“It’s one thing to have medicines,” Balster says, “but
people have to take them properly.”
When working in other countries, the best approaches
aren’t always the most intuitive. Sometimes it makes
sense to adapt models from the United States to fit
the needs of a developing country or community.
In other instances it’s better to create a program
from scratch for a particular place and culture.
“Understanding cultural context and adaptation to the
local community are essential for interventions to be
effective,” Sikkema says.
As health workers implement behavior-change
programs, they must also ensure their strategies are
good for the long haul, Balster says. “Historically,
there’s been too much of Western nations coming
in, dumping a lot of money on a problem and
disappearing when the money runs out.” Fortunately,
that appears to be changing, he says.
Stout, who works with communities around the
world through the Center for Global Initiatives, has
also witnessed a growing emphasis on involving locals
to create sustainable programs. Drawing on local
experience just makes sense, he says. “Natural healers
in South Africa provide services that you and I would
see as pretty close to counseling,” he points out. “In
Cambodia and Vietnam, midwives become the de
facto medical responders.” When global health workers
collaborate with these local sources of knowledge, they
stand to reach more people and continue to benefit
communities well into the future, he says.
Nevertheless, the psychology angle still sometimes
gets short shrift among global health initiatives. That’s
gradually changing, Stout says, as researchers continue
to demonstrate the value of psychology to global health.
Black adds that, in her view, most global health agencies
and organizations are happy to include the psychological
perspective — especially when that perspective includes
a preventive point of view. “I think psychologists would
be much better positioned to have a global impact if
they took their theories, which are strong and effective
in promoting positive behavioral changes, and put
them in a public health perspective,” she adds. “Don’t
wait until the problem has occurred. Think about
prevention, or better yet, health promotion.”
Ultimately, Balster adds, psychologists are poised
to make an important contribution to global health.
“There are associations of psychology in most every
country of the world,” he notes. “Psychology has the
wherewithal to be an organized global presence.” n
Kirsten Weir is a writer in Minneapolis.
Global mental health
When it comes to the global health agenda, deadly
diseases such as malaria, HIV, heart disease and cancer
claim much of the attention. Public health organizations
focus much less on mental health — to the detriment of
Depression ranks third on the list of the world’s
top chronic diseases, according to the World Health
Organization, and rates continue to rise. Depression
will likely overtake heart disease and cancer to become
the single most common chronic disease by 2030. Yet
according to a 2004 survey by the WHO, between 76
percent and 85 percent of people with severe mental
disorders in low- and middle-income countries receive no
treatment (Journal of the American Medical Association,
2004). Even more disturbing: Worldwide, suicide claims at
least a million lives each year, according to WHO figures;
that toll is expected to climb to 1. 5 million by 2020.
Despite the grim statistics, Elizabeth Carll, PhD, chair
of the United Nations Non-Governmental Organizations
(NGO) Committee on Mental Health, sees signs of positive
change. The committee lobbies the 193 nations of the
U.N. General Assembly and international agencies to
include mental health in the global health agenda, and
their advocacy is paying off. In September, at a summit on
non-communicable diseases, the U.N. General Assembly
adopted a declaration that included mental health
problems as risk factors for non-communicable diseases.
The declaration was a milestone for two reasons,
Carll says. First, it finally recognizes that mental and
physical health are two sides of the same chronic-disease
coin — and that both should be addressed in disease-control efforts. Second, the declaration acknowledges
that primary care is the best way to deal with a global
epidemic of chronic illness, and that mental health care
should be integrated into primary care.
There are other indications that the global mental
health movement is gaining momentum. Last summer,
a consortium of mental health professionals published a
paper identifying the “grand challenges in global mental
health” (Nature, 2011). The group identified 25 goals for
identifying risk factors, improving treatment and access to
care, raising awareness and transforming health systems
to address mental health.
And in January, a group of experts called publicly
for a U.N. General Assembly special session on mental,
neurological and substance abuse disorders (PLoS
Medicine, 2012). Such disorders should be “a global
development priority,” the authors write.
There’s a long way to go, but these advancements offer
reason for hope. “We have to be vigilant to make sure
mental health continues to be recognized,” Carll says.