the WHO are becoming increasingly important in controlling infectious diseases at a global level (Figure 3 ; arrow 5). For instance, the WHO played a critical role in controlling SARS by means of global alerts, geographically specific travel advisories and monitoring [ 59 ].

Food trade has become an increasingly important factor with regard to food security worldwide (Figure 3 ; arrow 10). At present, however, the developed countries usually subsidise their agricultural sectors. Current liberalisation policies are expected to have profound implications on food trade and, subsequently food security [ 60 ]. Some argue that the resulting free trade will create access to better and cheaper food supplies via food imports and can stimulate more efficient use of the world's resources as well as the production of food in regions that are more suitable to do so [ 60 , 61 ]. Free trade permits food consumption to grow faster than domestic food production in countries where there are constraints on increasing the latter. Accelerated economic growth can also contribute to food security (Figure 3 ; arrow 10) [ 60 ]. Others, however, argue that the forces of globalisation in fact endanger food security (e.g. see Lang [ 62 ]) and that countries should strive to become more self-sufficient [ 60 ]. For many countries the increasing dependence on food imports goes hand in hand with a higher vulnerability to shocks arising in global markets, which can affect import capacity and access to food imports [ 60 ]. Many food insecure countries are not able to earn enough with exporting goods in order to pay for the needed food imports [ 63 ].

At the global level, there are increasing international efforts to achieve widespread food security (Figure 3 ; arrow 5). For instance, the right to adequate food is directly addressed in the 1966 International Covenant on Economic, Social and Cultural Rights. In 1996, the World Food Summit reaffirmed the right of everyone to have access to safe and nutritious food. In case of extreme food-insecurity and insufficient import capacity, food aid may be provided in order to supplement the scarce food imports. Globalisation can affect food security by enhancing the knowledge of foreign nations about the usefulness of food aid (Figure 3 ; arrow 11) [ 60 ].

Besides food trade, one can also deal with the mismatch between demand and supply by increasing food production in food-short regions. The globalisation process can increase food security by facilitating the worldwide implementation of better technologies and improved knowledge (e.g. irrigation technologies, research on genetically modified food) (Figure 3 ; arrow 11). At the same time, the natural resource base for food production is increasingly threatened (Figure 3 ; arrow 12). Finally conflicts are, of course, a threat to food security and it is expected that food security in sub-Saharan Africa, for example, will not increase without the establishment of political instability (Figure 3 ; arrow 11) [ 64 ].

The effects of globalisation are also raising concerns over water security. The current globalisation process is accompanied by privatisation policies affecting the provision of water [ 65 ] (Figure 3 ; arrow 5). Governments and international financial institutions promote privatisation, as they believe it will promote market competition and efficiency. However, others are less optimistic about the effects of privatisation. In fact, some cases show that prices and inequalities in access even rise [ 66 ]. It is also argued that water, with vital importance socially, culturally, and ecologically, 'cannot be protected by purely market forces' [ 65 ]. On a global scale, there are increasing efforts to set up global guidelines or policies with regard to fresh water (Figure 3 ; arrow 5), however none of the international declarations and conference statements requires states to actual meet individual's water requirements [ 67 ].

The virtual trade of water is also believed to be of increasing importance (Figure 3 ; arrow 10). The water that is used in the production process of a commodity is called the 'virtual water' contained in that commodity. Therefore, the increasing global trade of commodities is accompanied by an increasing global trade in virtual water. The global volume of virtual water embedded in crop and livestock products traded between nations is estimated to be 1400 billion cubic metres per year [ 68 ].

In addition, the globalisation process can increase water security by facilitating the worldwide implementation of better technologies and improved knowledge (Figure 3 ; arrow 11). At the same time, the natural resource base is increasingly threatened as, for example, global climate change and deforestation profoundly affect our ecosystems ability to provide us with sufficient and adequate fresh water (Figure 3 ; arrow 12).

Globalisation is causing profound and complex changes in the very nature of our society, bringing new opportunities as well as risks. In addition, the effects of globalisation are causing a growing concern for our health, and the intergenerational equity implied by 'sustainable development' forces us to think about the right of future generations to a healthy environment and a healthy life.

Despite some empirical research efforts indicating the links between the globalisation process and specific health impacts, the present weakness in empirical evidence on the multiple links between globalisation and health is still a problem [ 44 ]. The described conceptual framework could give a meaningful contribution to further empirical research by serving as a well-structured 'think-model' or 'concept map'. It clearly demonstrates that an interdisciplinary approach towards globalisation and health is required, which draws upon the knowledge from relevant fields such as, for example, medicine, epidemiology, sociology, political sciences, (health) education, environmental sciences and economics.

In addition, the exploration of possible future health impacts of different globalisation pathways by means of scenarios analysis could provide a useful contribution to the ongoing discussions on globalisation and health [ 4 ]. Scenarios can be described as 'plausible but simplified descriptions of how the future may develop, according to a coherent and internally consistent set of assumptions about key driving forces and relationships' [ 69 ]. Recent research showed, however, that the health dimension is largely missing in existing global scenarios [ 70 ]. The developed framework for globalisation and population health has contributed to the understanding of future health implications and the model is, therefore, considered to be a useful tool to structure future scenario studies on the health implications of the globalisation process.

To conclude, the framework provides valuable insights in how to organise the complexity involved in studying the health effects resulting from globalisation. We claim that our approach has several beneficial characteristics. First, it is embedded in a holistic approach towards globalisation; in this paper we perceive globalisation as an overarching process in which simultaneously many different processes take place in many societal domains. In addition, the conceptual framework is embedded in a holistic approach towards population health. As a result, our model explicitly visualises that globalisation affects the institutional, economic, social-cultural and ecological determinants of population health and that the globalisation process mainly operates at the contextual level, while influencing health through the more distal and proximal determinants.

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Acknowledgements

We would like to thank all colleagues at the International Centre for Integrative Studies (ICIS) and the Netherlands Environmental Assessment Agency (MNP-RIVM) for the fruitful discussions leading to this paper. This work is financially supported by MNP-RIVM within the project 'Population & Health'.

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Huynen, M.M., Martens, P. & Hilderink, H.B. The health impacts of globalisation: a conceptual framework. Global Health 1 , 14 (2005). https://doi.org/10.1186/1744-8603-1-14

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Fundamentally, global health is about achieving better health outcomes for vulnerable populations and communities around the world. Those who study or practice global health work to eliminate health disparities in low-resource settings around the world through research, education and collaborative intervention.

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WHO and Its Impact on Global Health Issues Essay

The World Health Organization (WHO) is a focused agency of the United Nations (UN) that functions as a coordinating authority on global public health issues. When diplomats met to form the United Nations in 1945, one of the things they discussed an gave importance to was setting up a global health organization and incidentally, it was Jawaharlal Nehru, the first prime minister of independent India who proposed the establishment of such an organization. World Health Organization’s structure was convened on 7 April 1948, a date which is now celebrated as World Health Day throughout the world each year. It is a well endowed subsidiary of the UN and a constituent of the United Nations Development Group with its center of operations in Geneva, Switzerland.

The basic function of the World Health Organization, as stated in its constitution in the second chapter, article 1, is to take the world’s health matters in its hands and take charge for coordinating efforts to generally enhance public health throughout the world by aiming to provide each and every human being on earth access to fundamental and vital healthcare. Eradicating the world of poverty and health diseases, creating an interface between the developed and developing nations when pertaining to health issues, patronizing and supporting health programs in developing nations, coordinating and overseeing the procurement of health services, immersing in disease inspection and analysis, involving itself in promoting health and also to imparting health education, collaborating with governments and administrations all over the world to endorse health promotional programs are some of the other aims and objectives of the WHO.

The issues which are the center of attention of the World Health Organization are:

• Women’s Health
• Health In Africa
• Eradication of communicable diseases

Dr Margaret Chan, the Director-General of World Health Organization said; “I want my leadership to be judged by the impact of our work on the health of two populations: women and the people of Africa.”

It is very difficult to measure the achievements of the WHO is quantitative terms nevertheless it is possible to recognize certain positive achievements. Its first major accomplishment was the eradication of smallpox by conducting vast vaccination programs in 1979. Since then, the WHO has turned its attention to other diseases such as polio, leprosy and malaria, which have been controlled or are on the verge of eradication.

New international Child Growth Standards for infants and young children were published by the WHO in 2001. They provide guidance for the first time about how every child in the world should grow. The publication of the first report on the health of people in Africa underscores the fact that the WHO Africa Region, in which some 738 million people live, is coming up with its own solutions to Africa’s health problems.

WHO also initiated campaigns against the consumption of tobacco and each year WHO celebrates the convention of the WHO Framework on Tobacco Control also known as ‘No Tobacco Day’. Since it was inception by the World Health Assembly in 2003, 172 countries and the European Union have become Parties to the WHO FCTC. More than one billion people in 19 countries are now covered by WHO laws which require the printing of large, graphic health warnings on packages of tobacco.

All in all the extensive list of achievements of the WHO amounts to an overall achievement of considerable magnitude of which the organization and not least its dedicated staff and inspiring director general Dr Margaret Chan can well be proud.

Yet with all this work done the WHO cannot rest content. There is so much more to left to do.

Bibliography

“WHO | World Health Organization.” Web. 2011.

“The World Health Organization: Enlightened Goals and Remarkable Achievements-Vegetarian Era-The Supreme Master Ching Hai Hai News Magazine.151.” Web. 2011.

“Origins, History, and Achievements of the World Health Organization.” Web. 2011.

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Global Health Issues: Essay Example

Global health essay: introduction.

A study conducted to investigate global health’s plight reveals that it is at its utmost disaster. The study shows that the new skills brought about by science and medicine have failed to meet the global population’s needs. Although outstanding enhancements have been prepared in the health condition globally over the last century, these improvements have not met the requirements of everyone. The reason behind this is the dissimilar living standards in different countries.

It is believed that the significant risk to the existing and developing health disaster tend to be those obliged to societal determinants confirmed to harmfully affect people’s health, including poverty and unsafe living and effective surroundings. Weak health schemes, worldwide deaths, and disparities in the health staff, among others, bring about global health disorders. (Schnurr et al. 398)

As one of the most alarming disasters in global health, hunger has done a lot in slowing down many countries in the world. Haiti, my country of birth, is one of the countries affected by global health issues. Haiti is believed to be a country that has never enjoyed freedom for a long time. Many may wonder why there is so much hunger in the country; the reason behind it is because of the poverty that has dominated the country.

Poverty in Haiti is exceptional due to poor governance, education, and the continued earthquakes (Shah para. 5). The lack of support in the agricultural sector has also contributed a lot towards hunger in the country, a position that Jacques Diouf, the Director General of FAO agrees with. Diouf states, “Economic and social reconstruction of the country needs a restoration of food production and massive investment in rural area” (Jere 1752). For this reason, you will find that almost everybody in Haiti is affected directly or indirectly.

The research shows that in the 21st century, hunger is the leading risk to health worldwide. A report published by the World Health Organization reveals that hunger kills more people than cancer, heart disease, AIDS, malaria, and tuberculosis combined. It is also estimated that in every four children, one is underweight.

Due to the underweight condition, a child is likely to die from infectious diseases because of weakened immunity. According to one of the American researchers, “the hungry are the poorest of the poor, and enhancements in poverty don’t automatically reach them” (Dickenson 7) as it has been in Haiti. The impact of hunger can bring about poverty, malnutrition, and HIV/AIDS, among many more.

As many people know, poverty dramatically impacts the global health issue. The researcher has clearly proven that you may have nothing to eat if you are poor. Unlike in Haiti, many people are poor due to inadequate support from the government, which has not been stable for quite some time due to the alarming issues that arise in the country continually. It is believed that the most significant number of people in Haiti live below the poverty line causing the speedy growth of poverty in the country. (Jere, 1754)

Malnutrition

Malnutrition is not something new to the people of Haiti. Research shows that Haitians are chronically underfed due to insufficient food. Undernutrition affects the immune structure, mounting to the occurrences and sternness of diseases, and is an allied issue in approximately all children’s deaths. (Dickenson 8)

This disease will always withstand due to the lack of money caused by the country’s poor economy. In this case, many people indulge in prostitution in search of money, which is one of the most common ways of contracting HIV/AIDS. The behavior has spread rapidly due to poor governance, lack of enough to eat, and lack of education. In this situation, little is done to kick the disease out of the country. (Dickenson 9)

Current Aid Organizational

For these reasons, some organizations have come together to help this country from this alarming situation. These organizations are educating the people of Haiti, bringing about new technologies, and changing the drastically deteriorated economy. Some of these organizations include the Students for Global Citizenship Club (S4GC), Boston Aid Groups Lead, cell phones help aid groups, and the cholera struggle aid groups (Jere 1754).

