[MUSIC].
Today, I will talk to Professor
Ib Bygbjerg from the
University of Copenhagen. And Ib Bygbjerg is
also a senior consultant at the National University Hospital here in Copenhagen.
So, Ib Bygbjerg, you have been part of this field long before it
was titled global health.
Maybe you could briefly introduce us to your own background
and your own research and clinical interest in the field?
>> Yes, indeed.
It began long time ago, as you say, back in the seventies.
I was a medical student who worked among
tribal people in Orissa in North Eastern India.
And it happened to be
a place where you have as much malaria as you have in Africa.
And that really changed my life.
So I decided when I graduated from University
of Copenhagen, I would go and save the world.
And in that case, it should be in Congo, former Belgian Congo.
So I took some courses in Danish hospitals,
learned how to give birth to a child, or to assist in it.
And then, went to a tropical course in
Liverpool where I got the taste of tropical medicine
and got the standard textbooks of tropical medecine.
Evidently, it was a lot of colonial medicine that we were talking about,
the roots of tropical medicine. It was not to save the world, or the
poor people in Africa, but to save the life of
the colonialist.
But eventually it has developed more into a public health like situation.
Then we lived happily for maybe another 20 years with tropical medicine.
I actually became a specialist in tropical medicine in Denmark
and thought that when the world was
getting more and more international with more and
more travel, it would be obvious that you should have a need for a tropical
specialist, even in a temperate climate like Denmark.
However, our national board of health decided, then,
there was no need for such a thing.
But there would be a need for infectious diseases and it's true
that infectious diseases has a lot to do with tropical medicine.
Then there was a movement perhaps prompted by the father of World Health -
- Halfdan Mahler, that we should
think more across borders, more international.
We should have more equity in health.
And slowly tropical medicine was changed into tropical medicine
and international health, and then international health eventually.
So I was first a specialist in tropical medicine, with focus
on malaria, later HIV, tuberculosis.
And then I became a specialist
in infectious diseases, which is still infection.
But then when I got my professorship
in international health at this university in 98,
it was not as a professor in tropical medicine,
but as a professor in international health,
meaning that I
should know about maternal and child health, nutrition,
water, sanitation, a lot of public health.
That was really a change
for a clinician
and a person who had worked in
research laboratories with malaria parasites, lymphocytes, drugs
all of a sudden, to start thinking of
population. But I was, heartily welcomed at the
Institute of Public Health. And built up this unit of,
Infectious...
…not infectious, sorry...
[INAUDIBLE]
What the heart is full of...
international health and eventually I got a lot of other people on board, and
the research changed more and more into collaboration with developing countries.
among others with thanks to our Development Agency Danida, who has been
focusing a lot on The search capacity building in developing countries.
>> You've been a leader in the development of educational programs and
educational activities in, in the field of interest.
How have you seen the educational activities develop over the past decades?
>> So we started, with small causes in tropical medecine of 3 month's duration
with the assistance of London and Liverpool school of tropical medicine
[INAUDIBLE]
.
And there was also the basis of our education in international health
which was a post graduate masters of one years duration, primarily
people from Africa who had to learn more than about diseases,
also, how do I take responsibility for a district in Tanzania or wherever?
That's been running
for almost 15 years now.
But eventually the world has changed again.
We got the AIDS epidemic.
Some people claim that HIV has pushed globalization of thinking globally.
And I'm not sure that's the only reason, but anyway.
Globalization is over us, and for the last 10, 15 years, we have been
talking increasingly of global and not so much of international health.
International health has been more on low
and middle income countries, which I personally like.
But global health is also on what is the impact of
those countries and their health problems, or rich countries and vice versa.
What is Western lifestyle making
to developing countries, urbanization?
In the new Masters we have got, which is a pre graduate masters are two years,
it's much more on non medical issues. It's about, living conditions,
life, noncommunicable diseases, environmental health and so on.
And that very well reflects what is
global health compared to international health and tropical medicine?
