{"id":39445,"date":"2019-09-13T06:32:53","date_gmt":"2019-09-13T06:32:53","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjgh\/?p=39445"},"modified":"2019-09-13T06:32:53","modified_gmt":"2019-09-13T06:32:53","slug":"the-acronyms-that-divide-us-in-global-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjgh\/2019\/09\/13\/the-acronyms-that-divide-us-in-global-health\/","title":{"rendered":"The Acronyms that Divide Us"},"content":{"rendered":"

TLAs that every HCW Should Know to Better Understand the UNGA HLM on UHC and SDGs writes Alexander W. Peters .<\/em><\/p>\n

The Chair of Medicine (CoM) at a leading hospital cut me off mid-sentence, and I briefly lost my train of thought. \u00a0\u201cWhat are NCDs?\u201d he asked.\u00a0 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.\u00a0 \u201cNon. Communicable. Diseases.\u201d I responded with an arrogance regrettably unbecoming of a resident speaking to an attending.\u00a0 For a split-second, his face filled with the kind of sheepishness more commonly seen in medical students.\u00a0 Fortunately, before I could continue my condescending retort any further, he unassumingly sighed \u201coh, that makes more sense now.\u201d\u00a0 Our disbelief was shared, but as it often turns out in my interactions with attendings, the lesson was on me.<\/p>\n

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. \u00a0Accustomed to the intricate language of the World Development Indicators (WDIs) and multi-lateral organizations (MLOs), my homily on NCDs\u2014which dominate current global health discussions up to the highest levels\u2014had felt as second nature as skin tests (PPDs), gloves and masks (PPEs) and lab results (PTTs).<\/p>\n

In that moment, however, came a discouraging realization: a disconnect remains between modern medical professionals and the practice of global health. \u00a0Even 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.<\/p>\n

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<\/a>, we need not all be global health experts.\u00a0 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.<\/p>\n

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.\u00a0 Every September at its New York Headquarters, the United Nations (UN) hosts a General Assembly (UNGA, or \u201cUhn-Gah\u201d ) where heads of state convene to discuss matters of global importance.\u00a0 This September, at the 74th<\/sup> UNGA, there will be a special UN High-Level Meeting (HLM) on Universal Health Coverage (UHC).\u00a0 The meeting\u2019s theme is \u201cMoving Together to Build a Healthier World<\/a>,\u201d and global health advocates see it as an opportunity to focus high-level political attention on improving health care for all.<\/p>\n

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<\/a>, the lingo of global health can often be confusing and intimidating.\u00a0 It need not be.\u00a0 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.<\/p>\n

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.\u00a0 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. \u00a0For use as needed (PRN).<\/p>\n

Table 1: Brief glossary of global health acronyms for all healthcare workers<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Acronym<\/strong><\/td>\nTerm<\/strong><\/td>\nDescription<\/strong><\/td>\n<\/tr>\n
BLOs \/ MLOs<\/strong><\/td>\nBilateral Organizations (BLOs) and<\/em><\/p>\n

Multilateral Organizations (MLOs)<\/em><\/td>\n

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\u2019s Department for International Development (DFID).<\/td>\n<\/tr>\n
CHE<\/strong><\/td>\nCatastrophic Health Expenditures<\/em><\/td>\nFormal and informal out of pocket (OOP) payments<\/a> for medicines, health services, and other costs associated with receiving care (e.g. transportation) that can drive an individual or household below a nation\u2019s poverty threshold.\u00a0 Derived from a quotient related to OOPs and household income, and often further delineated as CHE vs. impoverishing health expenditures (IHE).<\/td>\n<\/tr>\n
FRP<\/strong><\/td>\nFinancial Risk Protection<\/em><\/td>\nReferring to initiatives that reduce the risk of impoverishment from receiving healthcare (e.g. health insurance).<\/td>\n<\/tr>\n
HSS<\/strong><\/td>\nHealth System Strengthening<\/em><\/td>\nChanges in policy and practice that improve a country\u2019s ability to provide access to safe and affordable healthcare when needed.<\/td>\n<\/tr>\n
LMICs<\/strong><\/td>\nLow- and Middle-Income Countries<\/em><\/td>\nWorld Bank Group income classification<\/a> referring to countries with gross national income (GNI) per capita* between $996 and $3,895. (*2019 classification based on 2017 GNI).\u00a0 Compare with:<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Low-income countries<\/em> (LICs): GNI per capita < $996<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Upper-middle income countries<\/em> (UMICs): GNI per capita = $3,896 to $12,055<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 High-income countries<\/em> (HICs): GNI per capita > $12,055<\/td>\n<\/tr>\n

