Spirituality is a universal human experience which acknowledges the existence of a spiritual being- a higher power that is believed by many to give life a meaning; bring forth hope for an after-life and offers peace of mind or general wellbeing of the soul. It refers to all efforts to discover purpose and destiny in relation to a sacred or significant being which may have a secular, religious, philosophical, humanist or personal facet. More so, spirituality and spiritual activities are rooted in values, beliefs, practices and philosophies that may impact peoples’ cognition, emotion, and behavior. Most people connect spiritually through religion and religious objects viewed as sacred or through a deep sense of awareness and consciousness. Others feel connected to spirituality through music, arts, values, moral principles or nature. It is believed that spirituality is related to- and in fact, plays a role in quality of life, wellbeing, health and wellness. However, the exact means by which spirituality relates to health unclear; except for the wide-held belief that the spirit, soul, mind and body are connected, and that the wellness of any one of them seems to affect the other significantly. It is believed that spirituality is beneficial for health and healing possibly because it teaches abstinence from unhealthy behaviors such as smoking and excessive drinking.

According to some research, there exists a link between beliefs and sense of well-being. More specifically, positive beliefs and energy as well as the comfort, and confidence conferred by spirituality through religious acts such as mindfulness meditation, yoga, rituals, prayer and religious activities promote healing, contribute to general well-being and may improve mental health. They may also prevent some health problems, promote a feeling of wellness and help one cope better with ill-health, stress or loss.

Mind-body medical research, a field that focuses on the complex relationship between social and spiritual elements and their influence on health and disease, involves investigating and promoting positive spiritual coping strategies used by patients to manage stress and disease. Despite the several published studies examining the connection between spirituality and health, outcomes have remained multifaceted and complicated with methodological controversy due to confounders including specific attitudes, behaviors, beliefs, emotions and practices unique to individuals.

Research suggests that individuals who participate in spiritual activities or acknowledge that spirituality is a source of strength and comfort are healthier and may possess greater healing capabilities. Additionally, some studies report positive associations between spirituality and life expectancy, decreased rates of stroke, cancer, cardiovascular disease, hypertension, drug abuse, suicide, and general mortality. To improve the benefits of spirituality to health, one must identify and spend time in the activities that foster a sense of inner peace, comfort, strength, love, and connection. Some of these activities may include selfless community service, volunteering, praying, meditating, singing devotional songs, reading religious books, watching inspirational videos, taking nature walks, having quiet times, thinking, yoga, playing sports, fellowshipping with people of the same faith, travelling and attending religious services. Noteworthy, it is important to share one’s beliefs with his/her physician, especially when being treated for a specific illness. This is because spiritual activities may influence feelings, understanding, decisions and adherence to instructions or medications in medical situations. Due to the complexity of spirituality-health relationship, an interdisciplinary perspective is required for further research and clinical care

Undoubtedly, commitment to the global prevention and control of HIV/AIDS pandemic continues to increase with great significance in recent years. However, the virus has remained persistent in spreading- almost to the point of ridiculing the much effort and work put into its control. According to a report by UNAIDS, an estimated 40 million people were living with HIV infection or disease by the end of 2005; a notable increase compared to the about 35 million people living with the virus in 2001. Additionally, about 5 million new HIV infections and 3 million AIDS deaths occurred in 2005- much more in both cases when compared to the previous years.

Despite these discouraging statistics about the rapid spread of HIV, some countries have achieved significant progress through successful projects and programs in reducing this spread and transmission. The much effort and corresponding progress of HIV prevention and control is demonstrated by the many success stories and programs in different countries and regions across the world:

• Thailand’s 100% condom program
• Uganda’s remarkable decrease in HIV prevalence
• Tanzania’s community-based management of sexually transmitted infections (STIs)
• Development and effective use of highly sensitive and specific HIV screening tests, which have nearly eliminated blood infection in the developed world and in some parts of the developing world
• Introduction of anti-retroviral drugs (ART) in the late 1980s which commenced a revolution in the management of HIV that can be compared to the advent of penicillin in the 1940s
• Administration of ART to mothers during labor and to newborns post-partum which reduces the risk of mother-to-child transmission (MTCT) by about 47%
• Use of combination ART, which is much more effective than mono-therapy
• Decrease in the cost of antiretroviral therapy in developing countries, prompting its expansion through the public sector

