Global health and development: conceptualizing health between economic growth and environmental sustainability

After World War II, health was firmly integrated into the discourse about national development. Transition theories portrayed health improvements as part of an overall development pattern based on economic growth as modeled by the recent history of industrialization in high-income countries. In the 1970s, an increasing awareness of the environmental degradation caused by industrialization challenged the conventional model of development. Gradually, it became clear that health improvements depended on poverty-reduction strategies including industrialization. Industrialization, in turn, risked aggravating environmental degradation with its negative effects on public health. Thus, public health in low-income countries threatened to suffer from lack of economic development as well as from the results of global economic development. Similarly, demands of developing countries risked being trapped between calls for global wealth redistribution, a political impossibility, and calls for unrestricted material development, which, in a world of finite land, water, air, energy, and resources, increasingly looked like a physical impossibility, too. Various international bodies, including the WHO, the Brundtland Commission, and the World Bank, tried to capture the problem and solution strategies in development theories. Broadly conceived, two models have emerged: a "localist model," which analyzes national health data and advocates growth policies with a strong focus on poverty reduction, and a "globalist" model, based on global health data, which calls for growth optimization, rather than maximization. Both models have focused on different types of health burdens and have received support from different institutions. In a nutshell, the health discourse epitomized a larger controversy regarding competing visions of development.