The Acronyms that Divide Us

TLAs that every HCW Should Know to Better Understand the UNGA HLM on UHC and SDGs writes Alexander W. Peters .

The Chair of Medicine (CoM) at a leading hospital cut me off mid-sentence, and I briefly lost my train of thought.  “What are NCDs?” he asked.  We had been discussing, in broad terms, how economic development and health improvements in low- and middle-income countries (LMICs) had resulted in profound epidemiologic transitions over the past half-century.  “Non. Communicable. Diseases.” I responded with an arrogance regrettably unbecoming of a resident speaking to an attending.  For a split-second, his face filled with the kind of sheepishness more commonly seen in medical students.  Fortunately, before I could continue my condescending retort any further, he unassumingly sighed “oh, that makes more sense now.”  Our disbelief was shared, but as it often turns out in my interactions with attendings, the lesson was on me.

After almost 2 years working in global health research and advocacy during a sabbatical from surgical training, I had, like any specialist, become immersed in the syntax of my field.  Accustomed to the intricate language of the World Development Indicators (WDIs) and multi-lateral organizations (MLOs), my homily on NCDs—which dominate current global health discussions up to the highest levels—had felt as second nature as skin tests (PPDs), gloves and masks (PPEs) and lab results (PTTs).

In that moment, however, came a discouraging realization: a disconnect remains between modern medical professionals and the practice of global health.  Even someone whose expansive research and training included a substantial focus on NCDs like diabetes mellitus (DM) and hypertension (HTN) could remain unacquainted with the lingo of leading global health trends.

Spanning from the bench to the bedside, the array of meaningful non-clinical pursuits in medicine is as broad as the human condition itself, and, despite high demand among medical students for global health teaching, we need not all be global health experts.  Nonetheless, the providers and purveyors of healthcare in this world may benefit from a clearer understanding of global trends so that they can better empathize with and advocate for increasingly globalized patients, or better interpret international health initiatives for the lay population around them.

In addition to avoiding awkward encounters with recent medical graduates (PGY-3s) at conference receptions, familiarity with the leanings and language of global health is of particular importance this year.  Every September at its New York Headquarters, the United Nations (UN) hosts a General Assembly (UNGA, or “Uhn-Gah” ) where heads of state convene to discuss matters of global importance.  This September, at the 74th UNGA, there will be a special UN High-Level Meeting (HLM) on Universal Health Coverage (UHC).  The meeting’s theme is “Moving Together to Build a Healthier World,” and global health advocates see it as an opportunity to focus high-level political attention on improving health care for all.

To the uninitiated, however, or to those whose medical training deemed the Cori and Krebs cycles fundamental but made little mention of the relationships between politics, economics, and health, the lingo of global health can often be confusing and intimidating.  It need not be.  Some high-level etymological osmosis could help temper the inevitable expansion of specialty-specific acronyms and abbreviations, and this year, foster a more universal understanding of what promoting global health means.

What follows (Table 1) is an incomplete-but-useful glossary of three-letter or more acronyms (TLAs) that any interested healthcare worker (HCW) should know to make better sense of health and health policy around the world.  Armed with this guide, you might learn that more community health workers (CHWs) and SOAs, for example, could help achieve the SDGs and grow GDPs in LICs that have relied on BLOs and MLOs like the WBG, WHO, and USAID to help reduce OOPs and protect people from CHEs; and if you follow the UNGA HLM on UHC, you might be one step closer to explaining how UHC promotes HSS and FRP, especially for people living in LMICs with RMNCH-related NCDs and NTDs.  For use as needed (PRN).

Table 1: Brief glossary of global health acronyms for all healthcare workers

Acronym Term Description
BLOs / MLOs Bilateral Organizations (BLOs) and

Multilateral Organizations (MLOs)

Organizations formed by two or more nations to address issues pertinent to those nations. These include the MLOs such as the United Nations (UN), World Health Organization (WHO), the World Bank Group (WBG), and BLOs such as the United States Agency for International Development (USAID), the Korea International Cooperation Agency (KOICA), and the United Kingdom’s Department for International Development (DFID).
CHE Catastrophic Health Expenditures Formal and informal out of pocket (OOP) payments for medicines, health services, and other costs associated with receiving care (e.g. transportation) that can drive an individual or household below a nation’s poverty threshold.  Derived from a quotient related to OOPs and household income, and often further delineated as CHE vs. impoverishing health expenditures (IHE).
FRP Financial Risk Protection Referring to initiatives that reduce the risk of impoverishment from receiving healthcare (e.g. health insurance).
HSS Health System Strengthening Changes in policy and practice that improve a country’s ability to provide access to safe and affordable healthcare when needed.
LMICs Low- and Middle-Income Countries World Bank Group income classification referring to countries with gross national income (GNI) per capita* between $996 and $3,895. (*2019 classification based on 2017 GNI).  Compare with:

·         Low-income countries (LICs): GNI per capita < $996

·         Upper-middle income countries (UMICs): GNI per capita = $3,896 to $12,055

·         High-income countries (HICs): GNI per capita > $12,055

NCDs^ Non-communicable Diseases Diseases resulting from a combination of genetic, physiologic, environmental, and behavioral factors.  Attributable to 71% of all global deaths. (Also known as chronic diseases).  ^Often seen as NCDIs, referring to non-communicable diseases and injuries.
NTDs Neglected Tropical Disease Communicable diseases prevalent in tropical and subtropical environments (e.g. lymphatic filariasis, onchocerciasis, dengue fever, etc.)
RMNCH Reproductive, Maternal, Newborn, and Child Health Referring to reproductive, maternal, newborn, and child health-related issues
SDGs The United Nations’ Sustainable Development Goals A set of 17 goals for 2030 agreed upon by all United Nations member countries to address health, education, economic, environmental, social protection, and other social needs for all people.  They include “Zero Hunger” (SDG2), “Good Health and Well Being” (SDG3), “Quality Education” (SDG4) “Affordable and Clean Energy” (SDG7), and “Peace, Justice, and Strong Institutions” (SDG16).”
SOAs Surgeons, Obstetricians, and Anesthesiologists Skilled providers of surgical, obstetric, and anesthesia care.  “SOA density“ refers to the number of skilled surgical, obstetric, and anesthesia providers per 100,000 people.
UHC Universal Health Coverage UHC is about ensuring that people have access to the health care they need without suffering financial hardship” (World Bank Group).


“UHC means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship” (World Health Organization).

UNGA United Nations General Assembly Annual meeting (held in September in New York, USA) of the United Nations’ member states.
WDI World Development Indicators A World Bank Group repository of official national, regional, and global data pertaining to economic, health, and social development.
WHA World Health Assembly Annual meeting on health (held in May in Geneva, Switzerland) of the United Nations’ member states.


About the author:

Alexander Peters (@alexpeters) is a resident in general surgery at Weill Cornell Medical College and a former Paul Farmer Global Surgery Research Fellow at the Program in Global Surgery and Social Change at Harvard Medical School.  His research centers on health economics and financing, medical education, innovation, and improving surgical care delivery in low-resource settings.


Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no relevant conflicts of interests to declare.

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