Caring for the World: A Guidebook to Global Health Opportunities

With so much attention focused on efforts to reform health care in the United States, it is easy to lose sight of the even more daunting health problems faced in other parts of the world. Many poor countries fail to provide even the barest minimum of health services to their citizens. Annual per capita health spending in the United States is greater than combined per capita health care spending in the poorest 70 countries. Living conditions in many places are grim, and life expectancies in developed nations are 30 years longer than in developing countries.

Caring for the World: A Guidebook to Global Health Opportunities describes these and other challenges in global health, but its main purpose is to serve as a manual for those interested in trying to address them. It presents detailed information about a wide range of options for doing so, the rewards and difficulties involved, and issues to take into account in planning and carrying out such a project.

The book sets the context with a brief overview of the field. The authors acknowledge that each of the topics covered, including human immunodeficiency virus/AIDS, tuberculosis, malaria, and maternal and child health, could be the subject of a chapter or book of its own. They note the progress that has been achieved in important areas, such as a marked reduction in extreme poverty worldwide from 1990 to 2004, and point out some of the many problems that remain. Each year, for example, at least 1 million individuals die of malaria, and 300 million are afflicted with acute illness from the disease.

Statistics like these can easily become overwhelming and so lead to the question of whether the contributions of any one individual can significantly affect these outcomes. One of the principal themes of the book is to show that this is possible. It does so primarily though personal accounts of individuals from varying backgrounds and professions, whose work in global health has been no less varied. One story is that of a journalist who helped raise hundreds of thousands of dollars for Ugandan children by organizing walks that mimic what 40 000 children in Uganda do every day to avoid being captured in an ongoing civil war. Another is that of a physician, now the dean of a prominent school of public health, who discovered early in his career that only physicians were allowed to prescribe oral contraceptive medications in Thailand. He helped conduct a study demonstrating that it was safe for nurse midwives to do this by following a simple checklist, leading to fundamental change in family planning services in that and many other countries.

To assist readers in identifying what their own goals in global health might be, the book outlines what the authors see as the 6 major areas of global health opportunities: research, clinical work, short-term work such as consulting, long-term work, education, and developing a new project. It then lays out some considerations to aid in choosing among these options. These considerations include not only aspirations but also constraints such as special medical needs and family concerns like the availability of schooling for children.

Possibly the most valuable chapter of the book is one devoted to even more pragmatic issues involved in trip planning and preparations. This chapter is, in a sense, a tutorial in what most take for granted in daily life but that cannot be assumed as givens in another country, especially one much poorer than the United States. Such basics as the meaning of unfamiliar gestures, and the existence of taboos and other social conventions, are mentioned. Some concerns may become obvious on arrival or after a problem arises but can be taken care of only in advance. For example, the authors recommend obtaining health insurance that includes coverage for medical evacuation for unexpected medical emergencies, to ensure transportation to a suitable medical facility if none is nearby. The chapter concludes with a checklist of what to bring (eg, batteries) and not to bring (eg, most valuables), as well as a timetable for organizing a trip.

The authors point out that, unfortunately, one does not have to travel abroad to encounter conditions like those in underdeveloped countries: “[t]he issues that we attempt to address as ‘global health’ issues in faraway resource-poor countries often need to be addressed within our own cities” (p 61). They note that lessons learned abroad while working with few resources can also be applied in the United States to achieve better health outcomes in similar settings attributable to poverty or natural disasters.

It is important to be aware that, as its title indicates, this book is a handbook and in part a reference work, not a treatise. More than half is made up of lists of global health organizations and programs. One chapter provides a list of 61 international medical electives, 93 medical language courses, and 15 global health conferences. Internet search engines would generate some of this information, but it is doubtful that they could substitute for the authors' experience and knowledge of the array of alternatives available.

In this and other ways, Caring for the World collects and distills a great deal of useful information. It manages to be both inspirational and appropriately cautionary. Like a guidebook for those visiting a city, especially for the first time, it should help those contemplating work in the field of global health both avoid the pitfalls and make the best of the experience.