Students for Global Citizenship Club (S4GC)

This organization has done a lot in promoting the responsiveness of Haitians regarding global matters and movements dealing with activism and volunteerism. The aim is to develop the lives of others. For this reason, the people of Haiti have learned how to help one another in times of need.

They have also learned the need to unite and form organizations that would take the country to great heights. Despite all the challenges Haitians face, they have something to enjoy after having centers that can now cater to their needs, especially regarding activism and leadership (Schnurr et al. 398).

Boston Aid Groups Lead

This organization has helped Haitians a lot by saving them during the earthquake. The organization also funded the victims of the earthquake. In doing so, the Haitians could not feel left behind from the comfort they received from this organization that was willing to heal their wounds even during these challenging times.

This organization has been doing wonders, even providing medical treatment for injured people during disasters. In these times of disaster, the organization remembers to advance nutritional aid and provide clean water for them to drink. It has developed and empowered the Haitians, so they can now better do the work by themselves. (Schnurr et al. 399)

Cell Phones Help Aid Group

Cell phones helped the Haitians a lot during this tough period. The main aim of this organization was to collect any relevant information that could assist the people whenever necessary. Any news that arose in the country was easily transmitted, and stern measures were taken immediately or before anything wrong happened.

This technology made the people feel connected, so they were eager to participate in the organization, finally leaving them with new knowledge. This technology simplified things since, previously, people could walk long distances to pass simple information. Now they have the chance to make use of the available technology, effectively saving on time and cost (Dickenson 10).

Cholera Intensifies Struggle for Aid Group

Due to the continued lack of proper diet, water pollution, and education, diseases had a wide path to enter the people of Haiti. This organization provided the most necessities in fighting any epidemic in the country. The organization was there to help stop the spread of disease, educate the people about appropriate hygiene, and humanize the dumping of unwanted waste. It was great for the country, making the people civilized by learning of all these (Schnurr et al. 399).

Illiteracy is among the leading issues associated with health problems. The level of illiteracy in Haiti is high, meaning that people cannot practice healthy eating habits. The discrepancy between the rich and poor is very high in Haiti. This discrepancy has led to increased health-related problems among poor citizens.

According to Kendall (293), Montrouis, Haiti has a club med that hosts the affluent people of the society and tourists. In contrast, just a few kilometers away, we have open markets characterized by raw meat, flies, homeless people, and malnourished families. It is a scenario of the rich bordering on the poor who live in adverse poverty and health-related issues. Haiti is not only the poorest state in the Western region but also cannot feed its citizens.

Due to that, people are exposed to malnutrition-related diseases like Marasmus and Kwashiorkor, among other conditions. According to Kendall (293), statistics show that an estimated 40 percent or more of the children in Haiti are chronically malnourished. The statistics also show that more than 80% of Haitians’ eating habits are poor, and they take less than 2,200 calories daily. The discrepancy is also seen in the income sector, where poor citizens are low-income earners who cannot afford food and medical services. 

Healthcare quality is low in poor nations, and people hardly receive it. Most countries in the developing world are faced with this issue. The dissemination of healthcare facilities and healthcare is expensive to deliver to the people. The cost of medicine, medical care, insurance, and accessibility to the healthcare infrastructure are the drawbacks that hinder the delivery of adequate and quality healthcare.

Hospitals lack medical services providers and health doctors. According to Goldstein (41), Haiti is one of the poorest nations that provide low-quality and inadequate healthcare, and its citizens are affected by this. Statistics by the WHO estimate that for every 100,000 Haitians, only eight doctors and ten nurses (Goldstein 41) are available. It has been recorded as the lowest ratio in the healthcare sector in the world, and hence a global issue.

The scenario is worse even in other parts of the world, whereby most clinics, national hospitals, and even health doctors located in urban centers cannot be accessed easily by low-income earners and those living in rural areas. Rural dwellers have limited access to medical and healthcare facilities. A study done in Haiti by the World Health Organization has shown that rural dwellers in Haiti face this problem, and it has become a significant concern to aid and humanitarian organizations.

Low life expectancy has become a health issue in the world. Most nations, especially the ones with low economies, face low life expectancy. In Haiti, life expectancy is as low as 53 years for women and 50 for men (Goldstein 41). Infant mortality is also high, with many children dying before their first and fifth birthdays.

The report shows that of every 1000 children, 74 die before celebrating their first birthday. Their mothers also die, with more than 520 women dying during childbirth. It has been attributed to low income, while inaccessibility to healthcare facilities has also contributed to the observed scenario. A comparison of the situation in Haiti with that of the United States reveals an existing gap between the developing and the developed countries.

Sanitation has become a global health issue affecting most societies worldwide. In developing countries, sanitation facilities like sewerage and toilets and access to cleaner and safer water are not well accessed. This situation is attributed to some of the factors and issues discussed in this paper, like poverty, low income, the discrepancy between the poor and the rich, and the management of the economies of these countries. In Haiti, access to proper sanitation is worse, given that it is an island recently hit by a devastating earthquake.

Drinking water in Haiti is not clean and is mainly drawn from rivers polluted with industrial and human wastes (Goldstein 41). Diseases such as typhoid, cholera, and hookworm, among others, are therefore widespread in the country. The situation has affected the population and has become a concern to the humanitarian and aids organization. Malaria, a killer disease in Africa, is also a considerable concern in Haiti because of the poor drainage system and malnutrition known to weaken the body, making it vulnerable to disease.

Observations in Global Health Issues

In general, global health issues have a significant impact on many countries, especially Haiti. It is because the country has never enjoyed the fruits of its labor, unlike the other countries. Some of the impacts, like poverty, malnutrition, and HIV/AIDS, have contributed significantly to a slowdown in the country’s economic growth. Other impacts like poor sanitation facilities, poor quality healthcare facilities, discrepancies between the poor and the rich, and low life expectancy have been part of the health issues in Haiti.

The paper summarizes how with the help of humanitarian organizations, poor Haiti now has something to smile about. Research indicates that Haitians had nothing to smile about until these organizations stepped in. They have dramatically changed the country, leaving something they can smile for with them.

Health Issues Essay: Conclusion

Hunger is a global health issue that can leave someone with no joy at all. Hunger has proven to be the leading disaster as a global health issue of significant concern to governments, and the situation is no different in Haiti. The paper clearly shows how hunger has resulted in the spread of HIV/AIDs, malnutrition, and poverty, among others, in Haiti.

The paper also shows that the discrepancy between the poor and the rich contributes to poor health in Haiti. Quality of healthcare and healthcare facilities has also contributed to most global health issues like malnutrition, low maternity, and mortality rate. Sanitation that includes sewerage, toilet, and drinking water are common issues inhibited in the world and Haiti.

Works Cited

Dickenson, Nancy. Global Health Issues and Challenges. Journal of Nursing Scholarship 36.1 (2004): 6-10. Print.

Goldstein, Margaret J. Haiti in Pictures . Minneapolis: Lerner Publications Co. 2005. Print

Jere, Behrman, “The Economic Rationale for Investing in Nutrition in Developing Countries”, World Development 11. 11(npg): 1749-1993. Print.

Kendall, Diana, E. Sociology in Our Times . Belmont, CA: Thomson/Wadsworth, 2008. Print.

Labonte, Ronald. “Setting global health research priorities. Burden of disease and inherently global health issues should both be considered” , BMJ Journals 326. 7392 (2003 ):326- 722. Print.

Schnurr, Paula, Kaloupek, Danny, Sandra Bloom, Stuart Turner & Kaltman, Stacey. “Grand Challenges in Global Health”, Science journal 302.5644 (2003): 398-399.Print.

Shah, Anup. World Hunger and Poverty . 2010. Web.

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The Case for Universal Healthcare: Ensuring Health as a Human Right

This essay is about the importance of universal healthcare and argues that healthcare should be accessible to everyone, regardless of financial status. It emphasizes that health is a basic human right and that universal healthcare promotes equality, economic benefits, and social cohesion. The essay highlights how universal healthcare can reduce overall healthcare costs through preventative care, alleviate medical debt, and address health disparities among different socio-economic groups. It also counters criticisms about increased government spending by pointing out the long-term economic gains and successful examples from countries with universal healthcare systems. The essay concludes that universal healthcare is essential for a just and prosperous society.

How it works

The domain of healthcare constitutes a quintessential facet of human existence, engendering a discourse spanning the global spectrum regarding its universal accessibility. The contention surrounding this issue remains fervent and pervasive. There exist compelling rationales advocating for the universality of healthcare, positing it as an entitlement irrespective of one’s pecuniary status. At the crux of this discourse lies the axiom that healthcare embodies an elemental human entitlement, indispensable for the sustenance and flourishing of individuals and collectives alike. This exposition shall delve into the imperative for the universal accessibility of healthcare, scrutinizing diverse vantages and ramifications.

Primarily and paramountly, the accessibility of healthcare epitomizes an inalienable human entitlement. The capacity to procure medical attention in times of exigency stands as a linchpin for leading a fruitful and gratifying existence. The deprivation of healthcare owing to fiscal constraints constitutes a transgression against this foundational entitlement. Across myriad societies, the chasms in healthcare access are glaring, with indigent individuals and households often precluded from availing themselves of indispensable medical amenities. This schism not only adversely impacts the individuals directly implicated but also begets broader societal repercussions. Robust individuals serve as societal assets, fostering positive contributions both economically and socially. Ensuring equitable access to healthcare stands as a stride toward actualizing parity and socio-judicial rectitude.

Moreover, the universality of healthcare holds the potential for substantial economic dividends. Prophylactic measures, which are more apt to be embraced in an environment where healthcare is universally accessible, harbor the potential to curtail the incidence of grave maladies necessitating exorbitant remediation. Preventative interventions, encompassing immunizations, routine check-ups, and timely interventions, epitomize cost-efficient modalities for nurturing public health. By preemptively addressing health maladies, individuals can forestall the onset of more severe health adversities, which are prodigiously dearer to rectify and manage. This not only mitigates aggregate healthcare expenditures but also alleviates the financial encumbrance borne by individuals and households. Additionally, a robust populace fosters heightened productivity, engendering augmented economic outputs and diminished absenteeism within occupational spheres. Nations espousing universal healthcare paradigms, such as Canada and the United Kingdom, frequently manifest superior health outcomes and reduced healthcare expenditures vis-à-vis nations bereft of analogous frameworks.

Another salient contention for universal healthcare pertains to its ameliorative impact on the specter of medical indebtedness. In nations devoid of universal healthcare, healthcare expenses can burgeon precipitously, precipitating fiscal destitution for myriad families. In the United States, for instance, medical indebtedness ranks among the preeminent triggers for insolvency. Families grappling with towering medical bills are frequently confronted with onerous choices, compelled to arbitrate between defraying healthcare expenses and attending to other imperative requisites, such as habitation, education, and sustenance. This fiscal exigency can engender enduring repercussions, perpetuating cycles of indigence and circumscribing prospects for economic ascension. By extending healthcare to all denizens, the onus of medical indebtedness is alleviated, endowing individuals with the latitude to concentrate on their health and well-being sans the augmented stressors borne of fiscal adversity.

Universal healthcare further assumes a pivotal mantle in mitigating health disparateness. Across sundry nations, yawning lacunae in health outcomes between disparate socio-economic cohorts are palpable. These disparages frequently stem from disparate access to healthcare amenities. Low-income denizens and marginalized communities are predisposed to deleterious health outcomes due to their incapacity to defray requisite medical expenses. By effectuating the universality of healthcare, these disparages can be attenuated, fostering more equanimous health outcomes. This assumes particular salience for susceptible demographics, such as the aged, juveniles, and those afflicted by chronic infirmities, who may be disproportionately impacted by the paucity of healthcare access. Ensuring equitable access to commensurate calibers of care fosters societal cohesion and undergirds the fortification of healthier communities.

