Is global health really global?

It accompanies a set of papers which were also presented at the conference. So far, these papers describe a range of global health issues, from the health status of the United Arab Emirates (1) through to social determinants of health in India (2). Two papers from Rwanda (3) and India (4) consider specific aspects of oral public health, which was a major sub-theme of the conference. An evolutionary process has occurred in thinking about how the world sees health. In the predominantly colonial era of the early 20th century, an important medical speciality known as tropical medicine emerged out of concerns about ill health associated with increasing travel to the tropics. Particularly in Europe, great institutions of tropical medicine grew in major port cities such as London, Liverpool, Antwerp and Amsterdam. An example of local relevance to Sri Lanka is a British description of a malaria epidemic in 1930s Ceylon (5). As colonialism was superseded by independence, so the models for handling health problems needed to change; the concept of international health evolved. This included a broadening into issues of health services and delivery of care, as well as specific diseases. Nevertheless, it was still a largely northern concept, concerned with the health of people somewhere else. At the same time, at least in its better manifestations, international health involved more of the increasing number of local health professionals in the areas of interest. An example from Sri Lanka in the 1980s is joint research between the Universities of Colombo and Edinburgh on malaria immunity (6). In the new Millennium and the 21st century, increasing globalisation in many fields left the concept of international health looking somewhat dated. Local situations were increasingly seen in their global context, for example, the importation of chikungunya and dengue fevers into Italy from, among other places, Sri Lanka (7). National and geographic boundaries may not have the defining role in health that they once had. This has partly come about as rapid technological developments have enabled communications and collaborations to happen much more effectively. It is becoming more common for health research projects to be more global than local, with many funders promoting international consortia which often include northern and southern partners (8). However, simply regarding everything as global health may also be an unhelpful oversimplification. A few things, like the health of astronauts in the space station (9) might be unambiguously beyond the …