The process of understanding the symptoms of a patient, conducting physical and laboratory-based examinations, drawing differential diagnoses and then creating a management plan is a rigorous evidence-driven and streamlined scientific process that all doctors learn to master. This was true within the walls of the hospital where I trained to become a physician.

Beyond those walls existed a community that faced multiple challenges that were beyond the scope of pure science. Few of those challenges originated from public health issues with things like water, sanitation or hygiene.

Many of the challenges at the time seemed to be more economic in nature, such as the high cost of health care, access to medicine and limited availability of quality health care providers in remote areas. This all forced me to expand my horizons and dissect health economics issues in order to gain the relevant tools to fully understand these challenges.

A master’s degree in international affairs pushed me to question the relevance of my scientific acumen and to appreciate the subjective nature of world affairs. It made me shed my black-and-white way of thinking and encouraged me to appreciate the grey zones of global politics.

The global health policy course I took was particularly eye-opening. The discussions on the politicized nature of global health paved the way toward connecting the dots of health economics issues faced by communities within the context of the larger international system.

Learning that the World Health Organization (WHO) receives funding from bigger, richer states which have shaped its policy focus areas was both informative and a little disheartening. The role of pharmaceutical companies’ voices in shaping discussions on global access to medicines for the poor reminded me of the communities I had served as a medical student and physician.

The issue of inaccessible medicine, which was affecting many people suffering from acute and chronic illnesses around me, revealed itself to be driven by many intertwined. Most importantly, the intellectual property rights system was designed to incentivize pharmaceutical companies to take on the multi-billion-dollar task of searching for treatments to illnesses affecting humanity.

Close inspection revealed that the pharmaceutical companies did not make these new medicines accessible to the world’s poor. And “illnesses affecting humanity” is a normative goal. The illnesses which could offer the most profit became the guiding lights of drug discovery.

A huge movement surrounding HIV, tuberculosis and malaria brought significant resources to this area at the cost of inattention toward tropical diseases which were then rightly termed as “neglected”.

Making an investment case before pharmaceutical companies became a widely adopted practice and innovative tools such as compulsory licensing empowered states to request distribution of certain drugs during emergencies.

Global health principles and issues discussed during the course also made the case that WHO and pharmaceutical companies are but few players today in the diverse mix of actors shaping global health governance.

Nongovernmental organizations, physician associations, scientific researchers, civil society organizations, philanthropies and patient organizations are increasingly organizing themselves to challenge the dominant discussions in global health. One such organization, the Asia Pacific Leaders Malaria Alliance, is building the capacity of 22 governments in the Asia Pacific to reduce the burden of malaria and champion the goal of eliminating malaria by 2030. They partner with academic institutions, non-governmental organizations and governments to drive evidence-based policies that can get countries closer to achieving malaria-free status.

The discussion of a case in which a patient’s voice made a few pharmaceutical companies agree to make the information of their clinical trials public via the International Clinical Trials Registry was worth taking note of. Patients began to receive the opportunity to enroll in clinical trials which could potentially offer them treatment for their otherwise intractable illnesses and pain.

The role of other international organizations such as the World Trade Organization, World Wildlife Fund and United Nations Environment Program, which are primarily not health-focused, but which shape health outcomes, became evident. Particularly with the COVID-19 pandemic and climate change, the concepts of animal-human interaction and planetary health or “One Health” are shaping policies which affect the health of humankind.

Some hope was also instilled by the discussions on collaborations and partnerships between many relevant actors to tackle the health challenges of the poor countries. Product development partnerships are one such innovative model which bring together philanthropic funds, pharmaceutical companies, non-governmental organizations, governments and international organizations. Resources, knowledge, capacities, demands and regulations thus amalgamate to drive the objective of researching, developing and distributing drugs for the diseases which most affect the poor people of the world.

The Drugs for Neglected Diseases Initiative is one such organization that brings attention to the “neglected” diseases of the poor. This proved the importance of creativity and innovation in finding solutions and tackling roadblocks which are created by profit and intellectual property driven pharmaceutical companies.

Finally, the global health course has introduced me to stakeholders, governance processes, tools and ideas which shape the health of all people. It has emphasized the role of regulations, politics and institutions in leading the discussion on crucial global health issues.

It has taken me beyond the scientific practice of looking at health in a black and white sense and given me a broader framework that will help me navigate the milieu of interconnected factors which influence health outcomes.

I will continue to serve the communities in need of improved access to health care and this module serves as a foundational building block that will help me bring hope to the eyes of these communities.

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The writer is a trained physician and a post-graduate student at the Lee Kuan Yew School of Public Policy, National University of Singapore (NUS). The article was written in the elective module Global Health Policy & Issues, at NUS.