Furthermore, universal healthcare engenders social equilibrium and engenders confidence in governance. When denizens perceive their cardinal exigencies to be met, they are more predisposed to vest their trust in and buttress their governance and societal apparatuses. This can usher in a milieu typified by stability and serenity, wherein individuals are predisposed to contribute to the commonweal. Conversely, when sizable cohorts of the populace are precluded from pivotal services like healthcare, it can foment societal tumult and schism. Universal healthcare can help efface these schisms, fostering a sense of solidarity and shared accountability.

Detractors of universal healthcare often propound that its instantiation augurs augmented governmental expenditures and amplified levies. While it holds veracity that endowing universal healthcare necessitates substantial investment, the concomitant longue durée boons frequently eclipse the outlays. By fostering a milieu of hale and hearty populace, abating medical indebtedness, and augmenting productivity, the economic dividends can offset the initial disbursements. Furthermore, myriad nations boasting universal healthcare frameworks manage to furnish superlative care sans extravagant outlays, attesting to the feasibility of striking an equilibrium between affordability and accessibility. Adroit management and apportionment of resources constitute cardinal tenets for rendering universal healthcare sustainable and efficacious.

Another focal point of contention pivots upon the caliber of care attendant upon universal healthcare paradigms. Certain quarters posit that the instantiation of universal healthcare might engender a debasement in the caliber of care, owing to the concomitant surge in demand and strain upon extant systems. Notwithstanding, empirical evidence gleaned from nations espousing entrenched universal healthcare systems proffers a contrarian narrative. Such nations oftentimes boast robust healthcare infrastructures, comprehensive training regimens for healthcare practitioners, and meticulously regulated benchmarks of care. By prioritizing preventative care and premature interventions, universal healthcare systems can sustain superlative care standards while efficaciously managing demand.

Universal healthcare, in addition, propounds a more holistic paradigm vis-à-vis health and well-being. When healthcare is rendered universally accessible, greater accentuation is accorded to preventative care, mental health services, and communal health initiatives. This comprehensive framework addresses the root causatives of health maladies and champions holistic well-being. By synthesizing corporeal, cerebral, and communal health amenities, universal healthcare can precipitate ameliorated health outcomes and a loftier quality of life for individuals and collectives.

The ethical rationale for universal healthcare is also compelling. In an equitable and just society, every denizen ought to be endowed with the opportunity to attain optimal health. The preclusion of healthcare predicated upon one’s fiscal prowess is fundamentally unjust, perpetuating inequity and undercutting the underpinnings of parity and human dignity. Universal healthcare constitutes a moral mandate, consonant with the tenets of benevolence, empathy, and societal responsibility.

The COVID-19 pandemic has additionally underscored the exigency for universal healthcare. The pandemic laid bare the vulnerabilities and lacunae entrenched within healthcare systems across the globe, particularly in jurisdictions bereft of universal healthcare frameworks. The accessibility of healthcare metamorphosed into a veritable matter of life and death, underscoring the import of having a system undergirding the capacity of all to receive medical care in epochs of crisis. Universal healthcare not only bolsters the resilience of healthcare infrastructures but also amplifies their responsiveness to exigent health crises. By provisioning comprehensive coverage, universal healthcare can better safeguard individuals and collectives from the repercussions of pandemics and sundry health exigencies.

In summation, the assertion for universal healthcare stands as robust and manifold. It constitutes a crucible of human rights, economic efficacy, societal equity, and societal stability. Guaranteeing universal access to healthcare is a sine qua non for cultivating healthier, more fecund, and more equitable societies. The long-range benefits of universal healthcare eclipse the tribulations thereof, rendering it an indispensable constituent of a fair and flourishing society. As we continue to broach the discourse apropos the future of healthcare, it behooves us to retain the fundamental dictum that health is an entitlement, not a privilege. By committing to universal healthcare, we can espouse a society that prizes the health and well-being of all its constituents, auguring a future wherein all are endowed with the opportunity to lead robust and gratifying lives.

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The digital transformation in pharmacy: embracing online platforms and the cosmeceutical paradigm shift

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In the face of rapid technological advancement, the pharmacy sector is undergoing a significant digital transformation. This review explores the transformative impact of digitalization in the global pharmacy sector. We illustrated how advancements in technologies like artificial intelligence, blockchain, and online platforms are reshaping pharmacy services and education. The paper provides a comprehensive overview of the growth of online pharmacy platforms and the pivotal role of telepharmacy and telehealth during the COVID-19 pandemic. Additionally, it discusses the burgeoning cosmeceutical market within online pharmacies, the regulatory challenges faced globally, and the private sector’s influence on healthcare technology. Conclusively, the paper highlights future trends and technological innovations, underscoring the dynamic evolution of the pharmacy landscape in response to digital transformation.

Introduction

Digital technology is driving a massive shift in the worldwide pharmacy industry with the goal of improving productivity, efficiency, and flexibility in healthcare delivery. In the pharmacy industry, implementing digital technologies like automation, computerization, and robotics is essential to cutting expenses and enhancing service delivery​​ [ 1 ]. With a predicted 14.42% annual growth rate, the digital pharmacy market is expanding significantly and is expected to reach a market volume of about $35.33 billion by 2026. This expansion reflects the pharmacy industry’s growing reliance on and promise for digital technologies​ [ 2 ].

Pharmacy services have always been focused on face-to-face communication and paper-based procedures. However, the drive for more effective, transparent, and patient-centered healthcare is clear evidence of the growing need for digital transformation. Breakthroughs like mobile communications, cloud computing, advanced analytics, and the Internet of Things (IoT) are reshaping the healthcare sector. These breakthroughs have the potential to greatly improve patient care and service delivery, as demonstrated in other industries including banking, retail, and media [ 3 ].

In the pharmacy industry, a number of significant factors are hastening this digital transition. Important concerns include the desire for cost-effectiveness, enhanced patient care, and more transparency and efficiency in medication development and manufacture. This change has been made even more rapid by the COVID-19 pandemic, which has highlighted the necessity for digital solutions to address the difficulties associated with providing healthcare in emergency situations [ 4 ].

In terms of specific technologies being adopted, artificial intelligence (AI) and machine learning are playing a pivotal role. The McKinsey Global Institute estimates that AI in the pharmaceutical industry could generate nearly $100 billion annually across the U.S. healthcare system. The use of AI and machine learning enhances decision-making, optimizes innovation, and improves the efficiency of research and clinical trials. This results in more effective patient care and a more streamlined drug development process​ [ 5 ].

The digital transformation in the pharmacy sector represents a pivotal shift in the delivery and experience of healthcare services. This evolution is more than a transient trend; it’s a fundamental alteration in the healthcare landscape [ 6 ]. The adoption of digital technologies is reshaping aspects of healthcare, including patient engagement and medication adherence, leading to enhanced healthcare outcomes. Research indicates that digital tools in pharmacy practices have resulted in more individualized and efficient patient care. Telehealth platforms, exemplified by companies like HealthTap, are being increasingly incorporated by pharmacies to augment patient care via technological solutions. The contribution of digital health technology to medication adherence is notable, employing a variety of tools such as SMS, mobile applications, and innovative devices like virtual pillboxes and intelligent pill bottles. These advancements are pivotal in addressing the critical issue of medication nonadherence in healthcare. Furthermore, digital health tools are empowering pharmacists with expanded clinical responsibilities, particularly in the management of chronic diseases like diabetes, where apps and smart devices provide essential features such as blood glucose tracking and medication reminders. This comprehensive integration of digital health into pharmacy practice signifies a transformative era in healthcare delivery and patient management [ 7 ].

Online platforms are being used increasingly by the pharmaceutical sector and educational institutions to improve efficiency, flexibility, and accessibility. The telepharmacy program at CVS Pharmacy is an example of how telepharmacy services, which provide remote counseling and prescription verification, bring pharmaceutical care to underprivileged communities [ 8 ]. Prescription accuracy and drug management are enhanced by e-prescribing software like Epic’s MyChart and digital health apps like Medisafe [ 9 ; 10 ]. Blockchain technology is also being investigated for transparent and safe supply chain management. Continuous learning and professional networking are made possible in education by Virtual Learning Environments (VLEs) like Moodle [ 11 ], simulation software like SimMan 3G Plus [ 12 ], Continuing Professional Development (CPD) platforms like the American Pharmacists Association [ 13 ], and online conference platforms, as shown in Fig.  1 . While these platforms offer significant benefits like enhanced access and cost-effectiveness, they also present challenges, including addressing the digital divide and ensuring the quality and credibility of online services to maintain professional standards and patient safety.

In this review, we summarized the digital transformation in the pharmacy sector, emphasizing the integration of online platforms and the emerging significance of cosmeceuticals. We discussed the global shift towards digital healthcare, including telehealth and online pharmacy services, and how these changes have been accelerated by the COVID-19 pandemic. The paper also examined the impact of digital technologies on pharmacy practice and education, with a focus on telepharmacy services, e-prescribing software, and digital health apps. Additionally, it addresses the challenges and opportunities presented by this transformation, including regulatory and safety concerns, and the need for continuous professional development in the digital era.

Comprehensive overview of different platforms in the pharmaceutical industry and education illustrating purposes and exemplary cases

The global impact of online pharmacy platforms

In recent years, the landscape of pharmacy practice and education has undergone a significant transformation, driven by technological advancements and catalyzed by the global COVID-19 pandemic. A study highlighting the increasing consumer trust in online medication purchases pre, during, and post-pandemic reveals a shift in consumer behavior towards online pharmacies [ 14 ]. This trend underscores a greater reliance on these platforms, where the perceived benefits significantly outweigh the perceived risks, indicating a positive reception and growing trust in digital healthcare solutions.

The adoption of telehealth, including telepharmacy, exemplifies this shift. In the United States, patient adoption of telehealth services surged from 11% in 2019 to 46%, with healthcare providers expanding their telehealth visits [ 15 ]. This shift is a reflection of how adaptable the healthcare sector is to digital platforms and how customer acceptance is increasing. The epidemic has also served as a catalyst, hastening the creation and uptake of online telepharmacy services throughout the world. The “new normal” has forced the addition of new platforms to support established sources of health information. The creation and evaluation of an online telepharmacy service in the Philippines during the pandemic serves as an example of this, demonstrating how quickly the global pharmacy industry adopted digital solutions. These services are essential for providing and elucidating pharmaceutical information within the context of primary healthcare delivery; they are not merely supplementary [ 16 ].

Simultaneously, pharmacist-led companies such as MedEssist and MedMehave, innovated digital platforms to facilitate services like flu shots or COVID-19 tests, reflecting a move towards customer-centric, digital-first services [ 17 ]. This transition enhances convenience and access to care but also introduces significant regulatory challenges. As the growth of online medicine sales disrupts traditional pharmacy markets, navigating these challenges becomes crucial for maintaining patient safety, quality standards, and fostering a trustworthy online healthcare environment [ 18 ].

Parallel to the practice changes, educational platforms for pharmacy have also evolved, especially under the impetus of the pandemic. These platforms have integrated a mix of traditional and student-centered teaching methodologies, including remote didactic lectures and on-site experiential training. The implementation of blended learning approaches, which combine remote lectures with on-site laboratory classes, reflects a broader educational trend towards hybrid models. This approach aims to leverage the advantages of both online and traditional methods, offering a more flexible and potentially more effective educational experience [ 19 ].

It takes more than just implementing new tools to integrate educational technology into pharmacy education, it also requires understanding how these technologies affect instruction and student learning. To effectively improve the educational experience, their utilization must have a purpose. There is an increasing amount of scholarly interest in this field, as evidenced by systematic reviews of the effects of new technologies on undergraduate pharmacy teaching and learning [ 20 ]. These digital platforms will probably become more significant in the future of pharmacy education, helping to mold the profession and guaranteeing that pharmacists are equipped to fulfill the ever-changing demands of the healthcare system. This development is indicative of a larger trend in the healthcare industry toward a more flexible, patient-focused, and technologically advanced environment [ 21 ].

Digital transformation in global healthcare

The recent advancements in digital transformation within global healthcare are significantly reshaping the landscape of healthcare and pharmacy services. These transformations are largely driven by the integration of digital technologies, which are redefining the tools and methods used in health, medicine, and biomedical science, ultimately aiming to create a healthier future for people worldwide [ 22 ]. In a 2018 report [ 23 ], Amazon’s potential entry into the $500 billion U.S. pharmacy market, the second-largest retail category, through mail-order and online pharmacies was highlighted as a significant industry disruptor. With licenses in at least 12 states in the US and a strategy focused on bypassing middlemen, Amazon’s historical success positions it to transform the pharmacy landscape, promising enhanced efficiency and cost savings for consumers.