>> So as you point out there are
many different fields of importance for global health.
It's very interdisciplinary.
Maybe you could provide examples of
how different disciplines contributes to global health?
>>There is an old model
[COUGH]
dating from 1985
Harrison's Diamond Model, where you
have illness or health in the middle, and what are the determinants?
It's about who you are, what are your genes, what is your environment.
What are your socio-economic conditions? What are your
health systems?
Do you have access and is it affordable et cetera?
And how can you talk about such strong determinants for your health without
talking about sociology that's socio-economic conditions,
economics. That's the same again.
Access to health It's about equity, it's about law, it's about human rights.
Anthropology is the whole concept body in this, and what is disease?
You name it.
Agriculture. Even some people talk about one health.
That's the impact of zoonosis or animal diseases on man and vice versa.
So you can't have a world where you are still talking about medicine,
and single organ diseases.
That's exactly the opposite of global health.
>> From your experience and background, what do you see
as the most important global health challenges we face today
and maybe some perspective on the future
challenges that we'll face in global health?
>> Well, in the good old days, which were not so good,
you died when you were young from children's diseases.
And when you were surviving that, you died from
tuberculosis or lack of food, pure malnutrition, accidents, wars.
But with the change of the world,
with the globalization, we have a new burden of disease.
And after infectious diseases of childhood and young people,
it's, the world is changing just like a life cycle.
So the world is growing older, and what is
a young world in many developing countries or emerging economies nowadays?
They have a lot of building. They have a lot of roads.
They have a lot of accidents. They have a lot of strife's and so on.
So accidents is the next wave. And then when you grow even older, you get
elder diseases. But the thing is
[COUGH],
that in many of the fastest developing countries, you have all three at a time.
You have a double burdens. Some people even say a triple burden.
The biggest challenge is to avoid thinking and managing
one-eyed into either one, because they are impacting each other.
There are now some indications that if you are malnourished,
anemic in pregnancy due to malaria and whatever.
This is still the situation in rural areas of Africa.
You were born low birth weight
[COUGH].
Then if you migrate to the city and you having a sedentary job, white collar job.
Everybody wants to become something typing on a
computer rather than going in the rice fields.
Then you can't tolerate it.
You can't tolerate sendentary life. You can't tolerate wasted lifestyle.
And food
[COUGH],
beecause you're programmed to survive, the survival of the.
Fittest.
And that means that if you are migrating and changing your
lifestyle in one generation, you will get the double burden of disease.
That means that you'll get your non-communicable diseases 10, 20 years
earlier And I don't think that's fair, for us to have been exposed to a hard life,
in the womb maybe.
And now if you are grown up, and just ready to sit down
and take it a little more easy and have a comfortable living,
you can't tolerate it. That's very unfair.
So, instead of starting to debate, should we go for non communicable diseases?
Should we go for infectious diseases?
Should we go for maternal and childhood, or whatever?
My point is,
we should do all of it integrated as much as we can.
And we should not skip doing more to malnouirished, poor, women, and children.
Its even more important than before because maybe they're permanently damaged
and get diabetes and hypertension because of their suffering in early lfie.
So please don't stop prioritizing maternal and child health, but do something to it.
What about the environment?
[COUGH]
How many people can we tolerate on this earth?
What about CO2 emissions?
What about flooding?
What about pollution, and so on? I think these are the major challenges.
If we want this world to survive and it's getting more and more globalized.
We will have to work together.
And that's what we are trying to do. It's not so easy, even in a
faculty, in a university.
[COUGH]
You could fight from morning to evening about the
resources. Should you focus more on this or on that?
But if we don't working together then we will have a problem.
So I hope with my new education that we can take on board
Young people, who are devoted to do something to change the world,
even if they come from a non medical or perhaps
because they're coming from a non medical background most of them.
Sociology, anthropology, political sciences, nutrition,
and some from the health also.
So, globalization is working together.
[MUSIC]