Good as the many success stories and achievements in HIV/AIDS prevention and control seem, a few woes, challenges or drawbacks are not lacking. Some of these obstacles include:

• Viral mutation: Mutations in HIV type 1 are a major impediment to the achievement of successful treatment and the development of vaccines. Although treatment has made long-term suppression of HIV a reality, drug resistance, drug toxicity, drug penetration and poor adherence to therapy are some of the most significant challenges that hinder cure and eradication of the virus.
• Lack of access to services: Irrespective of the progress in treatment of HIV, global efforts have not proved adequate to control the spread of the pandemic or to extend the lives of those infected. The desired level of success has not yet been achieved because many people who could benefit from available HIV control strategies and services; including treatment, lack access to them.
• Lack of Rigorous Evaluations: In addition to the above mentioned challenges, lack of reliable evidence to guide the improvement and selection of interventions for specific areas or populations has remained a barrier to effective HIV/AIDS control.
• Funding cuts: UNAIDS and the US-based Kaiser Family Foundation report that international AIDS funding was stagnant at $7.6 billion in 2009- the first year ever without an increase. More so, the funding for 2010 further declined, showing an actual drop from 2009 levels, the first significant decline in AIDS donor funding since the beginning of the pandemic.

It is important to continue studying and understanding the factors that place individuals and populations at risk of HIV as well to identify safe, acceptable, accessible and cost-effective interventions that can be implemented and evaluated for improvement. It is only through a continued commitment to HIV research, prevention, treatment and control that this generation can conquer the HIV pandemic, and declare it history.

A depressed economy is one which suffers a severe, continued, long-standing, recession in economic activities resulting from unforeseen rapid rise in the value of a unit of account. An economic depression is an uncommon and extreme form of recession categorized by duration, unusual rise in rates of unemployment, employees’ resistance to nominal wage cuts, long-lasting credit contracts such as mortgages, decrease in credit availability due to financial crisis and bank failures, price deflation, decreased output as consumers reduce and productions and investments decline, increased rate of bankruptcies including sovereign debt defaults, reductions in international trade and commerce, anxiety and volatile fluctuations in currency value. These reflect the fact that money, which is the root of the economy, essentially has a market like food or cars which has a specific value at any point in time depending on the existing economic conditions. From a purely economic standpoint, economic depression is defined by two factors; decline in real GDP exceeding 10%, or recession lasting 2 or more years.

Similar to medical depression, economic depression has broad and widespread social, economic and psychological effects. It leads to a dramatic reduction in employment, human potential and productivity as well as cripples a country’s output, efficiency and success. As a matter of fact, loss of employment, being one of the major concerns during an economic crisis, has a causal association with mental health problems such as depression. Depression then reduces the chances of re-employment and reintegration into an already stressed economy and ultimately leads to increased debts for the unemployed. Existing data from research show that financial hardship, typically resulting from a depressed economy, can also lead to increased mental health problems and anxiety, rent and mortgage debt, consumer debt and significant deterioration in quality of life and well-being. Following re-employment after economic depression, the labor force may experience reduction in independence, self-direction, locus of control and competence due to loss of skills during depression.

Although some individuals remain employed during an economic depression, they are not exempt from the consequences of the crisis. Constant anxiety due to job insecurity complicates existing depression and affects the productivity of the working force. There is also stress resulting from increased workload since independence and specified job duties are threatened by the contraction of the workforce. Consequently, the ambitions of individuals to pursue opportunities for employment are limited by less choices and more rigorous job requirements in the labor market. All these effects of a depressed economy ultimately affect nations and global health in general.

