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UTD HLTH 3310 Global Health Test 1
Terms in this set (48)
A condition where household income is below a necessary level to maintain living standards. In this type of poverty the household is unable to afford basic necessities like food or water. Examples of where these households are most prevalent is in sub-saharan africa and some south american countries where due to the economy it is hard for citizens to find jobs.
Physical: literal inability to travel to a clinic due either to lack of ability to commute (no car) or location (rural vs urban)
Information: lack of knowledge or attitudes about primary health measures or ideas (like basic hygiene or how to pay for healthcare)
Economic: ability to pay for necessary healthcare or treatments
Burden of disease
This is a measure to quantify the relative impact of different diseases and injuries in reducing the number of years of healthy life.
Takes into account:
-years of life lost(YLL), through premature death
-Years lived with disability(YLD), through life years with illness, injury, or disability
Ex. AIDS patients - up until recently had a large YLL + YLD
Ex. Cancer patients
Cultural and Linguistically Appropriate Services
Means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/consumers
Intended to be inclusive of all cultures and not limited to any particular population group
Designed to address the needs of racial, ethnic, and linguistic population groups that experience unequal access to health services
Aim: contribute to the elimination of racial and ethnic health disparities and to improve the health of all Americans
primarily directed at health care organizations
Makes cultural competence a legal requirement
Diseases transmitted from an animal to another animal, animal to human, human to human, or from human to animal.
May be caused by viruses, bacteria, parasites, or fungi.
Affect high-risk populations, such as children, pregnant women, the elderly, and the immunocompromised.
Examples: Malaria, influenza, west-nile virus, dengue.
Costs of illness
Cost of treatment and medication that can affect poor families as they bring them to poverty lines.
- Ill health is an important contributor to poverty and to economic vulnerability that is at the foundation of poverty.
There is typically a "cost" associated with treatment for an illness, disease, or injury.
Behaviors, attitudes, and policies that enable a system to work effectively in cross-cultural situations. Focuses on the capacity of a health system to improve outcomes by integrating culture into health service delivery. Should also be conscious of the dynamics between cultures, value diversity, and adapt services accordingly.
-Campinha-Bacote's model: breaks down cultural competence into an ongoing process of cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desires
7CC can aid in health outcomes by attempting to understand and adapt to cultural differences in health beliefs.
EX: If you are a healthcare worker in another country (or your own), you would want to be culturally competent and not just "know" about the beliefs and culture of that population but be willing to adapt your practices of health to the patients beliefs instead of your own.
Refers to the shared ideas, customs, and social behaviour of a particular group
An important component that impacts health via the social determinants of health
Health beliefs are influenced by one's culture
ex) Quran's prohibition of alcohol protect muslims from health risks but modesty of women's dresses hinder ability to partake in certain physical activities (165)
Cycle of poverty and health
The cycle of poverty and health explains how these two are linked. Poverty causes bad health due to poor nutrition, lack of clean water, and overcrowding. Likewise,bad health leads to poverty because it reduces a person's work productivity and it forces families to sell assets in order to afford treatment which leads to further poverty.
Determinants of health
behavioral, biological, socioeconomic and environmental factors that influence the health status of individuals or populations. For example, smoking is a determinant of health for lung cancer.
The unjust treatment of a group of people, for example those of a particular culture, ethnicity or religious group. Awareness of the existence and effects of such discrimination is important so as to act to prevent or limit this behavior. The following examples illustrate some of the challenges encountered in achieving equity in healthcare: Psychiatry, Life and Death, Sexual Behavior and Norms
Diseases vs. illness
Disease: the medical definition of sickness biological and physiological measures
-Clinical perspective-objective and universal
Illness: patients perspective on and experience of the disease
-Personal/lived concept- Subjective and impacted by culture
Essential medicines list (EML)
Essential medicines list is constructed by countries on the basis of criteria which include the national burden of disease as well as the efficacy and cost of the medicine. This process optimizes the use of limited resources and provides the most appropriate medical treatments. Every 2 years, WHO develops evidence-based EML as a reference for countries.
Example- Simvastatin was added to the World Health Organization EML in 2006 as there was an evident need for lipid lowering medication that treated patients with cardiovascular disease.
Belief in the superiority of one's own ethnic group; overriding concern with race. A tendency to view alien groups or cultures from the perspective of one's own.
