A dear friend asked me what I think about global public health issues.
My first reaction—considering that I belong to the generation that grew up watching Mike Bongiorno’s Rischiatutto on TV (which was the Italian prototype for television game shows modeled after those from the U.S. in the 1940s and 1950s)—was: “A million-dollar question!”.
Bearing in mind that among the most widely accepted definitions of public health are: “The science and art of improving the health of the population through organized societal efforts” (Acheson, 1988; WHO, 2000), but also: “ The process of mobilizing the local, regional, national, and international resources necessary to ensure the conditions under which all people can be in good health” (Breslow and Detels, 1991), it is clear that we are essentially talking about something very important and very complex, all the more so if the reference framework adopted is the global one—that is, one that concerns the health of all peoples across the entire planet.
It is worth emphasizing that, from an “ecological” perspective, health is not so much an end in itself as a fundamental tool for realizing one’s life plans over the course of one’s existence, with real opportunities to fulfill one’s potential (Amartya Sen’s famous “capabilities”). In essence, health is fundamentally linked to our quality of life, which inevitably goes beyond the—albeit necessary—satisfaction of basic needs or the treatment of any illnesses, to more broadly encompass the level of existential fulfillment that each person experiences in the “here and now” of their life journey. It should certainly be noted, however, that the protection of health has been internationally recognized as a right for nearly 80 years, and that it is the primary responsibility of governments—that is, public institutions—to make every effort to ensure that this (promotion and) protection is effectively implemented.
By adopting this “Global Public Health” perspective, there is virtually no area that can be excluded from the category of so-called “determinants of health” . And objectively speaking, the situation is by no means reassuring.
A few examples among many possible ones: 1) the increasingly evident climate crisis and its effects on human health in terms of heat waves, wildfires, flash floods, progressive desertification, and mass migration; 2) the staggering number of ongoing conflicts (estimated at over sixty) and their devastating toll in terms of deaths, injuries, and disabilities, as well as widows, widowers, and orphans; the persecution of individuals (through threats, detention, and torture); the destruction of local institutions, services, and the social fabric they support (education, food, water, sanitation, and healthcare) and environmental devastation (a warning was recently issued regarding future exposure in Ukraine to asbestos released by the destruction of buildings); 3) the rise—as Cardinal Parolin recently noted—of the “right of force” in place of the “force of law” (international) with the gradual abandonment of multilateralism and the alarming rise in human rights violations across virtually every corner of the globe—one need only consider the devastating consequences that the recent introduction of the new “European Pact on Immigration and Asylum” will have on people seeking international protection in the region of the world that has always been considered the cradle of human rights; 4) the evident increase in the prevalence of mental distress and psychiatric disorders globally (particularly anxiety and depression); 5) the terrible global impact of the “commercial determinants” of health, with particular reference to the rampant spread of so-called junk food (i.e., low-cost, processed foods of poor nutritional quality), carbonated and sugar-sweetened beverages, tobacco (including that consumed via e-cigarettes), and alcohol, which are causing a sharp global increase in chronic diseases such as diabetes, obesity, cardiovascular diseases, chronic respiratory diseases, and cancer—a trend that is largely attributable to the “deregulation” that allows large multinational corporations (the so-called “Big Food,” “Big Tobacco,” and “Big Pharma”) to profit at the expense of public health.
The list could go on, considering, for example: the so-called gender gap produced by strongly patriarchal societies (today, the term “manosphere” is used to refer to the network of online communities that promote male dominance, anti-feminist ideologies, and regressive models of masculinity); the absurd arms race, which diverts more and more resources away from the community’s fundamental needs, such as the right to housing or, more generally, social protection for vulnerable people; the effects of rising populist nationalism in fostering discriminatory and racist attitudes and behaviors toward ethnic minorities; the dynamics of social disintegration that lead, for example, to loneliness among older adults, particularly in cities; and certain hyper-competitive and hyper-accountability-driven social models recognized as underlying forms of social isolation, such as the “hikikomori” phenomenon among adolescents. Another much-discussed issue at present is the option of excluding adolescents or severely restricting their access to social media until a certain age. The debate regarding the risks of uncontrolled use of artificial intelligence is also growing rapidly. All of the issues briefly mentioned here are potential “case studies” in global public health.
The way in which all these determinants manifest globally is through “inequalities in health and care” (inequalities characterized by severity, systematicity, and preventability). In short, the negative consequences of exposure to adverse determinants follow the so-called “social gradient,” meaning that each population group (quintile) systematically experiences worse outcomes than the adjacent, less disadvantaged (or more affluent) group.
Must we therefore resign ourselves to a progressive and inevitable decline in health conditions globally? To a gradual withdrawal of institutions from their mandate to protect and safeguard health?
I do not believe it is justified—nor useful—to apply the so-called “pessimism of reason” to these issues.
I believe that the value of health—its quality in terms of universal protection, free from the dynamics of social Darwinism, in which even health and healthcare—according to the prevailing neoliberal theory—must be entrusted to the logic of a self-regulating market, with the consequence that access to this market is limited to those who can “buy” health— ultimately depends on the democratic resilience of a society.
I was deeply struck by a statement from the Commission on Social Determinants of Health (established in 2005 by the World Health Organization (WHO)) on the occasion of the launch of its report “Closing the gap in a generation: health equity through action on the social determinants of health” in 2008; the statement was: “Around the world, vulnerable and socially disadvantaged people have less access to health care, suffer from more illnesses, and die earlier than those in a more privileged social position. These inequalities are growing, even though global wealth and technological progress have never been greater.”
Even the long-standing issue of the sustainability of universal public health care systems, for example, tends to overshadow the fact that resource allocation depends on the level of political priority that decision-makers assign to the specific sector (in this case, health policies but also non-health policies that affect health) and that political recognition of a priority depends largely on how profitable it is perceived to be in terms of electoral support.
If, as Rudolph Virchow said, “medicine is a social science and politics is medicine on a large scale”, it seems worthwhile to try to refocus public attention on its role in active citizenship, the assertion of rights, and participation in decision-making processes. The battle for health equity cannot be waged without a rediscovery of the value of “community.” At the same time, in my view, we need an anthropological and cultural revolution capable of opposing the logic of consumerism and affirming a new humanism in which “being” is valued more highly than “having.”
I’ll conclude by recommending a book: The Health Gap The Challenge of an Unequal World by Michael Marmot, published in 2016 by ‘Bloombury’, with particular attention to the final chapter, titled “Organizing Hope”.
After all, to paraphrase a famous phrase attributed to Tertullian, in the face of the terrible ethical challenges of this world, one might say: “Spero quia absurdum.”
How to cite this article
Maurizio Marceca MD. (2026, July 28). Global Public Health Issues. The RIID Review. http://riidblog.org/post/28-07-2026/