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[MUSIC].

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Today, I will talk to Professor

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Ib Bygbjerg from the

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University of Copenhagen.
And Ib Bygbjerg is

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also a senior consultant at the National
University Hospital here in Copenhagen.

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So, Ib Bygbjerg, you have been part of
this field long before it

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was titled global health.

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Maybe you could briefly introduce us to your
own background

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and your own research and clinical
interest in the field?

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>> Yes, indeed.

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It began long time ago, as you say, back
in the seventies.

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I was a medical student who worked among

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tribal people in Orissa in North Eastern
India.

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And it happened to be

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a place where you have as much malaria as
you have in Africa.

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And that really changed my life.

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So I decided when I graduated from
University

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of Copenhagen, I would go and save the
world.

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And in that case, it should be in Congo,
former Belgian Congo.

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So I took some courses in Danish
hospitals,

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learned how to give birth to a child, or
to assist in it.

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And then, went to a tropical course in

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Liverpool where I got the taste of
tropical medicine

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and got the standard textbooks of tropical
medecine.

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Evidently, it was a lot of colonial
medicine that we were talking about,

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the roots of tropical medicine.
It was not to save the world, or the

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poor people in Africa, but to save the
life of

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the colonialist.

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But eventually it has developed more into
a public health like situation.

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Then we lived happily for maybe another 20
years with tropical medicine.

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I actually became a specialist in tropical
medicine in Denmark

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and thought that when the world was

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getting more and more international with
more and

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more travel, it would be obvious that you
should have a need for a tropical

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specialist, even in a temperate climate
like Denmark.

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However, our national board of health
decided, then,

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there was no need for such a thing.

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But there would be a need for infectious
diseases and it's true

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that infectious diseases has a lot to
do with tropical medicine.

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Then there was a movement perhaps prompted
by the father of World Health -

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- Halfdan Mahler, that we should

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think more across borders, more
international.

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We should have more equity in health.

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And slowly tropical medicine was changed
into tropical medicine

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and international health, and
then international health eventually.

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So I was first a specialist in tropical
medicine, with focus

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on malaria, later HIV, tuberculosis.

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And then I became a specialist

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in infectious diseases, which is still
infection.

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But then when I got my professorship

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in international health at this university
in 98,

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it was not as a professor in tropical medicine,

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but as a professor in
international health,

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meaning that I

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should know about maternal and child
health, nutrition,

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water, sanitation, a lot of public
health.

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That was really a change

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for a clinician

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and a person who had worked in

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research laboratories with malaria
parasites, lymphocytes, drugs

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all of a sudden, to start thinking of

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population. But I was, heartily welcomed at
the 

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Institute of Public Health.
And built up this unit of,

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Infectious...

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…not infectious, sorry...

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[INAUDIBLE]

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What the heart is full of...

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international health and eventually I got
a lot of other people on board, and

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the research changed more and more into
collaboration with developing countries.

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among others with thanks to our Development
Agency Danida, who has been

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focusing a lot on The search capacity
building in developing countries.

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>> You've been a leader in the
development of educational programs and

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educational activities in, in the field of
interest.

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How have you seen the educational
activities develop over the past decades?

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>> So we started, with small causes in
tropical medecine of 3 month's duration

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with the assistance of London and
Liverpool school of tropical medicine

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[INAUDIBLE]

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.

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And there was also the basis of our
education in international health

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which was a post graduate masters of one
years duration, primarily

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people from Africa who had to learn more
than about diseases,

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also, how do I take responsibility for a
district in Tanzania or wherever?

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That's been running

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for almost 15 years now.

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But eventually the world has changed
again.

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We got the AIDS epidemic.

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Some people claim that HIV has pushed
globalization of thinking globally.

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And I'm not sure that's the only reason,
but anyway.

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Globalization is over us, and for the last
10, 15 years, we have been

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talking increasingly of global and not so
much of international health.

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International health has been more on low

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and middle income countries, which I
personally like.

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But global health is also on what is the
impact of

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those countries and their health problems,
or rich countries and vice versa.

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What is Western lifestyle making

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to developing countries, urbanization?


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In the new Masters we have got, which is a 
pre graduate masters are two years,

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it's much more on non medical issues.
It's about, living conditions,

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life, noncommunicable diseases,
environmental health and so on.

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And that very well reflects what is

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global health compared to international
health and tropical medicine?