An example of Ethnocentrism is Europeans came to America and conquered the Native Americans because they thought that their culture was superior to theirs.
Another example: Nazism
sensitive to cultural differences; open-minded; composed of acceptance, adaptation, and integration
Ex. culturally competent healthcare providers who utilize LAS for diverse patients
biases that are at the conscious level, are deliberately formed and are easy to self-report
Ex. KKK? (also example of ethnocentrism)
According to the World Bank, when individuals live on less than US value of $1.25/day.
Today roughly 1.2 billion people worldwide meet this definition
Four principles of ethics in healthcare (Principle of Biomedical Ethics)
The four principles of ethics in healthcare are autonomy, beneficence, non-maleficence, and justice.
Autonomy includes the right to informed consent and to the choices made for one's body. One example of a patient's autonomy is the right to choose and move between different birthing positions during delivery.
Beneficence is the concept that actions by healthcare providers must have the goal of improving the health of a patient.
Non-maleficence states that healthcare providers are not allowed to deliberately harm their patients, exemplified by "do no harm" in the Hippocratic Oath.
Lastly, justice in healthcare encompasses fighting discrimination and biases towards patients in order for patients to receive quality care no matter their background.
An area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide
"The health of the whole planet... beyond geographical and political boundaries"
Health problems, issues, and concerns that transcend national boundaries and may best be addressed by cooperative actions
All people, all of the world, all health-care issues
- Patterns are important
Promotes interdisciplinary collaboration and is a synthesis of population based prevention with individual-level clinical care
HOWEVER, one should not distinguish between global health and public health more broadly
Same key principles as public health:
- Focus on the public good
- Belief in a global perspective
- A scientific and interdisciplinary approach
- The need for multilevel approaches to interventions
- The need for comprehensive frameworks for health policies and financing
Global health partnerships
Global health partnerships: is a non-profit organization of medical professionals and other volunteers who work as partners with local community organizations and health care providers to improve the health and well-being of the poor and marginalized. public-private partnerships, service provider-patient interactions, thematic partnerships, country-level financing/aid partnerships, global or international partnerships, academia-industry partnerships, academic-community partnerships, and intersectoral partnerships. Example: The Roll Back Malaria Partnership (1998). This is the global framework for coordinated action against malaria
increased interconnectedness and interdependence of people and countries (WHO).
Globalization impacts on economic activity, technological change and social and cultural change- relevant to the provision of health
effects of globalization on health
- Enhanced mobility to health professionals and consumers
- Provision of health services across national borders- using new technology
- Increase in multinational companies who are providing private health services and insurance.
Health has two main definitions, the biomedical definition of health and the WHO definition of health. The biomedical definition states that health is the absence of disease. However, the WHO definition defines health as complete physical, emotional, and social health, not merely the absence of disease. For example, someone could not be experiencing illness from a pathogen but might experience social stigma and discrimination, affecting their health. The health of a population is affected by both physical and social environmental factors.
Health status indicators
Determined by variety of factors, including age, culture, income, education, knowledge of healthy behavior, social status, sex, genetic makeup and access to health services.
The economic and social conditions under which people live and government policies also have an important influence on people's health.
Key Health status indicators: Infant mortality rate, life expectancy at birth, maternal mortality ratio, neonatal mortality rate, under-5 mortality rate (child mortality rate)
Basically, health status is how healthy a person or group is and the way that is determined is by the health status indicators, such as life expectancy at birth.
Measure different aspects of health within a community or group
There are two main types of indicators: health determinants and health status
- Health status indicators measure different aspects of the health of a population. Examples include life expectancy, infant mortality, disability or chronic disease rates.
- Health determinant indicators measure things that influence health. Examples include diet, smoking, water quality, income and access to health services. First Nations also consider language, culture and spirituality to be health determinants.
Health as a human right
Everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services, sanitation, adequate food, decent housing, healthy working conditions, and a clean environment.
Health behavior is the way that individuals act in order to maintain or promote their health and wellbeing (lecture)
Individual health behaviors and characteristics are one of the determinants of health → contributes to the overall health of the individual (textbook)
Can be influenced by things such as culture, and socioeconomic factors (textbooks)
Examples: cultures in which certain diets are more and/or less prevalent; individuals with poorer socioeconomic status not having enough to maintain a healthy behaviors.
