Global self-esteem is defined as a general or overall sense of worthiness possessed by people as a nation. According to Maslow’s self-actualization theory, self-esteem in addition to the need for achievement, competence, independence, and respect, is fourth in the hierarchy of needs. Self-esteem, being a fundamental human need and motive has been broadly investigated in social science research as well as in clinical, developmental and counseling psychology. Results from experiential studies recognize and emphasize the fact that self-esteem is one of the most significant concepts that explains and relates to several behavioral, health, economic and social outcomes of life and realities in a nation.
More specifically, some studies identify self-esteem as a significant determinant of health and emotional well-being, such that individuals with high self-esteem have greater emotional stability and are better at managing their emotions compared to others. Additionally, a 2006 New Zealand longitudinal research followed some adolescents and found that those with low self-esteem had poor physical and psychological health, poor economic prospect and increased chances of engaging in crime. Concurrently, high self-esteem has been associated with negative psychological and behavioral outcomes such as egoism, aggression, narcissism and violence.
The results of low and high self-esteem in individuals are reflected in the nation’s health and invariably, in global health. To avoid the dark side of self-esteem which is caused by low confidence and over-confidence or too high self-esteem, individuals and nations must strike a balance by possessing a healthy self-esteem. According to research in 2005 by David P. Schmitt and Juri Allik, self-esteem varies vastly in levels around the world. These researchers used the Rosenberg Self Esteem Scale to analyze data of about 17,000 people in 53 different countries. The results showed that the top five countries with the highest levels self-esteem are Serbia, Chile, Israel, Peru and Estonia while the countries with the lowest levels of self-esteem are Japan, Hong Kong, Bangladesh, Czech Republic and Taiwan.
The understanding of self-esteem was similar across these countries and in general: self-esteem was higher in countries that regard men and women equally; levels of self-esteem were not linked to life expectancy, literacy or standard of living; individualist and collectivist countries had lower and higher levels of self-esteem respectively; higher self-esteem was directly proportional to lower levels of anxiety; men had higher self-esteem than women and self-esteem increases as age increases. Another study examined the impact of national differences in self-esteem on suicide rates using data from the International Sexuality Description Project (ISDP). Results showed that suicide is particularly common in nations with comparatively low levels of self‐esteem; this association was consistent across sex and age but independent of economic affluence, social status, individualism, well‐being, and neuroticism.
In the world today, science matters because science serves and saves lives. The impact of science and technology in healthcare and global health in general cannot be overemphasized. Science and technology, by expanding human understanding, is at the forefront of innovations and inventions in healthcare. It creates a foundation for improvements in global health, unravels ideas, fuels discoveries, informs policies and programs as well as promotes better, healthier lives for all people. Science drives and transforms global health through discoveries and technologies as described below:
• Science and technology generates treatments, cures, and vaccines to manage global health challenges
Since the last few decades, science has created new health technologies that have driven incredible progress in global health. The many investments in science and research have produced over 100 vaccines, drugs, diagnostics, and other lifesaving global health tools have been developed and introduced. Some life-saving inventions include polio vaccine that eradicated the virus and antiretroviral treatments that have histrionically extended the lives of people living with HIV/AIDS. Furthermore, the meningitis A vaccine has saved 378,000 lives and prevented 673,000 new infections since 2010 while the child-friendly malaria drugs have reduced childhood malaria deaths by 65 percent since 2000.
• Science sheds light on population needs and aids the design of relevant research tools
Scientific research promotes progress in global health by developing tools that create positive health impacts for the populations and settings in which they’re applied. Research ensures that health care services are provided in a culturally sensitive way and that medications are available, affordable and user-friendly. Through research components and instruments such as surveys, surveillance, data analysis and reviews, science aids the comprehension of population dynamics and complexity as well as proffers reliable and effective solutions.
