Represents the income or wealth distribution of a nation's residents
Higher number = more inequality
Inequality more common in low income countries
What has spread from high-income countries to LMICs?
Smoking, alcohol use, obesity
How many global deaths are smoking and high-fat diets responsible for?
2/3 of all global deaths
How many cases of polio are asymptomatic?
How many cases of polio lead to irreversible paralysis?
1 in 200
How has polio decreased from 1988 to 2016?
~350,000 to 33
3 countries: Nigeria, Afghanistan, Pakistan
Global Polio Eradication Initiative (GPEI)
1988 World Health Assembly: established a public-private partnership for public health
How much money has been spent on polio eradication for last 25 years?
3 billion children have been immunized
Complexities and Challenges of eradication programs
Difficult to reach rural populations Competing priorities
Elderly Dependence Ratio
Elderly in Labor Force / Total Labor Force
Providing people with more or less benefits from a public program depending on their current income or wealth
How is the elderly population in US changing?
It is INCREASING
What is the compression of mortality and morbidity?
Diseases are starting LATER in life (rather than over prolonged period)
What is the "Perfect Storm" of Medicare?
1. High and Rising costs of care 2. Aging Population 3. Increasing Elderly Dependency Ratio
Medicare is not sustainable
How have Medicare, Medicaid, and Social Security changed spending over time?
Medicare: Increased (more people live longer) Medicaid: Possible Decrease (little nursing home care) SS: Increased (more people living longer)
1. Quality, Affordable HC for All Americans 2. Role of Public Programs 3. Improving Quality and Efficiency 4. Prevention of Chronic Disease and Improving Health 5. Health Care Workforce 6. Transparency and Program Integrity 7. Improving Access to Innovative Therapy 9. Revenue Provisions 10. Strengthening Quality Affordable Health Care for All Americans
What features of ACA were meant to avoid adverse selection?
Guaranteed issue— cannot exclude people with pre-existing conditions No rescission - cannot kick sick people off of their plans No annual or lifetime caps Can cover dependents up to 26 years old Effective clinical preventive services must be offered at no charge to patients
Out of Pocket spending allowed by ACA
Individual: $6,600 Family: $13,200
How much of premiums should be spent on healthcare?
Health insurance companies must spend 80-85% of premiums on health care (medical loss ratio)
Uncompensated Care Trends in 2015
Uncompensated care costs fell from 5.2% in FY13 to 2.9% in FY15
Average annual uncompensated care fell from $7.2 million to $3.8 million
Large Detroit hospital fell from $35.8 to $19.5 million
Medicaid Expansion under ACA
Mandated Expansion: Medicaid will cover everyone under 133% of FPL, including childless adults (12-20 million people)
Feds cover 100% of costs for newly eligible (2014-17), then 95% (2018-19), then 90% of costs after 2020
Reauthorized Children's Health Insurance Plan (CHIP) until 2019
Of 3,000 HPV, what % have basic risk information?
Only 7% of HPV chemicals have all six basic screening tests
Globally, rivers that serve X million (or billion) people are plagued by chemical, biological, and physical hazards?
How many Americans live in areas that > NAAQS?
127 million people in US live in counties that exceed national air quality standard
What % of global death/disease is due to environmental hazards?
¼ global disease burden due to modifiable environmental factors
1 billion lack safe water, 2.5 billion sanitation
How many premature deaths caused by pollution in 2015?
9 million (16% of deaths worldwide)
Infant Mortality disparity between Detroit and Michigan
Detroit Black babies - 14.5/1000 Michigan - 6.9/1000
Black babies also more likely to be born premature or low birth weight
Elderly population (over 65) change from now to 2030
Now - 14% 2030 - 20%
Which countries have negative population growth?
Ukraine (-0.8%/yr) Russia and Belarus (-0.6%/yr) Japan (21% population loss by 2030)
Medicare beneficiary estimate in 2030?
expected to rise by 50%
How much of federal budget does Medicare use?
15% ($670 billion/year)
Solutions to Medicare to solve unsustainability
Increase age of eligibility (same as SS) Increase premiums for high-income people Decrease benefits Means-test
6 Building Blocks of Health System
1. Service Delivery 2. Health Workplace 3. Information 4. Medical Products, vaccines, tech 5. Financing 6. Leadership/Governance
10 Essential PH Services
1. Monitor population health status 2. Diagnose and investigate 3. Inform and educate 4. Mobilize community partnerships 5. Develop policies and plans 6. Enforce laws and regulations 7. Link people to needed personal health services. 8. Assure competent public and personal health care workforce 9. Evaluate effectiveness, accessibility, and quality of health services 10. Conduct research