Humanitarian crisis can be explained as a remarkable and disastrous event or chain of events that threaten the health, safety and well-being of a group of people, community or the public at large. It is an emergency which prevents a population or large group of people from accessing basic needs such as food, water, healthcare, clothing and shelter. A crisis may result from an internal or external factor or differences, and typically occurs over a large area of land. These events often require local, national and international responses as the immediate community may be unprepared to handle such situations. There are different factors that cause or lead to humanitarian crises; consequently, response to each crisis should be targeted towards the particular sectors affected as well as meet the unique needs of the victims involved. Humanitarian crises may result from natural disasters, man-made catastrophes or a combination of complex emergencies, and may cause short, temporal, long-term or permanent damages. Some common examples of events categorized as humanitarian crisis include: armed conflicts, pollution, epidemics, flooding, pandemics, wildfires, famine and natural disasters including hurricanes and earthquakes.

The consequences of humanitarian crises are detrimental to health and leads to increased movement of people which may eventually result in refugee crisis if not addressed or handled properly. For these reasons, national and international agencies such as Ministries of Health, WHO and UNICEF need to assist in the rectification of these tragedies. Till date, the magnitude of the international humanitarian response has remained inadequate and unsatisfactory as up to 2 billion people in over 40 countries worldwide suffer several challenges- especially health-related, from crisis conditions. A recent study published in The Lancet titled “Health in Humanitarian Crisis” revealed that large-scale humanitarian crises are constantly ongoing in many African and Asian countries. Implicated countries include Syria, Afghanistan, Central African Republic, DR Congo, Iraq, Libya, Nigeria, Somalia, South Sudan, and Yemen. After assessing the evidence base for health interventions in humanitarian crises, the study found that there are significant variations in the quantity and quality of evidence available. This reflects the lack of emergency preparedness and limitation of health interventions accessible in times of emergencies and crises.

Noteworthy, many lessons have been learned from past failed responses and lack of recommendations to improve emergency preparedness (EP) and crisis response (CR). Therefore, it is important prioritize EP and CR as well as align humanitarian interventions with development programs, ensure the availability and accessibility of timely and robust health information and to make health interventions more efficient, effective, and sustainable during humanitarian crisis. According to WHO, focused and intensive preparation is fundamental to improved response systems. Identified priorities include health assessments, coordinated response strategies, joint action to tackle suffering and reduce deaths; early identification of response gaps and renovation of local systems that are essential for better health

Universal health coverage (UHC) is based on the fact that all humans have a right to health. It is a movement to make sure that everyone receives the health care and services that they need, at the time which they need it, in the appropriate way or quality and without suffering any financial hardship or going bankrupt while paying for them. To achieve this, it is important that the public sector, which is governments, fulfill their legal obligations to realize this human right to health. In view of UHC, it is therefore important to assess and evaluate the growing engagement and involvement of private parties in the health sector because of their reputation and mission to maximize and prioritize profits and gains. More so, private sectors are not under legal obligations to provide subsidized care or public goods; they may also not have sufficient funds and incentives to accommodate externalities that affect the availability, timeliness, accessibility and quality of health care services.

The engagement of the private sector in the delivery of healthcare includes a broad range of activities carried out by various non-governmental players. These players may include independent multi-national companies, nongovernmental organizations, and nonprofit entities. Undeniably, these private or non-state sectors, including international donors, non-governmental organizations, for-profit providers and traditional healers, play important roles in health care financing and delivery, especially in developing countries. In this way, private sectors have remained useful and their resources have been harnessed in furthering UHC and other public and global health goals through public private engagements or partnerships.  Though, this may present some challenges in terms of the ethics, efficiency, safety, effectiveness and cost of health services- given the fact that they’re set-up for profit.

These partnerships are complex and take a variety of forms. It is important for governments in developing countries to strengthen positive private partnerships and take advantage of them to achieve UHC since the lack of resources hinders them to solely deliver and finance healthcare unlike developed countries where the governments mostly fulfill this role. Consequently, the health systems of most developing countries are ‘mixed’- private sectors are integrated with public health systems, with market systems often playing the leading role. Unfortunately, in such systems and countries, insufficient government funding and poor regulation of the private sectors continue to undermine the equity and efficiency of the health system, healthcare and services in general.