• Science and technology supports emergency preparedness through the understanding, prediction and tracking of potential health risks
The early detection of an outbreak is important for effective response and the prevention of epidemics or pandemics. Science and technology is employed in the surveillance of infectious diseases through the use of weather patterns to project the possibility of insect-borne disease outbreaks and the use of genomics or evolutionary theory to predict anti-microbial resistance. Biotechnology, molecular biology and genetic engineering are also scientific advancements employed in the diagnosis of many infections, disease control and development of antibiotics.
• Technology provides information and data at our fingertips
The revolution of mobile technology and digital health has transformed the access and use of health information as well as how global diseases and health challenges are combated. Patients and health service providers now use mobile devices to access health information and track immunization coverage or monitor health services and supplies respectively. Doctors, nurses and other healthcare workers use short message service (SMS) to remind patients of their appointments and to adhere to their treatment regime. Finally, the government, through the ministry of health, can now deploy new data visualization tools in order condense data into accessible, comprehensible and easy-to-use information guide… thanks to science and technology.
Ethnic cleansing is defined as the organized, strategic and systematic elimination of other ethnic, tribal or racial groups from a region by a more powerful group, usually with the intention of creating ethnic homogeneity. Various kinds of forced migration are used to achieve this removal including deportation, population transfer, discrimination, inequity, deprivation, intimidation, genocide and genocidal rape. Ethnic cleansing is often accompanied by additional efforts to destroy and remove all physical, structural, religious and cultural traces of the cleansed group in the region. This attempt to create extinction is achieved through the demolition and destruction of houses, social centers, farms and infrastructure, as well as the desecration of monuments, cemeteries, spiritual symbols and religious houses.
Countries such as Sudan and Bosnia experience widespread ethnic cleansing, burning of villages, looming starvation, massive killings and gang rape. Ethnic cleansing was particularly observed in Sudan by the UN experts who took a 10-day trip to visit the country. Following the civil war in December 2013, over 50,000 people have been killed, approximately 2.3 million people have been internally displaced and about 6 million Sudanese are currently at risk of hunger. More so, up to 70 percent of schools in the country have been closed due to the current situation of the country.
Given the unethical and clearly inhumane nature of ethnic cleansing, several health impacts and consequences are predictable. In a study titled “Psychiatric consequences of ethnic cleansing: clinical assessments and trauma testimonies of newly resettled Bosnian refugees” by Weine et al, the authors interviewed Bosnian refugees referred from agencies managing refugee resettlement. The interviews were systematic, trauma-focused and clinical interviews which included standardized assessment scales. Their findings showed that the traumatic experiences of ethnic cleansing in these refugees were genocidal and correlated positively with age. In addition, post-traumatic stress disorder (PTSD) and depressive disorders were diagnosed in 65% and 35% of these refugees respectively. Conclusively, this study showed that ethnic cleansing resulted in high rates of PTSD, depression, as well as other forms of psychological morbidity, in the studied group. Another study on the “Long-term effects of ethnic cleansing in the former Polish-German borderland” showed that removing portions of the population forcefully wrecks social networks and discards specific skills and knowledge. Further, ethnically cleansed regions tend to remain different, with higher crime rates, lower civic engagement, and less efficient public services.
The most efficient and effective means to preserve global health is to prevent diseases or stop them before they spread across the world. World Health Organization (WHO), UNICEF, World Food Program and CDC’s activities protect populations from major global health diseases and pandemics. These international organizations, in collaboration with other organizations and individuals, prevent, detect, contain and control outbreaks at their source, saving lives and reducing healthcare costs. They also help different countries to build capacity to handle and respond accordingly to their respective health challenges. The major aim of global health security is to stop diseases where they start, as soon as possible.
Global health refers to the understanding of health systems and population health in a collaborative, international and global context. It is a multidisciplinary area of study, research and practice that focuses on prioritizing, improving and attaining health and equity for all people worldwide. This is done by highlighting and tackling health problems that transcend national borders or have a social, political and economic impact. Simply, global health is all about improving physical, social and mental health and wellbeing by influencing health determinants, reducing disparities and protecting against diseases, it can be measured by the prevalence of pandemics, emergency preparedness and life expectancy.
