Across the globe, all health is local

In public health, there is a growing understanding that “all health is global.” In an era of nonstop travel and trade between nations, diseases have no borders. Neither do the effects of phenomena like globalization, climate change, and economic recessions that ultimately have downstream effects on health outcomes across the world.

One thing I grew even more appreciative of during this PHAST Grenada experience, however, is the idea that all health is local. Like the common cliche about all politics being local, we can’t escape the importance of the local context in determining what sorts of public health interventions and policies are the most effective.

In our group’s case, we were working on what might, at first glance, sound like the opposite of a local intervention – writing the first draft of Grenada’s national alcohol policy. But throughout this week, I learned that it was important to remember a few key facts about Grenada: first, it’s small. The entire island’s population of roughly 109,000 could fit inside The Big House, with room
to spare. Geographically, traversing the entire island from north to south is a relatively quick jaunt.

As a result, a key characteristic of the nation is that it is strongly community-oriented. We learned that Grenada is the kind of place where not only does everyone know each other, they actually care about each other. Everywhere you go, people are waving at each other, stopping to say hi, or honking at each other in a friendly way. People look out for each other’s children. They care about public problems – including those relating to alcohol use and abuse.

The upshot of all this is that our national policy was, in a sense, a local policy. And in many ways, that was actually MORE exciting, not less. When we asked how likely it was that some of our more drastic recommendations – like raising the minimum age of purchase from 16 to 18, or instituting a legal age for alcohol consumption – would pass, government officials seemed to think that the level of community motivation and awareness of the issue was high enough across the
island to generate public consensus around such changes. Contrast that to the United States, where these days it seems like less and less of anything meaningful can be accomplished on the national stage.

It’s exciting that this project therefore gave us the ability to contribute to policy development on a national scale – because it behaves like policy on a local scale. Even more exciting, Grenada hopes that by proactively taking the reins of the alcohol issue, it can be a leader in alcohol policy across the Eastern Caribbean region. As a result, our work this week could cut across national borders in its influence.

Truly, all health is global. But in our work in public health, it’s worth remembering – all health is also local.

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