One of the critical areas identified in recent research is the establishment of five priorities of e-health policy making: strategy, consensus-building, decision-making, implementation, and evaluation. These priorities emerged from stakeholders’ perceptions and are crucial for the effective integration and adoption of digital health technologies​ [ 24 ]. This holistic approach is increasingly relevant for scholars and practitioners, suggesting a focus on how multiple stakeholders implement digital technologies for management and business purposes in the healthcare sector [ 25 ]​​. The deployment of technological modalities, encompassed within five distinct clusters, can facilitate the development of a digital transformation model. This model ensures operational efficiency through several dimensions: enhanced operational efficacy by healthcare providers, the adoption of patient-centered methodologies, the integration of organizational factors and managerial implications, the refinement of workforce practices, and the consideration of socio-economic factors [ 25 ].

Studies focusing on value creation through digital means suggest healthcare as a consumer-centric realm ripe for center-edge transformations, characterized by self-service and feedback cycles. These transformations are vital in addressing inherent tensions between patients and physicians, steering the focus towards value co-creation and service-dominant logic [ 26 ]. Participatory design and decision-making approaches are emphasized for enhancing health information technology’s performance and institutional healthcare innovation. Such approaches are particularly crucial in developing national electronic medical record systems and improving chronic disease treatment through electronic health records. Additionally, telehealth research integrates patients’ perceptions, contributing to the understanding of technology, bureaucracy, and professionalism within healthcare [ 27 ].

The impact of health information technology (HIT) on operational efficiencies is profound. Empirical studies, such as those by Hong and Lee [ 28 ], Laurenza et al. [ 29 ], and Mazor et al. [ 30 ], demonstrate positive correlations between HIT and patient satisfaction, quality of care, and operational efficiency. However, challenges remain, as Rubbio et al. [ 31 ] highlight deficiencies in resilience-oriented practices for patient safety. Organizational and managerial factors in digital healthcare transformation also receive significant attention. Hikmet et al. [ 32 ] and Agarwal et al. [ 33 ] investigate the role of organizational variables and barriers in HIT adoption, whereas Cucciniello et al. [ 34 ] delve into the interdependence between implementing electronic medical records (EMR) systems and organizational conditions. Further, Eden et al. [ 35 ] and Huber and Gärtner [ 36 ] explore workforce adaptations and the implications of health information systems in hospitals that can increases transparency of work processes and accountability. Lastly, examining healthcare financialization and digital division provides an international perspective, contrasting the regulated environment in the EU with the US’s use of online medical crowdfunding as a potential solution to reduce bankruptcy [ 37 ; 38 ]. Collectively, these studies suggest a comprehensive model where stakeholders leverage digital transformation for management, enhancing operational efficiency in healthcare service providers.

Marques and Ferreira [ 39 ] performed a systematic literature review of digital transformation in healthcare, spanning the period from 1973 to 2018. Utilizing the SMARTER (Simple Multi-attribute Rating Technique Exploiting Ranks) method, 749 potential articles were analyzed, culminating in the prioritization and selection of 53 articles for detailed examination. The literature was organized into seven thematic areas: (1) Integrated management of IT in healthcare, (2) Medical images, (3) Electronic medical records, (4) IT and portable devices in healthcare, (5) Access to e-health, (6) Telemedicine, and (7) Privacy of medical data. It was observed that the predominant focus of research resides in the domains of integrated management, electronic medical records, and medical images. Concurrently, emerging trends were identified, notably the utilization of portable devices, the proliferation of virtual services, and the escalating concerns surrounding privacy. See Fig.  2 for visual representation of multifaceted digital transformation in healthcare.

Visual representation of multifaceted digital transformation in healthcare: a synthesis of provider-patient dynamics, HIT impact, and strategic management. HIT; health information technology, HC; healthcare, EMR; electronic medical records. IT; information technology, Pt.; patient

Telehealth and online pharmacy advancements in pandemic management

In the realm of online pharmacies and telehealth, digital health technologies have been instrumental in managing the COVID-19 pandemic through surveillance, contact tracing, diagnosis, treatment, and prevention. These technologies ensure that healthcare, including pharmacy services, is delivered more effectively, addressing the challenges of accessibility and timely care. The role of telemedicine and e-pharmacies, in particular, has been emphasized in improving access to care worldwide. By enabling remote consultations and drug delivery, these platforms are making healthcare more accessible, especially in regions where traditional healthcare infrastructure is limited or overstretched [ 40 ].

The Canadian Virtual Care Policy Framework advocates for the swift adoption and integration of virtual care, propelled by the COVID-19 pandemic. It emphasizes enhancing access and quality, ensuring equity and privacy, and devising appropriate remuneration models, employing a collaborative, patient-centered approach while addressing digital disparities. During the COVID-19 pandemic, Canadian provinces and territories rapidly adopted virtual health care, leading to 60% of visits being virtual by April 2020, up from 10 to 20% in 2019. However, these implementations were often temporary and not fully integrated into healthcare systems. By August 2020, virtual visits decreased to 40%, with variations across regions, while provinces and territories used temporary billing codes for these services. The framework’s “Diagnostique” provides a thorough analysis of policy enablers and strategies for virtual care, underscoring the need for comprehensive policy and partnership engagement [ 41 ]. In the context of digital transformation in pharmacy, the Hospital News article outlines the application and infrastructure of telepharmacy services in Canada, highlighting the geographical challenges and the early adoption of telepharmacy in certain regions since 2003. It notes the use of various technologies like Medication Order Management, Videoconferencing, and Remote Camera Verification. Although lacking specific quantitative data, the article underscores the necessity for expanded telepharmacy services to ensure uniform care quality across diverse locations [ 42 ].

Similarly, Telehealth offers extensive resources for patients and providers in the United States, emphasizing programs like the Affordable Connectivity Program and Lifeline to facilitate access. The Health Resources and Services Administration enhances telehealth through support services, research, and technical assistance, reflecting a significant outreach impact [ 43 ]. The Office for the Advancement of Telehealth (OAT) under Health Resources and Services Administration (HRSA) works to improve access to quality health care through integrated telehealth services in the US. It supports direct services, research, and technical assistance, with over 6,000 telehealth technical assistance requests sent to Telehealth Resource Centers and approximately 22,000 patients served [ 44 ].

Internationally, In the UK, the National Health Service (NHS) spearheads digital health and care, providing significant innovation opportunities through vast data management. Support for digital health spans various stages, from discovery with organizations like Biotechnology and Biological Sciences Research Council (BBSRC) and Intelligent Data Analysis (IDA) research group, to development with networks such as Catapults and CPRD, and delivery with entities like the Academic Health Science Networks (AHSNs) and DigitalHealth.London. Regulatory bodies like the Medicines and Healthcare products Regulatory Agency (MHRA) and NICE ensure safety and efficacy. The collaborative ecosystem involves academic, healthcare, and industry stakeholders, aiming to enhance health and care services through technology and innovation [ 45 ].

In Australia, the government’s investment of over $4 billion into COVID-19 telehealth measures has facilitated universal access to quality healthcare. This initiative has provided over 85 million telehealth services to more than 16 million patients, with approximately 89,000 healthcare providers engaging in this service delivery. From 1 January 2022, telehealth services, initially introduced in response to COVID-19, will become an ongoing part of Medicare. This will allow eligible patients across Australia continued access to general practice (GP), nursing, midwifery, and allied health services via telehealth, deemed clinically appropriate by the health professional [ 46 ].

European nations such as the Netherlands, Austria, and Italy are at the forefront of implementing cross-organizational patient records, significantly enhancing telehealth communication and facilitating cross-border healthcare. The role of strong government support in advancing telehealth is pivotal. Ursula von der Leyen, the President of the European Commission, has been a prominent advocate for eHealth. She proposed the establishment of a European Health Data Space to streamline health data exchange across member states. France, a leader in telehealth legislation for nearly a decade, has pioneered a public funding scheme for tele-expertise at a national scale. Despite these advancements, challenges like legislative barriers and the lack of consistent political direction continue to impede progress in the telehealth domain​ [ 47 ].

The Asia-Pacific region anticipates a surge in telehealth adoption driven by digital demand and pandemic-induced behavioral changes, while South East Asia exhibits widespread telehealth growth across healthcare aspects [ 48 ]. The telehealth adoption across the Asia-Pacific region has shown remarkable growth between 2019 and 2021 and is projected to continue rising by 2024. China’s adoption nearly doubled to 47% and is expected to reach 76%. Indonesia’s usage more than doubled to 51%, with a forecast of 72%. Malaysia and the Philippines both anticipate reaching a 70% adoption rate, increasing from 30% to 29%, respectively. India’s adoption is projected to more than double to 68%, while Singapore, which had a significant increase from 5 to 45%, is expected to achieve a 60% adoption rate. This trend indicates a robust uptake of telehealth services in the region [ 48 ].

Global telemedicine and E-pharmacy policy dynamics

In the context of telemedicine and e-pharmacy regulations within South East Asia, a notable distinction emerges with Singapore, Malaysia, and Indonesia being the only countries to have formalized legal frameworks governing both telemedicine practices and the dissemination of electronic information. In these countries, tele-consultation is restricted to patients already under the care of healthcare practitioners or as part of ongoing treatment, specifically in Singapore and Malaysia. Additionally, for scenarios requiring more intensive medical intervention, such as new referrals, emergency cases, or invasive procedures, both Malaysia and Indonesia mandate physical presence and face-to-face consultations, emphasizing a cautious and regulated approach to remote healthcare. In Malaysia, the regulations further stipulate that online prescriptions, excluding narcotics and psychotropic substances, are permissible solely under the continuation of care model, reflecting a judicious use of digital prescription services [ 49 ].

In Central and Eastern Europe (CEE), telemedicine has experienced substantial growth, primarily catalyzed by the COVID-19 pandemic, which necessitated rapid advancements in technology and alterations in healthcare practices. The region’s robust digital infrastructure, coupled with the innovative drive of local companies and the challenges posed by an aging demographic, has significantly contributed to this expansion. According to the European Commission’s Market Study on Telemedicine, the global telemedicine market was projected to grow annually by 14% by 2021, a rate that was likely surpassed due to the pandemic’s impact. More specifically, the Europe Telehealth Market, valued at US $6,185.4 million in 2019, is anticipated to witness an annual growth rate of 18.9% from 2020 to 2030. This trend underscores the increasing reliance on and potential of telemedicine in addressing healthcare needs in the CEE region [ 50 ].

In the Middle East, telehealth and telepharmacy, have seen varied degrees of adoption and progress. Despite attempts to reform healthcare delivery in the region, the progress of telemedicine has been somewhat slow, with certain expectations yet to be fully realized. However, there has been notable development in the use and adoption of these technologies [ 51 ]​. In a survey comparing the utilization of digital-health applications in Saudi Arabia and the United Arab Emirates (UAE), it was observed that a higher percentage of Saudi participants have utilized online pharmacy services (48%) compared to the UAE (36%). Conversely, awareness of teleconsultation services without prior use was higher in the UAE (43%) than in Saudi Arabia (35%). Retention data indicates that a significant proportion of users in both countries continue to engage with these services, with 80% of Saudi participants and 71% of UAE participants using teleconsultations at varying frequencies. Notably, a substantial majority of users in Saudi Arabia reported regular use of online pharmacies (90%), slightly higher than the UAE (78%), reflecting robust ongoing engagement with these digital health modalities. Notably, consumer adoption of telehealth products is primarily driven by time savings (48%) and convenience (47%), with 24-hour accessibility and efficacy both influencing 34% of users. Affordability and personal recommendations are also notable factors, while a wide range of options and quality are lesser but relevant considerations [ 52 ].

In response to the COVID-19 pandemic, a cross-sectional study was conducted among 391 licensed community pharmacists in the United Arab Emirates to assess the adoption and impact of telepharmacy services. The study revealed a predominant use of telepharmacy services, particularly via phone (95.6%) and messaging applications (80.0%). The findings highlighted that pharmacies with more pharmacists and those operating as part of a group or chain were more likely to implement a diverse range of telepharmacy services. The study identified significant barriers to telepharmacy adoption in individual pharmacies, including limited time, inadequate training, and financial constraints. There was a noticeable shift in service provision during the lockdown, with an increased reliance on telepharmacy, especially among pharmacies serving 50–100 patients per day. However, a reduction in services such as managing mild diseases and selling health products was observed during the lockdown period. The study concluded that telepharmacy played a pivotal role in supporting community pharmacies during the pandemic, with its expansion facilitated by the UAE’s advanced internet infrastructure, supportive health policies, and widespread digital connectivity [ 53 ]. Collectively, these insights reflect a global shift towards integrating and enhancing telehealth services as a response to emerging healthcare needs and technological advancements.