The major threat to global health is that diseases know no borders. In the interconnectedness of today’s world, a disease threat anywhere is a threat everywhere. This is because diseases- specifically communicable diseases, exploit any gap to spread and multiply especially given the ease, rate and speed of international travel. Other threats and challenges facing global health include:
- New and recurring pandemics: These are global disease outbreaks such as HIV, influenza, Severe Acute Respiratory Syndrome (SARS), Ebola, Zika and other viral infections.
- Human and natural disasters: Climate change, air pollution, water pollution, poor sanitation and hygiene, flooding, droughts and other environmental conditions expedite the spread of diseases.
- Health inequity due to politics, social and economic disparities: Lack of access to basic health information and health care may result in unhealthy choices, STDs, high child mortality rates, and poor nutrition. These issues can be eliminated by healthy public policies, poverty alleviation and health education.
- Chronic diseases: Heart disease, stroke, cancer, diabetes and other chronic disease remain a burden for global health as they account for 70 percent of all deaths worldwide.
- Animal health and products: Animal health is naturally intertwined with humans- having connections to humans as pets or food sources. Hence it is easy to contact infections as many diseases originate from animals, which are often asymptomatic hosts.
In 2014, over 140,000 people died from armed conflicts. This figure only accounts for direct combat-related deaths. Consequently, the figures would be much higher (probably millions) if deaths from all forms of conflicts and wars were accounted for. The health implications of war extend beyond battlefields, into communities, usually with devastating results. Although men are more likely to be killed during wars, women and children often suffer lasting impacts and trauma. Rape and other forms of sexual violence are accompanied by wars, and are frequently used as weapons of war. Sexual violence results in deep psychological trauma, sexually transmitted diseases, unwanted pregnancies, and long-term physical damage.
The health effects of conflicts and wars seem pretty obvious and are well documented in research studies. In Nigeria, conflict groups have continued to clash, killing innocent citizens in various communities- the most recent incident being the unfortunate massacre in Plateau State in June, 2018. This creates fear, trauma and poor mental health across the country. In South Sudan, a country ruined by decades of conflict, girls are more likely to die in childbirth than they are to finish primary school. In Syria, rates of caesarean section – which increases many risks for both mother and baby – have risen as women refuse to have normal delivery in conflict-prone areas. During these conflicts, there have been occasions where premature babies die in incubators due to hospital power outage. Lack of power and the degradation of health services also imply disruptions in vaccinations programs, exposing susceptible individuals to previously rare diseases. For instance, the first case of polio in Syria for 15 years was confirmed in October 2013 following a decline in immunizations due to civil war. In Pakistan, health officials report insecurity as a major barrier to ending polio as 80% of new cases occurring in the war torn regions.
War and conflict are sure to result in tragedies including loss of lives, injuries, anxiety, mental distress, famine, mal-nutrition, damage to the environment, drainage of human and financial resources, fostering of a culture of violence, internal displacement and disease outbreaks. In the face of war, normally unthreatening and preventable diseases such as diarrhea and cholera become a big threat to health and life; chronic illnesses that can usually be managed and treated without pain aggravate to severe suffering; while pregnancy and childbirth become incredibly dangerous. As health systems fail during wars, maternal and newborn health indicators- which reflect a country’ overall health system performance- deteriorate significantly. This means increase in infant and maternal mortality rates. In general, peace begets good health. Conflict and war are overwhelming and may reduce people’s coping capacity, safety and access to food, medicines, medical supplies, safe and clean drinking water, sanitation, shelter and health services.
The mental health impacts of war are also challenging, traumas form near death experiences and loss of loved ones can have significant health impacts on survivors. Crowding in temporary shelters and poor hygienic situations increase the risk of waterborne disease outbreaks such as cholera, typhoid and dysentery. To reduce the negative health impacts of wars and minimize the risks of disease and death, priority must be given to ensuring that civilians can access their basic needs in the midst of war. Such needs include:
- Adequate and safe drinking water
- Hygiene and sanitation
- medical supplies and treatment
- Access to basic continuing health care for persons with special needs and vulnerable populations including pregnant women, children, the elderly, and chronically ill or disabled persons.