NCDs^<\/strong><\/td>\nNon-communicable Diseases<\/em><\/td>\nDiseases resulting from a combination of genetic, physiologic, environmental, and behavioral factors<\/a>.\u00a0 Attributable to 71% of all global deaths. (Also known as chronic diseases).\u00a0 ^Often seen as NCDIs, referring to non-communicable diseases and injuries<\/em>.<\/td>\n<\/tr>\n
NTDs<\/strong><\/td>\nNeglected Tropical Disease<\/em><\/td>\nCommunicable diseases prevalent in tropical and subtropical environments<\/a> (e.g. lymphatic filariasis, onchocerciasis, dengue fever, etc.)<\/td>\n<\/tr>\n
RMNCH<\/strong><\/td>\nReproductive, Maternal, Newborn, and Child Health<\/em><\/td>\nReferring to reproductive, maternal, newborn, and child health-related issues<\/td>\n<\/tr>\n
SDGs<\/strong><\/td>\nThe United Nations\u2019 Sustainable Development Goals<\/em><\/td>\nA set of 17 goals for 2030 agreed upon by all United Nations member countries<\/a> to address health, education, economic, environmental, social protection, and other social needs for all people.\u00a0 They include \u201cZero Hunger\u201d (SDG2), \u201cGood Health and Well Being\u201d (SDG3), \u201cQuality Education\u201d (SDG4) \u201cAffordable and Clean Energy\u201d (SDG7), and \u201cPeace, Justice, and Strong Institutions\u201d (SDG16).\u201d<\/td>\n<\/tr>\n
SOAs<\/strong><\/td>\nSurgeons, Obstetricians, and Anesthesiologists<\/em><\/td>\nSkilled providers of surgical, obstetric, and anesthesia care<\/a>.\u00a0 \u201cSOA density\u201c refers to the number of skilled surgical, obstetric, and anesthesia providers per 100,000 people.<\/td>\n<\/tr>\n
UHC<\/strong><\/td>\nUniversal Health Coverage<\/em><\/td>\n\u201cUHC is about ensuring that people have access to the health care they need without suffering financial hardship<\/em>\u201d (World Bank Group<\/a>).<\/p>\n

 <\/p>\n

\u201cUHC 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\u201d (<\/em>World Health Organization<\/em><\/a>). <\/em><\/td>\n<\/tr>\n

UNGA<\/strong><\/td>\nUnited Nations General Assembly<\/em><\/td>\nAnnual meeting (held in September in New York, USA) of the United Nations\u2019 member states.<\/td>\n<\/tr>\n
WDI<\/strong><\/td>\nWorld Development Indicators<\/em><\/td>\nA World Bank Group repository of official national, regional, and global data pertaining to economic, health, and social development.<\/td>\n<\/tr>\n
WHA<\/strong><\/td>\nWorld Health Assembly<\/em><\/td>\nAnnual meeting on health (held in May in Geneva, Switzerland) of the United Nations\u2019 member states.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

About the author:<\/strong><\/p>\n

\"\" Alexander Peters<\/strong> (@alexpeters<\/a>) 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. \u00a0His research centers on health economics and financing, medical education, innovation, and improving surgical care delivery in low-resource settings.<\/p>\n

 <\/p>\n

Competing interests:\u00a0<\/strong>I have read and understood BMJ policy on declaration of interests and declare that I have no relevant conflicts of interests to declare.<\/p>\n","protected":false},"excerpt":{"rendered":"

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. \u00a0\u201cWhat are NCDs?\u201d he asked.\u00a0 We had been discussing, in broad terms, how […]<\/p>\n

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