Unequal and/or inadequate distribution of resources and services can lead to differences in health status among different groups of people
Result in social disadvantage
Frequently observed between gender groups, dominant ethnic groups & ethnic minorities, & socioeconomic statuses
For example, rural areas tend to have fewer clinics and medical staff. Getting healthcare on time and in an emergency can be a problem.
Aiming to provide individuals and communities with the information they need to make decisions that affect their health and to help them live healthy lives
Health promotion programs encourage or modify behaviours, values, and attitudes
- Help protect and enhance health
- Core components of most health care professional roles
- Supporting environmental features involved in
1. Health promotion
2. Policies-set of guidelines
3. Regulations-ability to implement
4. Organization- coordinating resources to help implement
5. Financial- incentives
6. Social- people
7. Political-legislative support for regulations
Health professionals need to be able to communicate properly. Need to educate the patient and the community
- Diverse skills: understanding, communicate complex information, challenge inaccurate beliefs in a non confrontational manner
WHO, "the sum total of all the organizations, institutions and resources whose primary purpose is to improve health"
- improved health
- Responsiveness-how health care system responds in reasonable expectations of the population
- social and financial risk protection-mail goal to prevent causing poverty
- improved efficiency- involves facilitation of the progress towards health system goals within the given resources
Building blocks of healthcare system
- Service delivery
- Health workforce
- Medical products
- Health system financing
Leadership and governance
"the basic freedoms and protections that people are entitled to simply because they are human beings." (textbook) It is an acknowledgment of the fact that every person has a right to the essential things that are needed for an adequate standard of living.
Instances throughout history in which the rights of individuals were violated → the Nazi Medical Experiments; the Tuskegee Medical Experiments
Laws and frameworks created over the years to ensure the protection of the rights of individuals → the US Constitution and Bill of Rights; the Universal Declaration of Human Rights by the UN.
Human rights can include civil and political rights, economic, social, and cultural rights, and group or people's rights.
"How patients think, react, & cope when they suffer from illness"
How patients think about/perceive illness
How & when they seek help for health problems
Interaction w/ & utilization if health care systems & health care providers
Type of treatment
Being unaware of your actions, stereotypes towards a certain social group
Ex: instinctively holding your purse closer to you when walking past a group of homeless people on the street
Ex: when someone is really bubbly and generous you implicitly (unknowingly) reflect the same behavior even if you may not have displayed it prior to the encounter
Language access services (LAS)
Translators (does it in writing) and interpreters (does it in real time)
Ex. If there are pamphlets in Spanish
A disease associated with the way an individual or group of people live.
Can be prevented through regular physical activities; obesity, heart disease, etc.
Ex: lung cancer as a result of the lifestyle choice of smoking
One of the greatest threats to a child's health
A lack of proper nutrition, caused by not receiving enough to eat, or not enough of the essentials.
Ex; some cultures only have access to a specific food in which it may lack enough proteins, fats, and more
- Also, not having access to clean water can cause malnutrition.
Millennium development goals
Eight Millennium Development Goals by UN in 2000 committed to nations for the subsequent 15 years with strong focus on health issues
The 8 Goals: eradicate hunger and poverty, universal primary education, promote gender equality and empower women, reduce child mortality, improve maternal health, combat HIV/AIDS malaria & other diseases, ensure environmental sustainability, develop a global partnership for development
- Development of MDGs → first time health was linked with global security
- Importance on discussion about global health & poverty at political reforms
- Increased financial resources from governments and philanthropists (Ex: Bill & Melinda Gates Foundation)
Multiplier effect (of education)
Girls who are educated tend to marry later & have fewer children
Paid better in the workplace
More able to engage in political, social, & economic decision-making processes
Children more likely to survive, better nourished & educated
Small local charities or large international organizations
Typically function in LICs with unmet health needs, following natural disasters, and war zones
Normally provided free or highly subsidized health care
Ex: Marie Stopes International → delivers sexual & reproductive interventions; Medicins San Frontieres
Fill gaps in services
Common problems: "one-size fits all approach" ; top down - outsider approach
Nondiscriminatory health care
Access to health care services without discrimination based on race, gender, disabilities, age, ethnicity, LGBT individuals, mental health, etc.
Essential factor in determining health of individuals and provision of effective care
ex) india's transgender population- stigma and discrimination against this population has comprise their rights and alienated them from society.--> not treated correctly especially in sexual health.