Unni et al. [ 54 ] provided an extensive review of telepharmacy initiatives adopted globally during the COVID-19 pandemic. Predominantly, virtual consultations were utilized to enable at-risk patients and others to remotely access pharmacists, thereby monitoring chronic illnesses, optimizing medication usage, and providing educational support [ 55 ]. Home delivery of medicines was widely implemented to decrease the necessity for in-person visits and mitigate exposure risks [ 56 ]. Additionally, patient education was prioritized to ensure effective management of health conditions from a distance [ 57 ]. Notably, a network of hospitals in China developed cloud-pharmacy care, allowing patients to consult pharmacists via text and the internet, while Spain utilized information and communication technologies for remote pharmaceutical care [ 58 ; 59 ]. Zero-contact pharmaceutical care, introduced in China, facilitated online medication consultations, eliminating direct contact [ 60 ]. The Kingdom of Saudi Arabia and other regions adapted new e-tools and teleprescriptions to enhance service accessibility [ 61 ]. The U.S. focused on credentialing pharmacists for telehealth to ensure competent service provision, and New Zealand implemented hotline numbers for phone consultations to further reduce physical visits [ 62 ; 63 ]. These initiatives reflect a significant shift towards innovative, technology-driven solutions in pharmaceutical care during a global health crisis. Refer to Fig.  3 for a graphical depiction of the worldwide distribution and applications of telepharmacy initiatives.

The global distribution of telepharmacy programs with an analysis of geographical distribution, technological applications, and associated benefits

Tracing the Private Sector’s Impact on Healthcare’s Technological Transformation

The role of the private sector in the fourth industrial revolution.

The World Economic Forum underscores the private sector’s leading role in digital inclusion and the acceleration of actions pertinent to the Fourth Industrial Revolution. This revolution affects economies, industries, and global issues profoundly, indicating the private sector’s critical role in driving technological advancements and digital platforms that deliver impactful healthcare solutions [ 64 ].

Mapping digital transformation in healthcare

A comprehensive analysis performed by Dal Mas et al. [ 65 ] meticulously maps the intricate terrain of digital transformation in healthcare, spotlighting the private sector’s instrumental role. Initially, the investigation encompassed an extensive array of diverse studies, leading to the identification of five main areas of digital technologies: smart health technologies, data-enabled and data collection technologies, Industry 4.0 tools and technologies, cognitive technologies, and drug & disease technologies. These domains frame the future research pathways, primarily steered by the private sector’s innovative drive. A significant proportion of the literature addresses healthcare broadly, suitable for both private and public sectors, yet a notable segment specifically focuses on the private sector’s endeavors, with a pronounced emphasis on the pharmaceutical domain [ 66 ; 67 ].

Public-private partnerships in healthcare delivery

The highlighted technologies, including digital platforms and telemedicine, exemplify the private sector’s trailblazing contributions to digital healthcare advancements. For instance, public-private partnerships (PPP) in India have emerged as a pivotal model for realizing universal healthcare (UHC), especially against the backdrop of acute healthcare shortages and urban-rural divides. Notably, mega PPP projects have successfully deployed technology-enabled remote healthcare (TeRHC), demonstrating its feasibility and impact in reaching isolated communities. These initiatives, overcoming various challenges, serve as a compelling example for global adoption, underscoring the transformative role of PPP in healthcare delivery [ 68 ].. Furthermore, a considerable majority of the literature in telemedicine underscores the necessity for profound research implications, yet a significant minority suggests policy implications [ 69 ; 70 ], reflecting a complex synergy between the private and public sectors in sculpting the digital healthcare framework [ 71 ]. This synthesis underscores the private sector’s critical influence in propelling the digital transformation in healthcare, charting a course that progressively fuses technological innovation with healthcare provision.

A study highlights Indonesia’s strategic initiatives to capitalize on telehealth business opportunities, driven by the Ministry of Research and Technology’s robust support for Technology-Based Start-up Company schemes [ 72 ]. With a demographic boon of 298 million from 2020 to 2024, escalating non-communicable diseases (71%), and a growing base of 222.4 million JKN participants, the stage is set for transformative growth. Despite a critical shortage of health workers (0.4 doctors per 1000 population), the enthusiasm for telemedicine is evident, with 71% satisfaction in hospital telemedicine and 32 million active telehealth users. The Ministry’s foresight in fostering technology start-ups, exemplified by the TEMENIN platform with its 11 health platforms, is steering Indonesia towards a future where high-quality healthcare is accessible and sustainable.

Lab@AOR: a model for PPPs in healthcare sector

The “Lab@AOR” initiative stands as a paradigmatic example of PPPs effectuating digital transformation within the healthcare sector. This strategic collaboration, between the University Hospital of Marche and Loccioni [ 73 ], a private entity, underscores the capacity of PPPs to navigate intricate challenges, stimulate international cooperation, and contribute to the development of sustainable, patient-centric healthcare solutions. Specifically, Lab@AOR was instituted to confront the nuanced challenges associated with the robotization of healthcare service delivery, highlighting the initiative’s role in fostering technological advancement through public and private sector synergy [ 74 ]. The project illustrates the evolution of Lab@AOR through three main phases: the pioneering stage, where groundwork for collaboration was laid; the nurturing stage, where collaborative exchanges were fostered; and the harvesting stage, wherein the potential of the PPP was fully unleashed. In the pioneering stage, Lab@AOR focused on a critical healthcare service component: the in-hospital preparation of medications for oncological patients. The University Hospital of Marche identified a need for innovation to improve service quality, efficiency, and safety, while Loccioni sought a real-life setting to test and refine its robotized system, APOTECAchemo [ 75 ]. This convergence of needs led to a symbiotic partnership aiming to enhance healthcare delivery through technological advancement.

During the nurturing stage, the partnership expanded the scope of APOTECAchemo to include non-oncological medications and developed additional tools like APOTECAps for manual preparation support. This phase was characterized by intensive collaboration, knowledge sharing, and continuous innovation, demonstrating the dynamic capability of the PPP to adapt and evolve in response to emerging healthcare challenges. The harvesting stage marked the international expansion of Lab@AOR, transforming it from a local initiative to an international community focused on leveraging digitalization and robotization to improve care quality and patient-centeredness. The PPP’s growth was catalyzed by its open perspective and inclusive approach, engaging entities from various cultural and institutional contexts, and fostering a network of 31 nodes across 19 countries and 3 continents.

Advancements in telehealth business models and frameworks

In their investigative study, Velayati et al. [ 76 ] delved into the articulation of emergent business models in telehealth and scrutinized the deployment of established frameworks across a variety of telehealth segments. The research spanned an extensive range of sectors, notably telemonitoring, telemedicine, mobile health, and telerehabilitation, alongside telehealth more broadly. The scope further extended to encompass niche areas such as assisted living technologies, sensor-based systems, and specific fields like mobile teledermoscopy, teleradiology, telecardiology, and teletreatment, presenting a thorough analysis of the telehealth landscape. Within the telemedicine and telehealth services sector, Barker et al. [ 77 ] introduced the Arizona Telemedicine Program (ATP) Model, a quintet-layer approach aimed at efficiently distributing telemedicine services throughout Arizona. Complementing this, Lee and Chang [ 78 ] proposed a four-component model specifically tailored for mobile health (mHealth) services pertaining to chronic kidney disease, focusing on offering a cost-effective platform for disease support and management. In the realm of telemonitoring, Dijkstra et al. [ 79 ] utilized the Freeband Business Blueprint Method (FBBM), which includes service, technological, organizational, and financial domains, to facilitate multiple telemonitoring services. Furthermore, the systemic and economic differences were explored in care coordination through Business to customer (B2C) and business (B2B) models for telemonitoring patients with chronic diseases, with the B2C model’s economic advantages were highlighted [ 80 ].

General telemedicine frameworks also received attention. Lin et al. [ 81 ] constructed a six-component framework analyzing major telemedicine projects in Taiwan, while Peters et al. [ 82 ] developed the CompBizMod Framework in Germany, encompassing value proposition, co-creation, communication and transfer, and value capture, designed to evaluate and enhance competitive advantages in telemedicine. In the specialized field of telecardiology, a comprehensive nine-component sustainable business model was crafted to facilitate mutual benefits for service providers and patients. This model emphasizes the importance of a holistic approach in ensuring the longevity and effectiveness of healthcare delivery within this domain [ 83 ]. Meanwhile, Mun et al. [ 84 ] presented a suite of five teleradiology business models aimed at providing effective, high-quality, and cost-efficient diagnoses.

The teletreatment sector saw innovative models from Kijl et al. [ 85 ], who designed a model for treating patients with chronic pain, focusing on the interrelation of components in the value network and the role of information technology. Complementarily, Fusco and Turchetti [ 86 ] introduced four models for telerehabilitation post-total knee replacement, emphasizing partnerships between care units and equipment suppliers to reduce costs and waiting lists. The mHealth and assisted living technology sector witnessed the introduction of a wearable biofeedback system model by Hidefjäll and Titkova [ 87 ], which employed Alexander Osterwalder’s Business Model Canvas and focused on a comprehensive commercialization process. Additionally, Oderanti and Li [ 88 ] presented a seven-component sustainable business model for assisted living technologies, aimed at encouraging older individuals to invest in eHealth services while reducing the pressure on health systems. These diverse clusters and models reflect the multifaceted nature of telehealth, each tailoring its approach to meet the unique demands of its domain. They collectively aim to optimize service delivery, stakeholder involvement, cost efficiency, and patient care quality, marking significant strides in the ongoing evolution of digital healthcare.

Challenges and biases in healthcare technology

One key aspect is the emergence of novel medical technologies and their potential biases. These biases are often a result of insufficient consideration of patient diversity in the development and testing phases. For example, disparities in the performance of medical devices like pulse oximeters among different racial groups have been observed, potentially due to a lack of diverse representation in clinical trials. This indicates a tendency for the development of healthcare technologies that may not adequately serve all patient populations [ 89 ]. A study on the profitability and risk-return comparison across health care industries highlights the use of return on equity (ROE) as a measure of profitability from a shareholder’s perspective. This measure combines profit margin, asset utilization, and financial leverage. The study analyzed financial data of publicly traded healthcare companies, providing insights into the financial dynamics of the healthcare sector. It revealed that while companies like Pfizer Inc. and UnitedHealth Group reported similar profitability, they had substantial differences in profit margin and asset utilization, indicating diverse financial strategies within the healthcare sector. This study underscores the complexity of financial performance in healthcare, where profitability measures need to be balanced with risk assessment and the broader impact on healthcare provision​ [ 90 ].

Additionally, an article discusses the benefits, pitfalls, and potential biases in healthcare AI. It emphasizes that as the healthcare industry adopts AI, machine learning, and other modeling techniques, it is seeing benefits for both patient outcomes and cost reduction. However, the industry must be mindful of managing the risks, including biases that may arise during the implementation of AI. Lessons from other industries can provide a framework for acknowledging and managing data, machine, and human biases in AI. This perspective is crucial in understanding how the integration of advanced technologies in healthcare can be influenced by the drive for profitability and efficiency, possibly at the expense of equitable and patient-centered care [ 91 ; 92 ].

Cosmeceuticals in the online pharmacy market

Cosmeceuticals, a term derived from the combination of cosmetics and pharmaceuticals, refer to a category of products that are formulated to provide both aesthetic improvements and therapeutic benefits. These products, typically applied topically, are designed to enhance the health and beauty of the skin, going beyond the mere cosmetic appearance. The exploration of cosmeceuticals in the online pharmacy market reveals a multifaceted and rapidly expanding industry. Bridging the gap between cosmetics and pharmaceuticals, they form a significant portion of the skincare industry. Cosmeceuticals are formulated from various ingredients, with their main categories being constantly discussed and analyzed in the scientific community [ 93 ]. They have taken a considerable share of the personal care industry globally, constituting a significant part of dermatologists’ prescriptions worldwide [ 94 ]. This surge is further fueled by increasing consumer demand for effective and safe products, including anti-aging skincare cosmeceuticals, a need which has been intensified by concerns over pollution, climate change, and the COVID-19 pandemic [ 95 ].