In global health, there are many successful partnerships with the private sector that help save and improve lives- according to United States Agency for International Development (USAID). These partnerships facilitate additional funding, contribute unique expertise and help scale impact. USAID emphasizes collaboration, co-design, and co-financing with private sectors, as the drivers of capital markets, to achieve a faster, inclusive growth in global health.

Global self-esteem is defined as a general or overall sense of worthiness possessed by people as a nation. According to Maslow’s self-actualization theory, self-esteem in addition to the need for achievement, competence, independence, and respect, is fourth in the hierarchy of needs.  Self-esteem, being a fundamental human need and motive has been broadly investigated in social science research as well as in clinical, developmental and counseling psychology. Results from experiential studies recognize and emphasize the fact that self-esteem is one of the most significant concepts that explains and relates to several behavioral, health, economic and social outcomes of life and realities in a nation.

More specifically, some studies identify self-esteem as a significant determinant of health and emotional well-being, such that individuals with high self-esteem have greater emotional stability and are better at managing their emotions compared to others. Additionally, a 2006 New Zealand longitudinal research followed some adolescents and found that those with low self-esteem had poor physical and psychological health, poor economic prospect and increased chances of engaging in crime. Concurrently, high self-esteem has been associated with negative psychological and behavioral outcomes such as egoism, aggression, narcissism and violence.

The results of low and high self-esteem in individuals are reflected in the nation’s health and invariably, in global health. To avoid the dark side of self-esteem which is caused by low confidence and over-confidence or too high self-esteem, individuals and nations must strike a balance by possessing a healthy self-esteem. According to research in 2005 by David P. Schmitt and Juri Allik, self-esteem varies vastly in levels around the world.  These researchers used the Rosenberg Self Esteem Scale to analyze data of about 17,000 people in 53 different countries. The results showed that the top five countries with the highest levels self-esteem are Serbia, Chile, Israel, Peru and Estonia while the countries with the lowest levels of self-esteem are Japan, Hong Kong, Bangladesh, Czech Republic and Taiwan.

The understanding of self-esteem was similar across these countries and in general: self-esteem was higher in countries that regard men and women equally; levels of self-esteem were not linked to life expectancy, literacy or standard of living; individualist and collectivist countries had lower and higher levels of self-esteem respectively; higher self-esteem was directly proportional to lower levels of anxiety; men had higher self-esteem than women and self-esteem increases as age increases. Another study examined the impact of national differences in self-esteem on suicide rates using data from the International Sexuality Description Project (ISDP). Results showed that suicide is particularly common in nations with comparatively low levels of self‐esteem; this association was consistent across sex and age but independent of economic affluence, social status, individualism, well‐being, and neuroticism.

In the world today, science matters because science serves and saves lives. The impact of science and technology in healthcare and global health in general cannot be overemphasized. Science and technology, by expanding human understanding, is at the forefront of innovations and inventions in healthcare. It creates a foundation for improvements in global health, unravels ideas, fuels discoveries, informs policies and programs as well as promotes better, healthier lives for all people. Science drives and transforms global health through discoveries and technologies as described below:
• Science and technology generates treatments, cures, and vaccines to manage global health challenges
Since the last few decades, science has created new health technologies that have driven incredible progress in global health. The many investments in science and research have produced over 100 vaccines, drugs, diagnostics, and other lifesaving global health tools have been developed and introduced. Some life-saving inventions include polio vaccine that eradicated the virus and antiretroviral treatments that have histrionically extended the lives of people living with HIV/AIDS. Furthermore, the meningitis A vaccine has saved 378,000 lives and prevented 673,000 new infections since 2010 while the child-friendly malaria drugs have reduced childhood malaria deaths by 65 percent since 2000.
• Science sheds light on population needs and aids the design of relevant research tools
Scientific research promotes progress in global health by developing tools that create positive health impacts for the populations and settings in which they’re applied. Research ensures that health care services are provided in a culturally sensitive way and that medications are available, affordable and user-friendly. Through research components and instruments such as surveys, surveillance, data analysis and reviews, science aids the comprehension of population dynamics and complexity as well as proffers reliable and effective solutions.
• Science and technology supports emergency preparedness through the understanding, prediction and tracking of potential health risks
The early detection of an outbreak is important for effective response and the prevention of epidemics or pandemics. Science and technology is employed in the surveillance of infectious diseases through the use of weather patterns to project the possibility of insect-borne disease outbreaks and the use of genomics or evolutionary theory to predict anti-microbial resistance. Biotechnology, molecular biology and genetic engineering are also scientific advancements employed in the diagnosis of many infections, disease control and development of antibiotics.
• Technology provides information and data at our fingertips
The revolution of mobile technology and digital health has transformed the access and use of health information as well as how global diseases and health challenges are combated. Patients and health service providers now use mobile devices to access health information and track immunization coverage or monitor health services and supplies respectively. Doctors, nurses and other healthcare workers use short message service (SMS) to remind patients of their appointments and to adhere to their treatment regime. Finally, the government, through the ministry of health, can now deploy new data visualization tools in order condense data into accessible, comprehensible and easy-to-use information guide… thanks to science and technology.