A method to create a cohesive environment with the effective promotion of cultural competence within an organization that requires attention to the entire system, including:
- Organized strategy
- Diversity and cultural competence training for leadership team
- Management practices that focus on workforce (it should be diverse) and politics
- Culture of inclusion (diverse workforces)
- "Norm" of culturally and linguistically appropriate care
Involving individuals, leadership, government, teams, culture of the organization infrastructure, and politics
Example of organizational behavior: a team will agree to cohesively work together to tackle a problem and succeed.
Add/stir approach: not enough African Americans working, so lets hire some more to even it out.
Health of the population of a community, country, globally
Importance of social and environmental factors of health
Development of epidemiological tools to evaluate factors
Understanding of different factors to help make better informed decisions and regulation to improve public health
Access to health promotion & services (appropriate & cost effective)
Example: Clinics, universities, and schools post information on which flu virus is floating around this year to inform individuals/make them aware so they can take precautionary measure.
Public sector funding
Health care provision delivered by the state → responsibility of government to provide care
Aims to provide maximum benefit to most people, including vulnerable groups (ex: children & elderly)
Common issues of inefficiency and being slow to respond to needs & demands of changing populations
Health care provided through taxation or public insurance → taxation systems more efficient
Ex: Sweden, France → public makes regular contributions to government insurance fund exclusively allocated for health care provision
Ex: Cuba → entirely publicly funded health system → all health services delivered by state
Inequitable distribution of resources within a society → how basic resources are distributed within society
Can lead to certain areas within communities, countries, or globally becoming more prone to health disparities than others → poverty measured with reference to others in the same nation or society
Ex: fuel poverty → when a household spends a tenth of its income on energy
- Can be caused by high fuel costs, low incomes, and poorly insulated homes
Linked to poor health outcome
diminishing the net inequity in the world, looking beyond the patient to the health system, communities, societies, and the environment they live in and reflecting on how these affect health, sharing this learning and reacting against our learned helplessness (book)
the view that everyone deserves equal rights and opportunities —this includes the right to good health
Inequities in health, which are due to unfair policies and practices, lead to unequal distributions of money and power based on race, gender, or social class.
The sick role
Sick person is exempt from normal performance of their obligations
Social expectations regarding how society should view sick people and how sick people should behave.
Ex: when a person is sick and they take off work to try to get better, society doesn't shame them and it's socially acceptable/expected.
The three cultures present in any health care setting
The culture of the patient → their beliefs, values, languages, practices, expectations
- Language (ex. Bilingual patient)
- Values (ex. Proactive vs reactive health approach)
- Beliefs (ex. Female patient would rather have female physician and nurse due to religious background)
- Expectations (ex. Pt expects provider to hand them a prescription for treatment)
The culture of the provider → personality traits, beliefs & values (pg 132 CDHI)
- Communication skills & style of interaction (ex. Provider that likes to take time with patient to go into detail about results and prognosis vs provider that wants to see patients quick as possible to see more patients)
- Personal biases (ex. For or against abortion)
- Knowledge & training (ex. MD vs DO vs PA vs NP <- all similar yet different training to become a health care provider that assesses, treats, and prescribes medications)
- Acceptable courses of action
The culture of the Medicine
- traditions , practices, & ways of knowing within a particular medical setting
Title VI of the Civil Rights Act of 1964
Prohibits discrimination based on race, color, or origin in any program or activity that "receives Federal financial assistance"
Requires the recipients of federal financial assistance to provide access to Limited English Proficiency (LEP) persons
Services cannot be denied in healthcare setting because of language barrier
Ex: providing interpreter services; providing information in the languages of the population in the area of service
Two-way connection between health and education
Education is one of the strongest social determinants of health it enables informed decision making which affects health directly and indirectly.
Higher education typically related to increased health, also seen with high socioeconomic status relating to increased health (and we know socioeconomic status encompasses not just income value but also education)
World Health Organization
First specialized agency of the UN → global scope of health care issues rather than national
Has been at the "forefront of many key global health initiatives"
- Ex: eradication of smallpox; creation of the Framework Convention on Tobacco Control
WHO guidelines and statistics used to inform decision making for health related issues and problems across countries
"Drawing the world together to tackle health challenges"
Only health decision-making space with universal membership
Constantly redefining themselves to address issues of governance.
Member state-driven organization addressing global health issues.
- Three main bodies
1. World health assembly
2. WHO executive board
3. WHO secretariat
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