The global cosmeceuticals market is experiencing robust growth. Valued at USD 56.78 billion in 2022, it’s projected to expand to USD 95.75 billion by 2030, with a compound annual growth rate (CAGR) of 7.45%. This growth trajectory is propelled by the innovative integration of bioactive ingredients known for their medical benefits​ [ 96 ]. Another report confirms this upward trend, indicating the market was worth $45.56 billion in 2021 and is on a path of significant growth to USD 114 billion by 2030. The global disease burden is significantly impacted by various skin diseases, with dermatitis, psoriasis, and acne vulgaris among the most prevalent, contributing 0.38%, 0.19%, and 0.29% respectively. The pervasive nature of these conditions drives a substantial demand for effective treatments, propelling the integration of cosmeceuticals into the online pharmacy market. This integration not only offers convenient access to a range of therapeutic skincare products but also caters to the rising consumer inclination towards self-care and preventive healthcare. As a result, the online availability of cosmeceuticals is not just addressing the immediate needs of individuals suffering from skin conditions but is also reshaping the landscape of personal healthcare by making specialized treatments more accessible and customizable [ 97 ]. See Fig.  4 .

The left panel presents the market share distribution for key segments in the cosmeceuticals industry in 2021, including Skin Care Segment, and Supermarket & Specialty Stores, for Asia Pacific Revenue, with percentages for each category. The right panel displays the market value progression over time from 2021 to the projected value in 2030, with bold numbers indicating the value in billion USD for each year. The lower horizontal bar chart depicts the percentage contribution of various skin diseases to the global disease burden

Several factors are contributing to this expansion of the cosmeceuticals market. The market is driven by innovation in natural ingredients and a significant penetration of internet, smartphone, and social media applications, which attract potential consumer populations and reflect constantly changing consumer behavior [ 98 ]​​. The cosmeceuticals market’s robust CAGR and revenue share, especially in regions like Asia Pacific, further signify its burgeoning presence and potential within the global market [ 99 ]​. Integration into online pharmacies is a key aspect of this market’s evolution, offering easier access to these products for a wider customer base. As the market continues to grow, it’s anticipated that the blend of cosmeceuticals with online pharmaceutical platforms will become increasingly seamless, offering consumers a diverse range of accessible, effective, and beneficial skincare and health products. This integration is likely to be driven by the growing trend of e-commerce and digitalization in healthcare and personal care sectors.

The landscape of online pharmacies, particularly concerning cosmeceuticals, is evolving. While the overall penetration for non-specialty drugs in mail-order and online pharmacies is low, they represent a significant portion of specialty prescription revenues at 37%. Despite this, only 13% of consumers consider these as their primary pharmacy choice, indicating a growing but still emerging market​​​​. Strategies are in place to enhance the market appeal of these pharmacies, focusing on speed, convenience, and personalized experiences, such as video telehealth visits, to attract a broader consumer base [ 100 ].

The dissertation “L’Oréal Portugal: A Digital Challenge for the Active Cosmetics Division” authored by Ascenso [ 101 ] provides an in-depth examination of the impact of digital evolution on the Portuguese cosmeceutical sector and its implications for L’Oréal, a significant cosmetics company. It posits that while L’Oréal has foundational digital competencies, the rapidly evolving digital landscape presents a broad spectrum of potential risks and opportunities. The study details the operations of L’Oréal’s Active Cosmetics Division, which manages brands predominantly sold in pharmacies and parapharmacies, and explores the potential repercussions of digitalization on L’Oréal Portugal’s strategic and operational frameworks. Furthermore, the thesis highlights the expanding role of e-pharmacies and the need for legal reforms to facilitate their operation. It discusses the prevalent trends in the cosmetic industry, such as the increasing demand for natural, male-focused, and environmentally friendly products. The dissertation scrutinizes L’Oréal’s strategic pillars, including innovation, acquisition, and regional growth, emphasizing the need for the company to integrate advanced technologies and recalibrate its business methodologies in light of digital progression [ 101 ]. Although L’Oréal has initiated some digital strategies targeting consumers and pharmacies, there’s a recognized need for an intensified focus on digital marketing aimed at clients. An exploratory attempt by L’Oréal to implement an online ordering platform for pharmacies did not meet success, indicating possible industry unreadiness for such advancements. This case study serves as a critical examination of how traditional companies in the pharmaceutical and cosmetics sectors must adapt to the digital age’s challenges and opportunities [ 101 ].

In a collaborative endeavor with L’Oréal, an associated digital agency provided a comprehensive suite of services that encompasses the full management of social media pages, the development of e-commerce websites, the establishment of Customer Relationship Management (CRM) platforms tailored for pharmacies, and the execution of digital campaigns leveraging QR codes, SMS marketing, and newsletters. These digital tools confer a competitive edge, facilitating a deeper comprehension of consumer behavior and the potential to augment value extraction from customer interactions. For the laboratories, particularly those associated with cosmetics, the advantages are twofold: an increase in sell-out figures, thereby enhancing direct sales to end consumers, and a boost in sell-in metrics, reflecting a rise in transactions to pharmacies or wholesalers. The online ordering feature, as noted by João Roma, a manager at La Roche-Posay, could result in a cacophony of processes if laboratories were to individually develop distinct methods. He advocates for the utilization of pre-existing platforms, such as the established e-learning infrastructure, to spearhead ventures into the online marketplace [ 101 ].

A survey conducted specifically for L’Oréal’s e-learning platform, cosmeticaactiva.pt [ 102 ], across the Portuguese landscape garnered responses from 324 participants, comprising 71% general pharmacists, 13% technical assistants, 8% directors, 7% individuals responsible for procurement from laboratories, and 2% beauty/cosmetic advisors. The findings from this survey underscore the pervasive adoption of digital tools within the pharmacy sector: 82% of respondents affirmed the presence of their pharmacies on social media platforms, 80% reported the use of basic management software, 64% indicated the deployment of advanced management systems, 61% were conversant with online ordering systems directed at laboratories, 38% utilized a store locator, 28% had an established website presence, and a smaller segment of 12% offered online shopping facilities.

Another survey conducted within this study to evaluate the significance of dermocosmetic products in pharmacies yielded a mean importance rating of 4.38 out of 5, indicating that a majority of pharmacists consider these products to be highly important to their business operations. Factors critical to the differentiation of a proficient laboratory/supplier were innovation and cost-effectiveness, with mean scores of 1.9 and 2.7 respectively, on a scale from 1 (most important) to 5 (least important). A substantial majority of pharmacists, amounting to 81.8%, perceive their pharmacies as beacons of innovation and modernity. Detailed interviews elucidated that digital tools are indispensable in augmenting sales for cosmeceutical products by catalyzing demand—a dynamic not feasible with medicinal products. These tools are paramount in managing customer loyalty, facilitating enhanced communication with existing clients via online and mobile channels. Despite the challenges posed by digitalization, particularly in the realms of logistics and human resources, the management at L’Oréal is well-equipped to swiftly adapt to the evolving business landscape, as evidenced by the proactive adoption and integration of these digital strategies [ 101 ] as illustrated in Fig.  5 .

Results from Ascenso [ 101 ] survey assessing digital challenges for L’Oréal in the Portuguese cosmeceutical sector. Digital Tools Usage in Pharmacies (upper left) : the bar chart showing the percentage of respondents using various digital tools in pharmacies. Suppliers’ Choosing Factors (upper right) : the bar chart displaying the mean scores of factors that distinguish a good laboratory/supplier. General Pharmacists Opinion (lower left) : A line chart illustrating the mean ratings of pharmacists’ opinions on whether the pharmaceutical sector is modern, changing, conducive to innovations, adapted to consumer needs, and more developed than other sectors. Importance of Digital Development Tools for Pharmacies (lower right) : A vertical bar chart demonstrating the mean scores for the importance of different digital development tools for pharmacies

The digital transformation strategies, exemplified by companies like L’Oréal, extend beyond the mere targeting of end consumers, encompassing the perspectives of various stakeholders, including retailers. This broadened focus reflects a holistic and integrated approach to digital marketing and customer engagement, indicative of a larger trend within the market. The significance of digital channels in facilitating comprehensive customer interaction and brand development is increasingly recognized. The distinction of organizations such as L’Oréal in their digital initiatives highlights the competitive advantage that can be garnered through innovative digital strategies.

The receptiveness of industry professionals, such as pharmacists, to emerging digital trends, along with the readiness of companies to engage in non-face-to-face sales models, marks a paradigm shift in traditional sales and distribution methods. This shift is reflective of a broader market trend where digital platforms are becoming integral to the customer journey. Furthermore, the potential for online sales in specialized sectors, such as dermocosmetics, and the benefits that organizations derive from the technological advancement of their client base, underscore an escalating acknowledgment of e-commerce and digital tools as crucial elements of a business strategy. This trend, with L’Oréal as a prime example, emphasizes the broader market movement towards digital transformation, not merely as an option but as a necessity for maintaining relevance and competitiveness in an ever-evolving market landscape.

The global regulatory landscape for cosmeceuticals

Sophisticated regulatory legislation and enforcement mechanisms characterize many developed countries such as the USA, EU Member States, Canada, and Japan. These nations, along with influential organizations like the World Health Organization (WHO), significantly shape international market rules and regulations due to their market size and regulatory capacity [ 103 ]. The WHO is particularly noted for its crucial role in setting global standards, with a focus on developing and promoting international standards related to food, biological, pharmaceutical, and similar products [ 104 ]. In contrast to pharmaceuticals, the cosmetic industry necessitates a more advanced international regulatory framework due to consumers’ extensive exposure to these products. The distinction between cosmetics and pharmaceuticals varies significantly across different countries, with the USA employing a voluntary registration system for cosmetics and the EU and Japan requiring mandatory product filings prior to marketing [ 105 ]. Concerns over the safety of pharmaceutical and cosmetic products are highlighted, with an increasing consumer focus on “natural, ecological, and clean” products [ 106 ]. However, the lack of a regulatory framework for these categories underscores the need for more advanced regulations to mitigate health risks.

Intergovernmental cooperation is emphasized, with the US and EU portrayed as dominant players in the pharmaceutical and cosmetic industries, respectively. Regulatory capacity, which is essential for defining, implementing, and monitoring market rules, varies among countries and markets. This capacity depends on several factors, including staff expertise, statutory sanctioning authority, and the degree of centralization of regulatory authority [ 103 ]. The regulatory systems of the EU and US are explored, focusing on their unique approaches to medicine authorization and regulation. The European Medicines Agency (EMA) in the EU and the Food and Drug Administration (FDA) in the US serve as pivotal regulatory bodies [ 107 ; 108 ]. The EMA’s centralized procedure and the FDA’s premarket approval process are detailed, along with subsequent postmarket regulatory procedures. For instance, EU and US cosmetic regulations are compared, revealing differences in their approaches and the evolution of the EU’s regulatory landscape through various amendments and directives. In particular, directive 76/768/EC has been superseded by Regulation (EC) N° 1223/2009, serving as the principal regulatory framework for finished cosmetic products in the EU market. This regulation enhances product safety, optimizes the sector’s framework, and eases procedures to promote the internal cosmetic market. Incorporating recent technological advancements, including nanomaterials, it maintains an internationally acknowledged regime focused on product safety without altering existing animal testing prohibitions [ 109 ].

The Eurasian Economic Union’s (EAEU) regulatory framework for medicines and medical devices is detailed, including the legal framework established for regulating the circulation of these products. The conformity assessment methods, such as the EAC Declaration and the State Registration process, are required for manufacturers to demonstrate their products’ compliance with the standards [ 110 ]. Armenia is also part of the EAEU’s legal framework, which aims to unify regulations for the production and registration of pharmaceuticals and medical products by 2025. This unification is expected to reduce administrative costs for manufacturers and improve medicinal products for patients. Despite significant developments in the cosmetics industry, Armenia does not have an extensive regulatory framework for it. Prior to joining the EAEU, the only regulation concerning cosmetic products was the Order of the Minister of Health of the Republic of Armenia on “Hygiene Requirements of the Production and Safety of Perfume-Cosmetic Products.” Since joining the EAEU, Armenia has unified its national legislation with EAEU regulations, but there are challenges and gaps in the direct applicability of the EAEU’s technical regulations in the country [ 111 ].

