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Provide 2 reasons why global health is an important.
Better understanding of global health progress
Diseases not restricted by boundaries
The world is "shrinking", so everyone's health is a concern for all
Issues may be local, but solutions are made with global input
Give an example of how culture could positively or negatively affect one's health.
Positively: if it is socially acceptable to get screened/tested for a disease, you are more likely to do it
Negatively: if it is socially unacceptable to use contraceptives, you are less likely to think about/do something about reproductive health
What are the Millennium Development Goals, and how do they relate to health?
MDGs: created by the UN; 8 of them with 15 core targets (all health related)
All related to improving health worldwide - some directly (improve maternal health), some indirectly (achieve universal primary education)
primary--> give an example of a typical health service provided
provided by physician who is first point of contact with patient (general practitioner)
General wellness exams/routine vaccinations
secondary--> give an example of a typical health service provided
provided by specialist physicians and general hospital, usually located in towns and cities (NOMS Health Center; Grant Hospital)
Treatment for certain illnesses and conditions, medical care and surgeries primary level providers cannot do
ER; referrals from GP
tertiary--> give an example of a typical health service provided
provided by specialized hospitals generally located only in cities (OSU Wexner Med Center - University hospitals)
Specialized hospitals staffed with wide range of physicians and can address a diverse array of illnesses with high-level diagnostics, treatments and surgeries
Treatment of complicated cases
What are the Millennium Development Goals (name)
1 Eradicate Extreme Hunger and Poverty
2 achieve universal primary education
3 promote gender equality and empower women
4 reduce child mortality
5 improve maternal health
6 combat HIV/AIDS, malaria, and other diseases
7 ensure environmental sustainability
8 develop a global partnership for development
What are three of the most important steps that can be taken to improve the effectiveness and efficiency of weaker health systems in low- and middle-income countries?
Increased education
Improved organization
Better managed finances
Why would the burden of disease from household air pollution in low- and middle-income countries be larger than that from ambient air pollution?
Lack of ventilation - cooking done indoors (indoor air very poor quality)
Name one of the most important micronutrient deficiency and one health problem it can cause.
Vitamin A - night blindness
Zinc -night blindness; diarrhea diseases
Iodine - goiter
Iron - anemia
three ethical principles stated in the Belmont Report
Respect for Persons, Beneficence, Justice.
Respect for Persons
treat individuals as autonomous persons; protect individuals with diminished autonomy; individuals should be able to make an informed decision
Beneficence
maximize possible benefits and minimize possible harms; risk/benefit assessment
Justice.
fairness in distribution; must be fair procedures and outcomes in the selection of participants
WHO definition of Health
"Health is a state of complete physical mental and social well-being and not merely the absence of disease or infirmity"
Definition of Public Health
"the science and the are of preventing disease, prolonging life, and promoting physical health and mental health and efficiency through organized community efforts toward a sanitary environment; the control of community infections; the education of the individual in principle of personal hygiene; the organization of medical and nursing service for the early diagnosis and treatment of diseases; and the development of the social machinery to ensure to every individual in the community a standard of living adequate for the maintenance of health"
Differences between PH and Medicine Approaches
PH→ vaccinate entire community
Medicine→ immunize 1 individual for particular disease
Definition of Global Health
health problems, issues, and concerns that transcend national boundaries and may best be addressed by cooperative actions"
Examples of Important global health concerns
women dying of pregnancy-related issues
malnutrition among children → South Asia & Africa
infectious and noncommunicable diseases
impact of environment
countries organize and manage health systems
search for new technologies improve problems
different actors who work together to solve health problems
The Determinants of Health(6)
1 Persona & inborn features of individuals
2 Social & Cultural issues
3 Environment
4 Education
5 Personal Health practice and Behaviors
6 Access to Healthcare
Key Health Indicators (5)
1 Life expectancy at birth
2 Infant Mortality rate
3 Neonatal mortality rate
4 Child mortality rate (under-5 mortality rate)
5 Maternal mortality ratio
Morbidity
sickness or any departure, subjective or objective, from a psychological or physiological state of well-being
death rate
number of death per 1000 population in a given year
disability
cause to people of temporary or long-term reduction in a person's capacity to function
Prevalence
number of people suffering from a certain health condition over a specific time period
measures the chances of having a disease
point prevalence
the proportion of the population that is diseased at a single point in time
incidence rate
rate at which new cases of a disease occur in a population
chance of getting the disease
the number of persons contracting a disease per 1000 population at risk for a given period of time
usually specified as the number of people getting the disease over a year, per 100,000 people at risk
Vital Registration
record births, deaths, and causes of death
An accurate system is key to having quality data on a population
Due to lack of proper vital registration systems
not completely accurate with low income countries
with improved systems will be able to more accurately determine numbers
Measuring the Burden of Disease
Health-Adjusted Life Expectancy (HALE)-
Disability-Adjusted Life Year (DALY)-
Disability-Adjusted Life Year (DALY)-
a unit for measuring the amount of health lost because of a particular disease or injury
"Health gap measure,"
indicating losses due to illness, disability and premature death in a population