Ethnic cleansing is defined as the organized, strategic and systematic elimination of other ethnic, tribal or racial groups from a region by a more powerful group, usually with the intention of creating ethnic homogeneity. Various kinds of forced migration are used to achieve this removal including deportation, population transfer, discrimination, inequity, deprivation, intimidation, genocide and genocidal rape. Ethnic cleansing is often accompanied by additional efforts to destroy and remove all physical, structural, religious and cultural traces of the cleansed group in the region. This attempt to create extinction is achieved through the demolition and destruction of houses, social centers, farms and infrastructure, as well as the desecration of monuments, cemeteries, spiritual symbols and religious houses.

Countries such as Sudan and Bosnia experience widespread ethnic cleansing, burning of villages, looming starvation, massive killings and gang rape. Ethnic cleansing was particularly observed in Sudan by the UN experts who took a 10-day trip to visit the country. Following the civil war in December 2013, over 50,000 people have been killed, approximately 2.3 million people have been internally displaced and about 6 million Sudanese are currently at risk of hunger. More so, up to 70 percent of schools in the country have been closed due to the current situation of the country.

Given the unethical and clearly inhumane nature of ethnic cleansing, several health impacts and consequences are predictable. In a study titled “Psychiatric consequences of ethnic cleansing: clinical assessments and trauma testimonies of newly resettled Bosnian refugees” by Weine et al, the authors interviewed Bosnian refugees referred from agencies managing refugee resettlement. The interviews were systematic, trauma-focused and clinical interviews which included standardized assessment scales. Their findings showed that the traumatic experiences of ethnic cleansing in these refugees were genocidal and correlated positively with age. In addition, post-traumatic stress disorder (PTSD) and depressive disorders were diagnosed in 65% and 35% of these refugees respectively. Conclusively, this study showed that ethnic cleansing resulted in high rates of PTSD, depression, as well as other forms of psychological morbidity, in the studied group. Another study on the “Long-term effects of ethnic cleansing in the former Polish-German borderland” showed that removing portions of the population forcefully wrecks social networks and discards specific skills and knowledge. Further, ethnically cleansed regions tend to remain different, with higher crime rates, lower civic engagement, and less efficient public services.

The most efficient and effective means to preserve global health is to prevent diseases or stop them before they spread across the world. World Health Organization (WHO), UNICEF, World Food Program and CDC’s activities protect populations from major global health diseases and pandemics. These international organizations, in collaboration with other organizations and individuals, prevent, detect, contain and control outbreaks at their source, saving lives and reducing healthcare costs. They also help different countries to build capacity to handle and respond accordingly to their respective health challenges. The major aim of global health security is to stop diseases where they start, as soon as possible.

Global health refers to the understanding of health systems and population health in a collaborative, international and global context. It is a multidisciplinary area of study, research and practice that focuses on prioritizing, improving and attaining health and equity for all people worldwide. This is done by highlighting and tackling health problems that transcend national borders or have a social, political and economic impact. Simply, global health is all about improving physical, social and mental health and wellbeing by influencing health determinants, reducing disparities and protecting against diseases, it can be measured by the prevalence of pandemics, emergency preparedness and life expectancy.