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>> So as you point out there are

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many different fields of importance for
global health.

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It's very interdisciplinary.

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Maybe you could provide examples of

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how different disciplines contributes to
global health?

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>>There is an old model

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[COUGH]

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dating from 1985

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Harrison's Diamond Model, where you

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have illness or health in the middle, and
what are the determinants?

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It's about who you are, what are your
genes, what is your environment.

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What are your socio-economic conditions?
What are your

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health systems?

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Do you have access and is it affordable et
cetera?

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And how can you talk about such strong
determinants for your health without

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talking about sociology that's
socio-economic conditions,

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economics. That's the same again.

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Access to health It's about equity, it's
about law, it's about human rights.

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Anthropology is the whole concept body in
this, and what is disease?

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You name it.

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Agriculture. Even some people talk about
one health.

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That's the impact of zoonosis or animal
diseases on man and vice versa.

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So you can't have a world where you are
still talking about medicine, 

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and single organ diseases.

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That's exactly the opposite of global
health.

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>> From your experience and background,
what do you see

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as the most important global health
challenges we face today

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and maybe some perspective on the future

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challenges that we'll face in global
health?

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>> Well, in the good old days, which
were not so good,

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you died when you were young from
children's diseases.

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And when you were surviving that, you died
from

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tuberculosis or lack of food, pure
malnutrition, accidents, wars.

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But with the change of the world, 

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with the globalization, we have a new burden of
disease.

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And after infectious diseases of childhood
and young people,

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it's, the world is changing just like a
life cycle.

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So the world is growing older, and what is

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a young world in many developing
countries or emerging economies nowadays?

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They have a lot of building.
They have a lot of roads.

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They have a lot of accidents.
They have a lot of strife's and so on.

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So accidents is the next wave.
And then when you grow even older, you get

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elder diseases.
But the thing is

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[COUGH],

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that in many of the fastest developing
countries, you have all three at a time.

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You have a double burdens.
Some people even say a triple burden.

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The biggest challenge is to avoid thinking
and managing

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one-eyed into either one,
because they are impacting each other.

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There are now some indications that if you
are malnourished,

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anemic in pregnancy due to malaria and
whatever.

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This is still the situation in rural areas
of Africa.

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You were born low birth weight

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[COUGH].

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Then if you migrate to the city and you
having a sedentary job, white collar job.

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Everybody wants to become something typing
on a

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computer rather than going in the rice
fields.

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Then you can't tolerate it.

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You can't tolerate sendentary life.
You can't tolerate wasted lifestyle.

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And food

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[COUGH],

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beecause you're programmed to survive, the
survival of the.

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Fittest.

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And that means that if you are migrating
and changing your

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lifestyle in one generation, you will get
the double burden of disease.

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That means that you'll get your
non-communicable diseases 10, 20 years

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earlier And I don't think that's fair, for
us to have been exposed to a hard life,

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in the womb maybe.

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And now if you are grown up, and just
ready to sit down

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and take it a little more easy and
have a comfortable living,

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you can't tolerate it.
That's very unfair.

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So, instead of starting to debate, should
we go for non communicable diseases?

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Should we go for infectious diseases?

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Should we go for maternal and childhood,
or whatever?

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My point is,

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we should do all of it integrated as much
as we can.

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And we should not skip doing more to
malnouirished, poor, women, and children.

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Its even more important than before
because maybe they're permanently damaged

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and get diabetes and hypertension because
of their suffering in early lfie.

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So please don't stop prioritizing maternal
and child health, but do something to it.

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What about the environment?

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[COUGH]

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How many people can we tolerate on this
earth?

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What about CO2 emissions?

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What about flooding?

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What about pollution, and so on?
I think these are the major challenges.

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If we want this world to survive and it's
getting more and more globalized.

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We will have to work together.

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And that's what we are trying to do.
It's not so easy, even in a

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faculty, in a university.

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[COUGH]

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You could fight from morning to evening
about the

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resources. Should you focus more on this or
on that?

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But if we don't working together then we
will have a problem.

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So I hope with my new education that we
can take on board

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Young people, who are devoted to do
something to change the world,

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even if they come from a non medical or
perhaps

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because they're coming from a non medical
background most of them.

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Sociology, anthropology, political
sciences, nutrition,

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and some from the health also.

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So, globalization is working together.

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[MUSIC]