In the context of the necessity for clear regulatory framework stems from two reasons. Firstly, cosmeceuticals - products straddling cosmetics and drugs - demand intensified regulatory attention. Examples include the 2007 FDA seizure of Jan Marini’s Age Intervention Eyelash, which contained the drug ingredient bimatoprost, and products boasting human stem cell cultured media, which claim rejuvenating effects but may pose safety risks due to minimal oversight [ 112 ]. A noted 1450% increase in FDA warnings (from 4 to 62 letters) between 2007 and 2011 and 2012–2017, with 8 targeting stem cell ingredient promotions, underscores the growing concern [ 113 ]. The FDA’s limited capacity to identify and assess potential drug-adulterated cosmetics raises concerns.

The second aspect focuses on the necessity for a more comprehensive and unbiased scientific and medical perspective in the FDA’s ingredient review process. The Personal Care Products Safety Act proposes a balanced committee formation including industry, consumer, and medical representatives, yet advocates for the inclusion of specialized professionals like chemists, dermatologists, toxicologists, and endocrinologists. Specific ingredients like diazolidinyl urea and quarternium-15, although effective antimicrobials, are flagged for potential skin allergy risks and formaldehyde release. The preservative 4-methylisothiazolinone, banned in Europe for rinse-off products, is noted for increasing allergic contact dermatitis cases in the US [ 114 ]. The lag in US cosmetic regulation compared to the EU is acknowledged, with the Personal Care Products Safety Act considered a significant advancement, albeit in need of further refinement [ 115 ].

The importance of consumer safety in the global regulatory landscape for cosmeceuticals, particularly for products that blur the line between cosmetics and pharmaceuticals, is a critical issue due to several key factors. Firstly, the cosmeceutical market is expanding rapidly, driven by new ingredients promising various skincare benefits like anti-aging and photoprotection. This growth necessitates clear regulatory guidelines to ensure that these products are safe and their claims are clinically proven. The FDA, for instance, differentiates between cosmetics and cosmeceuticals based on their intended use, particularly if a product is marketed as a cosmetic but functions in a way that affects the structure of the human body, classifying it as a cosmeceutical [ 116 ].

Secondly, the legal and regulatory distinctions between drugs and cosmetics are significant. Drugs are subject to FDA approval based on their intended use in treating diseases or affecting the body’s structure or function, whereas cosmetics are not. This difference becomes crucial when products are marketed with drug-like claims but are not regulated as drugs, potentially leading to consumer safety issues. For example, botanical cosmeceuticals, which contain natural ingredients like herbal extracts, need thorough evaluation to ensure consistency in therapeutic effects [ 117 ]. Additionally, cosmeceutical manufacturers must be careful with marketing and advertising claims to avoid legal implications. Misleading claims can lead to lawsuits and regulatory actions, as seen in past cases where companies faced consequences for unfounded product claims. Moreover, the FDA advises cosmeceutical manufacturers to follow Good Manufacturing Practices (GMP) to reduce the risk of misbranding or mislabeling. These guidelines include production practices and specific warning statement guidelines, emphasizing the importance of substantiating the safety of these products [ 118 ].

The global regulatory landscape for online pharmacy

Online pharmacies pose various risks to consumers, including the potential health hazards from counterfeit or substandard medications and the inappropriate use of prescription drugs. The regulatory landscape for these pharmacies varies significantly across nations, with some countries like the United States implementing specific laws, while others, such as France, have instituted outright bans [ 119 ]. The European Union, for instance, has implemented a mandate effective from 1 July 2015, which requires member states to adhere to legal provisions for a common logo specific to online pharmacies. This is coupled with an obligation for national regulatory authorities to maintain a registry of all registered online medicine retailers, as detailed by the European Medicines Agency [ 120 ]. Furthermore, the sale of certain medications online within the EU is permissible, contingent upon the registration of the pharmacy or retailer with respective national authorities​ [ 121 ]. Additionally, the Council of Europe’s MEDICRIME Convention introduces an international treaty that criminalizes the online sale of counterfeit medicinal products, enforcing prosecution irrespective of the country in which the crime is perpetrated [ 122 ].

Switzerland presents a unique stance, where Swissmedic strongly advises against the online purchase of medicines due to the high risk of illegal sourcing and poor quality. However, Swiss mail-order pharmacies with a valid cantonal license to operate a mail-order business are exempted from this advisory​ [ 123 ]. The Swiss Mail-Order Pharmacists Association and its affiliates, such as Zur Rose AG and MediService AG, actively advocate for a modern and equitable regulation of mail-order medicine sales​ [ 124 ]. The legislative framework is further bolstered by the Federal Act on Medicinal Products and Medical Devices, which regulates therapeutic products to guarantee their quality, safety, and efficacy​ [ 125 ]. In the Middle East, community pharmacy practice is predominantly governed by national Ministries of Public Health or equivalent governmental entities, with most community pharmacies being privately owned​ [ 126 ]. The region’s involvement in the Global Cooperation Group, which encompasses various international regulatory bodies like the EMA and USFDA, signifies a collaborative approach towards drug regulatory affairs in the MENA region [ 127 ]. Despite these advances in regulatory collaboration, it is notable that currently no specific regulations have been detected for online purchases from online pharmacies in the Middle East, highlighting a significant area for potential regulatory development. Furthermore, a notable transition is observed in pharmacy education across several Middle Eastern nations, with an inclination towards introducing Pharm.D degrees to replace traditional pharmacy degrees, reflective of evolving educational standards in the pharmaceutical field [ 128 ]. This shift in education parallels the need for updated regulatory frameworks, especially in the context of the burgeoning online pharmacy sector.

Furthermore, Australia permits the sale of both Prescription-Only Medicines (POMs) and Over-the-Counter (OTC) medications online, provided that brick-and-mortar pharmacies comply with all relevant laws and practice standards [ 129 ]. In contrast, South Korea maintains a stringent stance, prohibiting the online sale of both POMs and OTC medicines, with sales confined exclusively to physical stores registered with the Regulatory Authority (RA) [ 130 ]. China, Japan, Russia, Singapore, and Malaysia exhibit a more selective regulatory framework. China and Russia allow the online sale of OTC medicines only, with China imposing additional restrictions on third-party e-commerce platforms and Russia having introduced a draft law in December 2017 to formalize this practice [ 131 ; 132 ]. Japan permits the online sale of certain OTC medicines, explicitly excluding specific substances such as fexofenadine and loratadine [ 133 ]. Similarly, Singapore and Malaysia endorse the online sale of specific OTC medicines only, adopting a “buyers beware” approach to caution consumers about the associated risks [ 134 ; 135 ]. Lastly, the legal landscapes in India and Indonesia remain ambiguous. India’s RA has effectively banned the online sale of medicinal products, yet this prohibition lacks legislative backing. Indonesia, too, grapples with unclear regulations, leaving the legal status of online pharmacies indeterminate [ 136 ].

In response to these risks, several initiatives have been developed to guide and certify online pharmacies. In the United States, LegitScript offers certification to online pharmacies that comply with criteria such as appropriate licensing and registration [ 137 ]. Similarly, the Verified Internet Pharmacy Practice Sites (VIPPS) program, accredited by the National Association of Boards of Pharmacy, ensures pharmacies adhere to licensing requirements in the states where they dispense medications [ 138 ]. Internationally, the Health On the Net Foundation has introduced the HONcode, an ethical standard for health websites globally. This code certifies sites that provide transparent and qualified information. However, due to the absence of international harmonization, the HONcode’s certification is limited to US and Canadian pharmacies verified by VIPPS [ 139 ]. The lack of a harmonized international approach presents significant challenges. Consumers do not have access to a comprehensive, global repository of all certified pharmacies. The diverse certification schemes are not well articulated or interconnected, leading to consumer unawareness about their significance or existence. Moreover, enforcing standards across different legal jurisdictions is complex without a unified agreement. To enhance consumer protection, it is imperative to develop and promote a standardized, minimal international code of conduct for online pharmacies. Such a code would unify requirements and allow all initiatives to clarify their roles under a common framework. Adequate oversight in the borderless online pharmacy market can only be achieved through collaborative efforts. To visualize the infographic of the global regularity landscape for the online pharmacy see Fig.  6 .

Comprehensive representation of the regulatory landscape for global online pharmacies, detailing international and national initiatives, certification programs, and conventions aimed at minimizing risks associated with the purchase of medications via online platforms

Technological innovations and Future trends in global pharmacy

The global pharmacy sector is undergoing a transformative shift, driven by the rapid advancement of technological innovations. As the world becomes increasingly digital, the integration of cutting-edge technologies like Artificial Intelligence (AI) and blockchain is setting the stage for a new era in pharmaceutical care and management. These advancements promise to revolutionize the industry by enhancing efficiency, accuracy, and security, ultimately leading to improved patient outcomes and a more streamlined healthcare experience [ 140 ].

Walgreens, in partnership with Medline, a telehealth firm, has developed a platform for patient interaction with healthcare professionals via video chat. AI’s role extends to inventory management in retail pharmacies, allowing pharmacists to predict patient needs, stock appropriately, and use personalized software for patient reminders. Although not all inventory management software in retail pharmacies utilizes AI, some, like Blue Yonder’s software developed for Otto group, demonstrate the potential of AI in predicting product sales with high accuracy, thus enhancing supply chain efficiency [ 141 ; 142 ]. At the University of California San Francisco (UCSF) Medical Center, robotic technology is employed to improve patient safety in medication preparation and tracking. This technology has prepared medication doses with a notable error-free record and surpasses human capabilities in accuracy and efficiency. It prepares both oral and injectable medicines, including chemotherapy drugs, freeing pharmacists and nurses to focus on direct patient care. The automated system at UCSF receives electronic medication orders, with robotics handling the picking, packaging, and dispensing of individual doses. This system also assembles medications on bar-coded rings for 12-hour patient intervals and prepares sterile preparations for chemotherapy and intravascular syringes [ 143 ].

In the realm of global pharmacy, blockchain technology emerges as a pivotal force, driving advancements across various facets of healthcare and pharmaceuticals. At the forefront of its application is the enhancement of supply chain transparency [ 144 ]. Blockchain’s immutable ledger ensures the provenance and legitimacy of medical commodities, offering an unprecedented level of visibility from manufacturing to distribution. This is particularly vital in areas plagued by counterfeit drugs, where systems like MediLedger are instrumental in verifying the legality and essential details of medicines [ 145 ].

The utility of blockchain extends to the implementation of smart contracts — scripts processed on the blockchain that bolster transparency in medical studies and secure patient data management [ 146 ]. These contracts find extensive use in advanced medical settings, as evidenced by a blockchain-based telemonitoring system for remote patients and Dermonet, an online platform for dermatological consultation [ 147 ].

Furthermore, blockchain is revolutionizing patient care through patient-centric Electronic Health Records (EHRs). By decentralizing EHR maintenance, blockchain empowers patients with secure access to their historical and current health records [ 148 ]. Prototypes like MedRec and systems such as MeD Share exemplify how blockchain can provide complete, permanent access to clinical documents and facilitate the sharing of medical data between untrusted parties, respectively, ensuring high information authenticity and minimal privacy risks [ 149 ; 150 ]. In verifying medical staff credentials, blockchain again proves invaluable. Systems like ProCredEx, based on the R3 Corda blockchain protocol, streamline the credentialing process, offering rapid verification while allowing healthcare entities to leverage their existing data for enhanced transparency and assurance about medical staff experience [ 151 ].

The integration of blockchain with Internet of Things devices for remote monitoring marks another leap forward, significantly bolstering data security. By safeguarding the integrity and privacy of patient data collected by these devices, blockchain mitigates the risk of tampering and ensures that only authorized parties can access sensitive information [ 152 ]. Besides, a blockchain-based drug supply chain initiative, PharmaChain, utilizes AI for approaches against drug counterfeit and ensures the drug supply chain is more traceable, visible, and secure. For online pharmacies, this means a more reliable supply chain and assurance of drug authenticity, crucial for maintaining trust and safety [ 153 ].