The major threat to global health is that diseases know no borders. In the interconnectedness of today’s world, a disease threat anywhere is a threat everywhere. This is because diseases- specifically communicable diseases, exploit any gap to spread and multiply especially given the ease, rate and speed of international travel. Other threats and challenges facing global health include:

1. New and recurring pandemics: These are global disease outbreaks such as HIV, influenza, Severe Acute Respiratory Syndrome (SARS), Ebola, Zika and other viral infections.
2. Human and natural disasters: Climate change, air pollution, water pollution, poor sanitation and hygiene, flooding, droughts and other environmental conditions expedite the spread of diseases.
3. Health inequity due to politics, social and economic disparities: Lack of access to basic health information and health care may result in unhealthy choices, STDs, high child mortality rates, and poor nutrition. These issues can be eliminated by healthy public policies, poverty alleviation and health education.
4. Chronic diseases: Heart disease, stroke, cancer, diabetes and other chronic disease remain a burden for global health as they account for 70 percent of all deaths worldwide.
5. Animal health and products: Animal health is naturally intertwined with humans- having connections to humans as pets or food sources. Hence it is easy to contact infections as many diseases originate from animals, which are often asymptomatic hosts.

In 2014, over 140,000 people died from armed conflicts. This figure only accounts for direct combat-related deaths. Consequently, the figures would be much higher (probably millions) if deaths from all forms of conflicts and wars were accounted for. The health implications of war extend beyond battlefields, into communities, usually with devastating results. Although men are more likely to be killed during wars, women and children often suffer lasting impacts and trauma. Rape and other forms of sexual violence are accompanied by wars, and are frequently used as weapons of war. Sexual violence results in deep psychological trauma, sexually transmitted diseases, unwanted pregnancies, and long-term physical damage.

The health effects of conflicts and wars seem pretty obvious and are well documented in research studies. In Nigeria, conflict groups have continued to clash, killing innocent citizens in various communities- the most recent incident being the unfortunate massacre in Plateau State in June, 2018. This creates fear, trauma and poor mental health across the country. In South Sudan, a country ruined by decades of conflict, girls are more likely to die in childbirth than they are to finish primary school. In Syria, rates of caesarean section – which increases many risks for both mother and baby – have risen as women refuse to have normal delivery in conflict-prone areas. During these conflicts, there have been occasions where premature babies die in incubators due to hospital power outage. Lack of power and the degradation of health services also imply disruptions in vaccinations programs, exposing susceptible individuals to previously rare diseases. For instance, the first case of polio in Syria for 15 years was confirmed in October 2013 following a decline in immunizations due to civil war. In Pakistan, health officials report insecurity as a major barrier to ending polio as 80% of new cases occurring in the war torn regions.

War and conflict are sure to result in tragedies including loss of lives, injuries, anxiety, mental distress, famine, mal-nutrition, damage to the environment, drainage of human and financial resources, fostering of a culture of violence, internal displacement and disease outbreaks. In the face of war, normally unthreatening and preventable diseases such as diarrhea and cholera become a big threat to health and life; chronic illnesses that can usually be managed and treated without pain aggravate to severe suffering; while pregnancy and childbirth become incredibly dangerous. As health systems fail during wars, maternal and newborn health indicators- which reflect a country’ overall health system performance- deteriorate significantly. This means increase in infant and maternal mortality rates. In general, peace begets good health. Conflict and war are overwhelming and may reduce people’s coping capacity, safety and access to food, medicines, medical supplies, safe and clean drinking water, sanitation, shelter and health services.

The mental health impacts of war are also challenging, traumas form near death experiences and loss of loved ones can have significant health impacts on survivors. Crowding in temporary shelters and poor hygienic situations increase the risk of waterborne disease outbreaks such as cholera, typhoid and dysentery. To reduce the negative health impacts of wars and minimize the risks of disease and death, priority must be given to ensuring that civilians can access their basic needs in the midst of war. Such needs include:

• Adequate and safe drinking water
• Hygiene and sanitation
• medical supplies and treatment
• Access to basic continuing health care for persons with special needs and vulnerable populations including pregnant women, children, the elderly, and chronically ill or disabled persons.