GLOBAL HEALTH
What does "global health" mean according to Mukherjee's framework?
Global health is the pursuit of health equity for all people worldwide, focusing on addressing health disparities between and within countries.
Educational Explanation: Global health centers on reducing health inequities rather than just studying diseases across borders. It emphasizes solidarity, human rights, and addressing the root causes of health disparities through comprehensive healthcare delivery systems.
What percentage of USAID programs were terminated by the Trump administration in 2025?
Over 90% of all USAID programs were terminated, with over 5,600 USAID workers fired or placed on leave.
Educational Explanation: The Trump administration has terminated over 90% of all USAID programs, and over 5,600 USAID workers have been fired or placed on leave. The dismantling of USAID has also shuttered much of PEPFAR, which has saved more than 25 million lives.
What pandemic does Mukherjee identify as foundational to modern global health delivery?
The AIDS pandemic of the late 20th century.
Educational Explanation: The field of global health has roots in the AIDS pandemic of the late 20th century, when the installation of health care systems supplanted older, low-cost prevention programs to help stem the spread of HIV in low- and middle-income Africa.
What are Partners in Health's "Four S's" for healthcare delivery?
Staff, Stuff, Space, and Systems
Educational Explanation: Mukherjee outlines the staff, stuff, space, and systems necessary to provide high-quality health care (PIH's mantra). This framework represents PIH's comprehensive approach requiring trained healthcare workers, medical supplies, physical infrastructure, and organizational processes.
What does the GINI coefficient measure and how does it relate to health outcomes?
Income inequality
How unequal wealth is
Gap between rich and poor
Economic inequality measure
Educational Explanation: The GINI coefficient measures income inequality within a country, from 0 (everyone has equal income) to 1 (one person has all the income). Countries with higher GINI coefficients (more inequality) tend to have worse health outcomes even when controlling for average wealth, because inequality itself damages health through stress, reduced social cohesion, and unequal access to resources. This shows that how wealth is distributed matters as much as total wealth for population health.
Define "social determinants of health" and explain why they are central to global health equity.
Social determinants are the economic, social, and political conditions that shape where people live, work, and age, directly influencing health outcomes and creating health inequities.
Educational Explanation: It really needs to address the social determinants, and understand why they are so unequal. These include factors like income, education, housing, and access to resources. Addressing only medical factors without changing social conditions perpetuates health inequities.
According to UNAIDS, what are the projected consequences if PEPFAR funding is permanently halted?
6.3 million additional AIDS-related deaths are possible if PEPFAR were halted.
Educational Explanation: PEPFAR supports 20 million people in 55 countries, including 500,000 children. "Treatment for HIV/AIDS is ongoing—people are not cured, they are treated. Losing access to those drugs is a life-threatening situation." According to UNAIDS, an additional 6.3 million AIDS-related deaths are possible if PEPFAR were halted.
After the 1994 genocide, how did Rwanda rebuild its health system?
Community health workers
Local healthcare programs
Community-based healthcare
Insurance for everyone
Educational Explanation: Rwanda created community health cooperatives where neighbors could get health insurance together, trained community health workers to provide basic care, and paid hospitals based on how well they performed rather than just how many services they provided.
How does "global health" differ from "international health" in Mukherjee's framework?
Global health emphasizes equity, human rights, and addressing root causes of health disparities, while international health focused more on disease control and technical interventions.
Educational Explanation: Global health represents an evolution from international health by centering equity, social justice, and addressing structural determinants rather than just focusing on disease control or technical medical interventions across borders.
What does GDP measure and why might it be misleading for understanding population health?
Gross Domestic Product
Total economic output
How much money a country makes
Economic performance measure
Educational Explanation: GDP measures the total value of goods and services produced in a country, often used to assess economic performance. However, GDP can be misleading for health because it doesn't measure distribution - a country can have high GDP but terrible health outcomes if wealth is concentrated among elites. Also, GDP counts harmful activities (like pollution cleanup) as positive economic activity, and ignores unpaid care work that's crucial for health, mostly done by women.
What is "structural violence" and how does it manifest in global health systems?