Gives a better estimate of the health of a population than death rate
Accounts for health conditions like mental illness that rarely cause death
**compared to measuring deaths→ DALY take account of periods in which people are living in ill health or with disability
Health-Adjusted Life Expectancy (HALE)-
summarizes expected number of years to be lived in what might be termed the equivalent of good health
People with lower socioeconomic status will have higher rates
of communicable diseases,
illness
death related to maternal causes
malnutrition
smoking
alcohol
diet
Risk Factors
an aspect or personal behavior or life- style, an environmental exposure, or an inborn or inherited characteristic, that, on the basis of epidemiological evidence, is known to be associated with health-related conditions considered important to prevent•
Most important risk factors in low- and middle- income countries are:
malnutrition,
high blood pressure and high cholesterol
smoking
unsafe sex
Most important risk factors in high income countries are:
high blood pressure
high cholesterol
overweight and obesity
Population Growth
Majority of population growth will occur in low- and middle-income countries•
Put pressure on the environment
Create need for more infrastructure and services
Aging
Population of the world is aging
Implications for burden of disease because people will be living longer with morbidities and disabilities
Health Care financing will be affected by change in ratio of working people to those over 65 years
Elderly support ratio→ share of the population that is working at the car of the population that is 65 years of age or more
Urbanization
Majority of the world's population lives in urban areas for the first time
Enormous pressure on urban infrastructure like water and sanitation
The Demographic Divide
Highest income countries: low fertility, declining populations, aging populations
Lowest income countries: relatively high fertility, growing populations
The Demographic Transition
Definition→ Shift from pattern of high fertility and high mortality to low fertility and low mortality
Mortality declines due to better hygiene and nutrition
Population grows with younger share of population increasing
Fertility declines
Population growth slows and older share of population increases
Demography and Health The Epidemiologic Transition
Shift from burden of disease dominated by communicable disease to burden of disease dominated by non communicable disease
Most low-income countries are in ongoing transition so they face large burdens of communicable and noncommunicable disease
Progress in Health Status
Improvements in raising life expectancy and improving health not uniform across countries
Life expectancy in South Asia and sub- Saharan Africa lag that in other regions
Life expectancy in Europe and Central Asia changed little due to break-up of Soviet Union
Life expectancy in East Asia has increased dramatically due to rapid economic growth
The Development Challenge of Improving Health
Health usually increases as national income increases
Some countries have achieved higher life expectancies than their incomes would predict
This is possible with investments in nutrition, education, good hygiene, and low-cost services that have a high impact such as vaccination programs
The Importance of Ethical and Human Rights Issues in Global Health
Failure to respect human rights is often associated with harm to human health
Health research with human subjects puts people at risk for the sake of other people's health
Health investments must be made in fair ways since resources are limited
The Rights-Based Approach
Assess health policies, programs, and practices in terms of impact on human rights
Analyze and address the health impacts resulting from violations of human rights when considering ways to improve population health
Prioritize the fulfillment of human rights
Limits to Human Rights
Circumstances in which someone's rights may be temporarily suspended
Suspension of rights should be as narrow as possible
Suspension should be carried out with due process and monitored
Nazi Medical Experiments
Conducted experiments on euthanasia victims, prisoners of war, occupants of concentration camps
International Scientific Commission investigated and documented abuses after war
Questions over whether it is ethical to use data the Nazis generated
The Tuskegee Study
US Public Health Service conducted a study on the natural history of syphilis in African American men
Study went on for 40 years
Subjects were never given treatment
Eventually led to regulations for the protection of human research subjects
The "Short-Course" AZT Trials
Trials of a "short-course" AZT regimen to prevent mother-to-child transmission of HIV
Some people thought that poor people were being exploited since the trials were taking place in low-income countries
Studies remain controversial
The Nuremberg Code
First document to specify ethical principles that should guide physicians engaged in human research
"Voluntary consent of the human subject is absolutely essential
The Declaration of Helsinki
Developed ethical principles to guide physicians conducting biomedical research on humans
Principles apply equally to nonphysicians
The Belmont Report
US National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research
Identified basic ethical principles
Developed guidelines for research
Clinical research protocol must satisfy six conditions:
Social value
Scientific validity
Fair subject selection
Acceptable risk/benefit ratio
Informed consent
Respect for enrolled subjects
Research in Low- and Middle-Income Countries
Important issues when the subjects are likely to be poor, under-educated and without access to good care:
Standard of care
Post-trial benefits
Ancillary care
Research Oversight Today
Ethical review by a research ethics committee
Safeguard against exploitation
Regulations vary from country to country
Key Challenges for the Future for Research
Students of global health get insufficient exposure in their training to ethical issues
No mechanisms of enforcement of humans rights
Shortage of trained personnel for reviewing research
Lack of reviews of how investments are made
Unsolved ethical problems
Fair Processes for ethical research
Transparency about how decisions are made
Representation from stakeholders affected
Appropriate use of scientific data