Barriers to global health development: An international quantitative survey.

Global health's goal of reducing low-and-middle-income country versus high-income country health disparities faces complex challenges. Although there have been discussions of barriers, there has not been a broad-based, quantitative survey of such barriers.432 global health professionals were invited via email to participate in an online survey, with 268 (62%) participating. The survey assessed participants' (A) demographic and global health background, (B) perceptions regarding 66 barriers' seriousness, (C) detailed ratings of barriers designated most serious, (D) potential solutions.Thirty-four (of 66) barriers were seen as moderately or more serious, highlighting the widespread, significant challenges global health development faces. Perceived barrier seriousness differed significantly across domains: Resource Limitations mean = 2.47 (0-4 Likert scale), Priority Selection mean = 2.20, Corruption, Lack of Competence mean = 1.87, Social and Cultural Barriers mean = 1.68. Some system-level predictors showed significant but relatively limited relations. For instance, for Global Health Domain, HIV and Mental Health had higher levels of perceived Social and Cultural Barriers than other GH Domains. Individual-level global health experience predictors had small but significant effects, with seriousness of (a) Corruption, Lack of Competence, and (b) Priority Selection barriers positively correlated with respondents' level of LMIC-oriented (e.g., weeks/year spent in LMIC) but Academic Global Health Achievement (e.g., number of global health publications) negatively correlated with overall barrier seriousness.That comparatively few system-level predictors (e.g., Organization Type) were significant suggests these barriers may be relatively fundamental at the system-level. Individual-level and system-level effects do have policy implications; e.g., Priority Selection barriers were among the most serious, yet effects on seriousness of how LMIC-oriented a professional was versus level of academic global health achievement ran in opposite directions, suggesting increased discussion of priorities between LMIC-based and other professionals may be useful. It is hoped the 22 suggested solutions will provide useful ideas for addressing global health barriers

Significant barrier domain x health domain interactions.

<p>Significant barrier domain x health domain interactions.</p

Proposed solutions for the five most frequently selected Top 4 barriers.

<p>Proposed solutions for the five most frequently selected Top 4 barriers.</p

Barrier rating questions.

<p>Barrier rating questions.</p

Mean and SD for barrier factor ratings with significant region effects.

<p>Mean and SD for barrier factor ratings with significant region effects.</p

Scree plot from exploratory factor analysis on barrier severity ratings.

<p>Scree plot from exploratory factor analysis on barrier severity ratings.</p

Seriousness ratings for individual barriers.

<p>Seriousness ratings for individual barriers.</p

Factor loadings for global health experience variables.

<p>Factor loadings for global health experience variables.</p

Barriers and factor loadings.

<p>Barriers and factor loadings.</p

Scree plot for exploratory factor analysis on global health experience variables.

<p>Scree plot for exploratory factor analysis on global health experience variables.</p