Structural violence refers to systematic ways that social, economic, and political structures harm certain groups by preventing them from meeting basic needs, creating health inequities.
Educational Explanation: From the ongoing impacts of racism to the momentum for the delivery of care. Structural violence operates through institutions and policies that systematically disadvantage populations - like economic systems that result in some countries spending $0.04 per person on mental health while others spend $65.
According to 2025 reports, by what percentage did US global health funding decline between 2024 and 2025?
A: 67% drop - more than $9 billion reduction in US financing.
Educational Explanation: Development assistance for health (DAH) declined 21% globally between 2024 and 2025, driven largely by a 67% drop—more than $9 billion—in U.S. financing. The United States has historically been the largest funder overall, contributing around 35% of DAH each year for the past decade.
Why did Pakistan struggle to build a health system after 1947 Partition?
All the medical colleges were in India
Partition refugees needed healthcare
Had to spend money on military instead
Weak government
Border wars
Educational Explanation: When British India was divided, Pakistan got very little health infrastructure because most medical colleges and hospitals ended up in India. Millions of refugees needed immediate care, but Pakistan had to spend most of its money on military conflicts with India instead of building hospitals and training doctors.
Explain the difference between "solidarity" and "charity" approaches in global health work.
Solidarity involves working alongside communities as equals sharing power and decision-making, while charity maintains hierarchical relationships where outsiders provide help to passive recipients.
Educational Explanation: Implementing global health projects together with people in affected countries is an act of solidarity and social justice. Solidarity requires mutual learning, shared decision-making, and long-term commitment, while charity maintains power imbalances and can perpetuate dependency rather than building local capacity.
What happened to health systems during 1980s-90s structural adjustment programs?
Health budgets cut
User fees introduced
World Bank/IMF policies
Educational Explanation: World Bank and IMF required countries to cut spending, introduce healthcare user fees, and privatize services. Poor people suddenly had to pay for healthcare that used to be free, worsening health outcomes.
Explain "political economy of health" and its importance in understanding global health inequities.
Political economy of health examines how power relationships, economic systems, and political processes shape health outcomes and access to healthcare.
Educational Explanation: Political and economic processes are arguably the primary causes of most health inequities across and within the Global South. This framework analyzes how factors like trade policies, debt structures, and resource extraction create and maintain health disparities.
How does Nepal's current triple crisis (political protests, economic stagnation, pro-monarchy movement) illustrate the interconnection between political stability and global health systems?
Nepal's 19+ protest deaths amid social media bans and pro-monarchy sentiment demonstrate how political instability directly undermines health systems - governments in crisis mode cut health budgets (Rs3 billion reduction) and lose international aid (USAID suspension) while focusing resources on security and repression.
Educational Explanation: Nepal simultaneously faces Gen Z protests with 19+ deaths over corruption and social media bans, a growing pro-monarchy movement (nearly half of citizens favor restoring Hindu monarchy), and economic stagnation (4.2% growth, ranking 6th of 8 South Asian nations). This political crisis directly impacts health: the government cut health budgets by Rs3 billion while deploying 2000+ police for protest control, and USAID suspended programs affecting 25,000+ HIV patients. This illustrates Paul Farmer's argument about "political economy of health" - health outcomes are shaped by political and economic structures. When governments face legitimacy crises, they prioritize security over health services, and international partners withdraw support due to instability. The result is that ordinary citizens bear health costs of political failures, demonstrating how structural violence operates through both economic and political systems.
How did Belgian colonial ethnic classifications in Rwanda contribute to the 1994 genocide?
Belgians created Hutu and Tutsi divisions
Colonial identity cards
Divide and rule strategy
Ethnic classifications led to genocide
Educational Explanation: Belgian colonizers took flexible social categories (Hutu, Tutsi, Twa) and turned them into rigid ethnic identities, issuing identity cards that classified people by "ethnicity." They initially favored Tutsis for education and administrative roles, then switched to favor Hutus before independence. This colonial manipulation of identity created the foundation for ethnic hatred that exploded into the 1994 genocide, showing how colonial categories can have deadly long-term health and social consequences.
