For the past few decades, there has been a rise in efforts by ophthalmologists to address blindness outside our own country. Several academic training programs have well-established fellowships in global ophthalmology. There is a certain sense that to be global is to be sexy. In the context of global medicine and global ophthalmology, saying we are “global” shows that we are seeking to address issues bigger than ourselves and that we work in exotic far-flung places. But more precision is needed because defining what “global” means determines what we set out to do. The definition influences the strategic direction.
For some years, there has been a search for a clear definition of “global” ophthalmology. Quite a few reasonable definitions exist and have been set forth by thought leaders in the broader field of global medicine. Rather than look at specific definitions, I find it helpful to identify the core elements that characterize a definition of “global” within the context of health care and ophthalmology. There are three of them: equity, universality and the need for a coherent multidisciplinary approach.
Global ophthalmology is guided first and foremost by the concept of equity. A glance at health statistics quickly reveals vast inequities. For example, one way to compare ophthalmic care worldwide is to look at the number of ophthalmologists per million people. The United States has about 60 ophthalmologists per million people. Nigeria, on the other hand, has three. We can also compare the status of disease. According to the World Health Organization, 18 million people are bilaterally blind from cataracts. That means that about one in 350 people on the planet is bilaterally blind from cataracts. The fact that in our practices we don’t see one bilaterally blind person with cataracts every 350 patients is an indication of inequity in the distribution of cataract blindness and of cataract surgery. Those of us involved in global ophthalmology seek to address these inequities and to even out the disparate statistics.
Second is the concept of universality — that everyone, regardless of where they live, deserves good vision and good eye care. In the United States, we hear about “universal” health coverage and we are indeed talking about health coverage for all people, but we are talking about “universal” within our own country. Universality in the global health context is talking about the whole wide world. Global ophthalmology seeks to address the vision health of all people everywhere. This element of the definition clearly affects strategy.
These two concepts, equity and universality, have their underpinnings in two principles: the oneness of humanity and justice. Throughout much of human history, when peoples encountered one another, they regarded each other as rather different. They placed emphasis on their differences rather than their similarities. Since the mid-1800s, the idea of the oneness of humanity has been gradually taking hold. Historical differences of race, culture, nation and sex have given way to a recognition of the fundamental oneness of all human beings. The rise in technologies that have brought people into closer contact with one another has affirmed our oneness. When a humanitarian crisis arises now, communication technologies make it easier to realize that, “Gee, they’re just like me!” And this realization is often quickly followed by the feeling that, “Man, this isn’t fair. It isn’t just.” These twin principles of the oneness of humanity and the desire for justice are, in the broadest sense, the drive behind global medicine. Global ophthalmology seeks to bring about equity in vision care for everyone in the world. The recognition of our oneness and the desire for justice send hundreds of ophthalmologists each year outside the comforts of their own practices to restore sight to those without access to eye care, to train those who can serve their own populations, and to lend their expertise or financial resources to strengthening health systems.
In the next installment, we will examine the third core element of the definition of global ophthalmology: the need for a coherent multidisciplinary approach.
Cataract. International Agency for the Prevention of Blindness. https://www.iapb.org/knowledge/what-is-avoidable-blindness/cataract/. Accessed April 25, 2018.
Number of ophthalmologists in practice and training worldwide. International Council of Ophthalmology, http://www.icoph.org/ophthalmologists-worldwide.html. Accessed April 25, 2018.