In response to the COVID-19 pandemic, the PharmaGo platform has emerged as an innovative solution in Sri Lanka, revolutionizing the delivery of pharmacy services. As traditional pharmacies grapple with the challenges of meeting all customer needs in one location, PharmaGo addresses this by providing a comprehensive online pharmaceutical service. It allows customers to access a wide range of medications through a single platform, reducing the need to visit multiple pharmacies. Utilizing image processing technology, pharmacy owners can accurately identify prescribed medicines, while the system’s predictive analytics forecasts future drug demands, enhancing stock management. Additionally, PharmaGo’s AI-powered medical chatbot offers real-time guidance, ensuring a seamless and efficient customer experience. This platform represents a significant advancement in healthcare accessibility and pharmacy service delivery in the pandemic era [ 154 ]. In the same context, ontology-based medicine information system, enhancing search relevance through a chatbot interface was presented by Amalia et al. [ 155 ]. Addressing conventional search engines’ limitations in interpreting data relationships, it employs semantic technology to represent metadata informatively. The ontology as a knowledge base effectively delineates disease-medicine relationships, with evaluations indicating a 90% response validity from the chatbot, offering a robust reference for medical information retrieval and its semantic associations.

Future trends for the digital transformation of in the pharmaceutical sector

Future trends for the digital transformation of pharmacies globally are heavily influenced by the transformative impact of digital technologies on healthcare delivery. The integration of telemedicine, electronic health records, and mobile health applications is pivotal in enhancing patient care. These technologies are instrumental in improving data sharing and collaboration among healthcare professionals, increasing the efficiency of healthcare services. Additionally, they offer significant potential for personalized medicine through data analytics and play a crucial role in patient engagement and self-management of health. The importance of these technologies in creating a more connected and efficient healthcare system is underscored, marking a significant shift in the global healthcare landscape [ 156 ].

In the pharmaceutical sector, the COVID-19 pandemic has catalyzed a significant shift towards Pharmaceutical Digital Marketing (PDM), particularly for over-the-counter drugs. This shift focuses on utilizing online pharmacies and digital platforms for targeted advertising, directly reaching consumers. The trend towards purchasing OTC drugs online has grown, driven by the convenience and efficiency of digital channels. While PDM faces challenges like regulatory constraints and the need for digital proficiency, it offers substantial opportunities in enhancing customer engagement and precise marketing. The future of PDM is poised to be more consumer-centric, integrating advanced technologies like AI, and emphasizing personalized marketing strategies to strengthen brand engagement and customer interaction [ 157 ].

Artificial intelligence holds immense potential to revolutionize the field of pharmacy, offering numerous benefits that can significantly enhance efficiency and patient care. One of the primary applications of AI in this sector is the automation of routine tasks. By utilizing AI, pharmacies can automate critical processes such as prescription processing, checking for drug interactions, and managing inventory. This automation not only streamlines operations but also minimizes the likelihood of human error, thereby increasing the overall efficiency of pharmacies [ 158 ].

Furthermore, AI can play a pivotal role in personalized medication management. This is particularly beneficial for patients with chronic conditions such as diabetes who require careful management of their insulin dosages, as fluctuations in blood sugar levels can lead to serious complications. AI systems can monitor patients continuously, provide timely reminders for medication intake, and dynamically adjust treatment plans based on individual health data. Such personalized management ensures that patients receive optimal care tailored to their specific needs, potentially improving treatment outcomes. Incorporation of AI into electronic health records presents another significant advancement. By integrating AI with EHRs, healthcare providers can access real-time patient data. This integration empowers healthcare professionals to make more informed care decisions, enhancing the quality of patient care. Moreover, it significantly reduces the likelihood of medication errors, a critical concern in healthcare.

Likewise, AI’s capability to analyze extensive patient data is invaluable. It can identify patterns and trends in medication adherence, detect potential drug interactions, and pinpoint adverse drug reactions. These insights are crucial for healthcare professionals and researchers. By understanding these patterns, they can develop more effective medication adherence strategies and support systems, contributing to better patient outcomes and advancing the overall field of pharmaceutical care.

In the expansive realm of chemical space, the pharmaceutical industry faces the continual challenge of identifying new active pharmaceutical ingredients (APIs) for diverse diseases [ 159 ]. High throughput screening (HTS), despite its advancements in recent decades, remains resource-intensive and often yields unsuitable hits for drug development. The failure rate of investigational compounds remains high, with a study citing only a 6.2% success rate for orphan drugs progressing from phase I to market approval [ 160 , 161 ].

Machine learning presents a transformative approach to this challenge. It offers an alternative to manual HTS through in silico methodologies. ML-driven drug discovery boasts several advantages: it operates continuously, surpasses the capacity of manual methods, reduces costs by decreasing the number of physical compounds tested, and early identifies negative characteristics of compounds, such as off-target effects and sex-dependent variability [ 162 ].

A substantial advancement in the realm of machine learning has emerged from major pharmaceutical entities, notably AstraZeneca, in conjunction with research institutions. This progress is evidenced by the development of an innovative algorithm that demonstrates both time efficiency and effectiveness in the sphere of drug discovery. The recent introduction of this algorithm significantly enhances the process of determining binding affinities between investigational compounds and therapeutic targets. It surpasses traditional in silico methods in terms of performance. The application of this algorithm underscores the remarkable potential of machine learning in accelerating the identification and development of novel therapeutic agents [ 163 ].

Moreover, the proficiency of machine learning in managing vast and intricate datasets has rendered it indispensable in research focused on cancer targets, utilizing diverse and extensive datasets. This approach is fundamental in numerous drug discovery initiatives, especially those targeting various forms of cancer. A wide array of ML techniques, ranging from supervised to unsupervised learning, are employed to discern chemical attributes that are indicative of potential therapeutic efficacy against a spectrum of cancer targets. This methodology is crucial in identifying novel compounds that could be effective in cancer treatment, leveraging the rich and complex data available in oncological research [ 164 ].

The digital transformation in the pharmacy sector is significantly reshaping healthcare delivery, driven by the integration of cutting-edge technologies like Artificial Intelligence and blockchain. This transformation is marked by a substantial growth in the digital pharmacy market, with a projected annual growth rate of 14.42%, leading to a market volume of approximately $35.33 billion by 2026​​.

One major aspect of this transformation is the growing reliance on online pharmacy platforms, largely influenced by the COVID-19 pandemic. Consumer trust in online medication purchases has significantly increased, indicating a shift towards digital healthcare solutions. The adoption of telehealth services, including telepharmacy, has surged, with patient adoption in the United States increasing from 11% in 2019 to 46%. This shift towards digital-first services enhances convenience and access to care but also introduces regulatory challenges, particularly in maintaining patient safety and quality standards in the rapidly evolving online healthcare environment​​.

The cosmeceuticals market, a segment within online pharmacies, is experiencing robust growth. Cosmeceuticals, which bridge the gap between cosmetics and pharmaceuticals, have become a significant part of the skincare industry. The market, valued at USD 56.78 billion in 2022, is projected to expand to USD 95.75 billion by 2030. This expansion is driven by factors like innovation in natural ingredients and significant penetration of internet, smartphone, and social media applications. Despite the growth, the overall penetration for non-specialty drugs in mail-order and online pharmacies remains low, representing a significant portion of specialty prescription revenues. The evolving landscape of online pharmacies in the cosmeceuticals sector reflects a trend towards more accessible and customizable personal healthcare solutions​​.

Technological innovations are setting the stage for a new era in pharmaceutical care and management. AI’s role extends to areas like inventory management in retail pharmacies, where it predicts patient needs and enhances supply chain efficiency. Blockchain technology enhances supply chain transparency and legitimizes medical commodities, especially crucial in areas affected by counterfeit drugs. Blockchain also plays a vital role in patient-centric Electronic Health Records and telemonitoring systems. For instance, PharmaGo, an innovative platform developed in response to the pandemic, provides a comprehensive online pharmaceutical service, demonstrating the significant advancements in healthcare accessibility and pharmacy service delivery​​.

These technological advancements are instrumental in improving data sharing and collaboration among healthcare professionals. They offer significant potential for personalized medicine through data analytics, playing a crucial role in patient engagement and self-management of health. The future trends in the pharmaceutical sector, particularly influenced by the COVID-19 pandemic, indicate a shift towards Pharmaceutical Digital Marketing (PDM) and a more consumer-centric approach. AI’s potential in revolutionizing pharmacy includes automation of routine tasks, personalized medication management, real-time patient data access, and the identification of patterns in medication adherence and potential drug interactions​​.

Data availability

No datasets were generated or analysed during the current study.

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Almeman, A. The digital transformation in pharmacy: embracing online platforms and the cosmeceutical paradigm shift. J Health Popul Nutr 43 , 60 (2024). https://doi.org/10.1186/s41043-024-00550-2

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Mediwave earns global recognition at GLOMO Awards 2024 for Emergency Response HealthTech

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Mediwave, a leading-edge HealthTech company, was recognised as a finalist at the prestigious Global Mobile Awards (GLOMO), part of the Mobile World Congress (MWC) powered by GSMA in Barcelona, Spain. This acknowledgment underscores Mediwave’s exceptional contributions to the field, particularly its innovative and integrated use of AI, Internet of Medical Things (IoMT), and Mixed Reality technologies. Mediwave has transformed Sri Lanka’s national-level free pre-hospital emergency care ambulance service, 1990 Suwa Seriya, with its end-to-end Emergency Response Suite. This solution, recently featured as the world’s first of its kind, digitises and augments the service delivery with AI, AR, and mixed reality capabilities. This achievement is a significant milestone for Mediwave as it expands its global reach with a suite of life enhancing HealthTech solutions, including Emergency Response, Digital Healthcare Enablement, and AI Smart Health portfolio.

The company also showcased its full range of innovations at 4 Years From Now (4YFN), an integral part of the MWC GSMA, which serves as a catalyst for startups taking centre stage in future-proof tech, providing them with invaluable networking opportunities and exposure. Mediwave Chief Executive Officer Suren Pinto reflected on attending the event, stating, “It was a proud and humbling moment for our Emergency Response Suite to be showcased alongside leading global brands at the GLOMO Awards. We are grateful for the 1990 Suwa Seriya Foundation for collaborating with us to bring this solution to life and create tremendous impact in Sri Lanka. With our pioneering solutions, we have ventured into Australia, the USA, and selected Asian countries. As an emerging force in the healthcare space, I look forward to the many milestones and growth stories we will build together with industry veterans.” Mediwave is transforming the healthcare ecosystem by introducing life-enhancing technology that can be seamlessly integrated into multiple industries impacted by emergencies and life-threatening scenarios. Their innovative technology allows for swift, proactive, and immersive interventions, enhancing connected patient care with a scalable architecture. Headquartered in Singapore, Mediwave is among the select few end-to-end solution providers in the global HealthTech space, driving transformative change and forging a robust healthcare ecosystem globally. With its Tech Hub strategically placed in Sri Lanka, the company is forging global connections in the US, Australia, Malaysia, Sri Lanka, and beyond.

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Middle East

The u.s. is used to drawing red lines for adversaries. how does it work for allies.

by  Scott Simon ,  Greg Myre

Demonstrators hold up lights from their phones during a rally organized by Hong Kong mothers in support of extradition law protesters, in Hong Kong on July 5, 2019. Hector Retamal/AFP via Getty Images hide caption

Opinion: 'Glory be to thee, Hong Kong!'

by  Scott Simon

Trump's speeches follow a familiar playlist, featuring greatest hits among new tunes

by  Stephen Fowler

Ukrainian journalist Illia Ponomarenko on his memoir about the war

Israel's eurovision contestant qualifies for the final, braces for protests.

by  Jackie Northam

A new book traces the life of Fu Pei-mei, who brought Chinese food to the world

Music interviews, 'mother' is dj and musician samantha poulter's new house music album, rep. mike levin on why democrats wrote to biden urging action on the southern border, fresh off a holiday, new data on china's economy gives cause for hope.

by  Scott Simon ,  John Ruwitch

A powerful solar storm is bringing northern lights to unusual places

by  Regina G. Barber

Washington's ferry system is seeing the impact of decades of underfunding

by  Joshua McNichols

Saturday Sports: NBA and NHL playoffs, baseball's hot new pitcher

Arkansas's new statues at the u.s. capitol are of daisy bates and johnny cash.

by  Scott Simon ,  Danny Hensel

The Americas

In chile, a once-extinct language is coming back to life.

by  John Bartlett

Pam Grier on season 2 of 'Them: The Scare' and Black representation in Hollywood

Thanks, mom. love, npr.

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