How does the concept of "metabolic rift" apply to understanding global health inequities in the context of environmental degradation?
Metabolic rift describes how capitalist production disrupts natural cycles, creating environmental health hazards that disproportionately affect poor populations while benefits flow to wealthy countries.
Educational Explanation: Metabolic rift, from Marxist ecology, explains how resource extraction and industrial agriculture disrupt ecological cycles. In global health, this manifests as environmental health disparities where pollution, resource depletion, and climate change disproportionately harm poor communities who contribute least to these problems while wealthy populations benefit from the economic activities causing environmental degradation.
What was the 1884-1885 Berlin Conference and how did it affect African health systems?
Europeans divided up Africa
Scramble for Africa
Conference that colonized Africa
Europeans drew borders without asking Africans
Educational Explanation: The Berlin Conference regulated European colonization of Africa, dividing the continent among European powers without any African representation. This "Scramble for Africa" created arbitrary borders that split ethnic groups and traditional healing systems, while concentrating medical resources in colonial administrative centers. The conference established the legal framework for extractive colonialism that prioritized European health over African wellbeing and created the foundation for contemporary health inequities across the continent.
Explain the concept of "preferential option for the poor" in global health delivery and its implications for resource allocation.
A: Preferential option for the poor means deliberately prioritizing the health needs of the most marginalized populations, often requiring more resources and different approaches than standard healthcare delivery.
Educational Explanation: This principle, rooted in liberation theology and adopted by Partners in Health, argues that achieving health equity requires giving priority to those who have been most excluded from healthcare. It challenges efficiency-based resource allocation that might serve easier-to-reach populations first.
According to the 2025 Lusaka Agenda, what fundamental reform is needed in global health financing?
Moving from fragmented donor-driven funding to coordinated domestically-financed health systems with country ownership and integrated service delivery.
Educational Explanation: The Lusaka Agenda proposed coordinated action to speed up progress towards domestically-financed health systems and universal health coverage. The current system shows highly fragmented international health financing with many parallel funding streams focusing on single diseases rather than creating effective systems. This creates high transaction costs and places unsustainable burdens on countries, with money channeled towards donor interests rather than country needs.
Five key shifts for the long-term evolution of the GHI ecosystem
At the heart of the Lusaka Agenda are five key shifts that need to be accelerated to shape the evolution of GHIs and the broader global health financing ecosystem:
What was the American Colonization Society and how did it relate to global health patterns?
Organization that sent freed slaves back to Africa
Created Liberia
White people's solution to slavery
Sent Black Americans to West Africa
Educational Explanation: The American Colonization Society (1817-1964) was founded by white Americans who wanted to send freed enslaved people "back" to Africa, leading to the creation of Liberia in 1822. This created a settler colonial situation where African Americans became the elite ruling class over indigenous Africans, establishing hierarchical health systems similar to other colonial contexts. The society reflected racist beliefs that Black and white people couldn't coexist, while creating new forms of colonialism in West Africa.
What is "epistemic violence" in global health and how does it relate to knowledge production?
Epistemic violence refers to the systematic exclusion of local knowledge systems and the dominance of Western scientific frameworks that marginalize other ways of understanding health and healing.
Educational Explanation: Epistemic violence operates through the privileging of certain forms of knowledge (typically Western biomedical) while marginalizing others (traditional healing, community knowledge). This creates hierarchies in global health where local knowledge is devalued, research is extractive, and solutions are imposed rather than developed collaboratively.
What is "intersectionality" and why does it matter for understanding global health inequities?
How different types of discrimination overlap
Kimberlé Crenshaw's concept
Race, class, and gender together
Multiple forms of oppression at once
Educational Explanation: Intersectionality, coined by Kimberlé Crenshaw, shows how race, class, gender, and other identities interact to create unique experiences of discrimination. In global health, this means understanding that a poor woman of color doesn't just face racism + sexism + classism separately, but a specific form of oppression that combines all three. For example, maternal mortality affects poor women of color most severely not just because of poverty OR race OR gender, but because of how these intersect in healthcare systems.