N309 Global Health Test #1
Terms in this set (70)
What is the difference between public health and clinical care?
1. Population focus
2. Greatest good for greatest number
3. Emphasis on preventing disease and promoting health of communities
4. Interventions target environment, behavioral lifestyles, and medical care
1. Individual focus
2. Needs of an individual are more important than the needs of a group
3. Emphasis on diagnosing and treating diseases
4. Interventions are medical
-____1____: A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
-____2____: The science and practice of protecting and improving the health of a community, as by preventative medicine, health education, control of communicable diseases, application of sanitary measures and monitoring of environmental hazards.
-____3____: Health problems, issues, and concerns that transcend national boundaries and may best be addressed by cooperative action
1. Health (WHO, 1948)
2. Public health
3. Global health.
What are different ways that people view health?
1. Clinical- the absence of disease, illness, or symptoms
2. Functional- the ability to perform as expected in social/work roles
3. Adaptive- ability to adapt to environment and stressors, maintaining stability
4. Eudaimonistic- ideal state of human nature. Exuberant well-being. Transcendence to higher levels of humanness. Ability to achieve highest potentials.
Why should we study global health?
1. Understand the progress made and remaining in global health problems
2. Many health problems require global solutions and internal cooperation
3. Diseases cross borders
4. Ethical responsibility to address health disparities
--Health Disparities: Health disparities refer to differences in the health status of different groups of people. Some groups of people have higher rates of certain diseases, and more deaths and suffering from them, compared to others
5. Health is basis of economic and social development
6. Health promotes global security and freedom
7. Learn how to improve US health
--US spends more but has poorer health
How many Millennium Development Goals (MDGs) are there and by what year should they be met? What are some of the types of problems covered in the MDGs?
8 MDGs (w/15 core targets) should be met by 2015:
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 & other diseases
7. Ensure environmental sustainability
8. Develop Global partnership for development
-MDGs 1, 4, 5, & 6 deal directly with health
What made smallpox eradication successful?
1. No animal or insect (vector) carried the virus
2. Smallpox is easily diagnosable
3. A vaccine was available that did not require refrigeration
4. The available technology included a bifurcated needle for easy application; small amount of vaccine needed
5. Lifetime immunity
What are the 5 most populous countries in the world?
__________ contribute directly (e.g., germs) or indirectly (e.g., poverty) to many health conditions, diseases, and disabilities
Determinants of health
examples of determinants of health
1. Individual characteristics (genetics, age, and sex)
2. Physical environment (social and economic environment)
--> water & mosquito breeding, poor sanitation, air pollution
3. Employment & working conditions
4. Access to health services (emergency care, primary care, public health)
--> public health (health education, safety net programs, vaccinations, & health monitoring)
5. Health behaviors
6. Healthy child development
7. Social & economic environment
8. Governance, policies, and interventions
What are key indicators of health or disease burden? How are they measured?
1. Life expectancy
--> cause specific, infant mortality, neonatal mortality, maternal mortality, under 5 mortality
--> prevalence rate, incidence rate
-Disease burden indicators:
1.Health-adjusted life expectancy (HALE)
2. Disability-adjusted life expectancy (DALY)
______ estimate of how much life expectancy quality is lost by mortality, morbidity, and disability
Disease Burden Indicators
How are indicators of health or disease burden measured?
1. vital health records systems
-->(birth & death records)
2. public health surveillance systems
--> (reportable diseases, health monitoring surveys)
4. health surveys
_____ is the average number of years a newborn baby could expect to live if current mortality trends persist for the rest of the newborn's life
Life Expectancy at Birth
How do we calculate Infant Mortality Rate?
(Number of infant deaths (0-364 days)/ Number of live births during the year) x 1000 = deaths per 1,000 live births in a year
How do we calculate Neonatal Mortality Rate
(Number of neonate deaths (0 to < 28 days)/Number of live births during the year) x 1,000 = neonatal death per 1,000 live births in a year
--> Sensitive to conditions present at birth or birthrelated
_____ is the number of women who die as a result of pregnancy and childbirth complications per 100,000 live births in a given year
--> how is it calculated?
Maternal Mortality Ratio
--> (Number of maternal deaths / Number of
live births) X 100,000 live births (during a
______ is the probability that a newborn baby will die before reaching age 5
Under 5 Mortality Rate
--> expressed as a number per 1,000 live births
_______ is the % of deaths are from a specific cause
---> Requires accurate cause of death data
---> Highlights key areas for prevention
Cause-specific Mortality Rate
How do we calculate Prevalence rate?
Number of all people with a disease/ Average population or total in group (during a time period)
How do we calculate Incidence rate?
= (Number of new cases/ Total population at risk (minus "old" cases))
X multiplier (e.g. 100) during a period of time
How are incidence and prevalence different?
-Prevalence = all cases
-Incidence = new cases
Define mortality, morbidity, incidence, and prevalence
1. Mortality- how many deaths/in a group for what time
2. Morbidity- how much sickness/in a group for what time
3. Prevalence rate- (number of all people with a disease/average population or total in a group_
4. Incidence rate- (number of new cases/average population-old cases)
-the less-used measure of disease burden
-Average years that a person can expect to live in "full health" taking into account years lived in less than
-->Higher HALE is better ↑
Most Used Measure of Disease Burden
-health lost due to particular illnesses & disabilities in a particular year in a particular population compared with the healthiest possible population
Disability Adjusted Life Years (DALY)
-Higher DALY = a society with more premature
death, illness, and disability....so....
lower DALY is better ↓
-Policies & programs aim to decrease DALYs
How do genetics and epigenetics differ?
1. Epigenetics- refers to heritable changes in gene expression; changes lead to later chronic diseases
2. Genetics- study of heredity and the passing of characteristics
What are DALYs and what "losses in health" are considered in DALYs versus mortality rates?
disease burden indicator, health loss due to a particular illness and disability
What are sources of data for monitoring health in a country?
Population pyramids, population growth, demographic divide
What are the demographic and the epidemiologic transitions?
1. Demographic- age shifts in population
2. Epidemiologic- shifts from communicable to non-communicable disease
What are examples of leading causes of death shared in low/middle- and high-income countries? What are examples of areas where these differ?
-Stroke, ischemic heart disease, chronic lung disease, lower respiratory infection, diabetes
-Low/Middle: Diarrheal diseases, HIV/AIDS, malaria, road injuries, TB
-High income: tracheal and lung cancer, alzheimer's, colorectal, chronic kidney disease
What regions of the world have the shortest life expectancy?
Shortest: sub-saharan Africa and South Asia
Longest: Latin America and the Caribbean
What are the 3 broad groups of causes of death used by WHO?
-Group I- communicable, maternal, perinatal, nutritional
-Group II- Non-communicable diseases
--> cancer, cardiovascular, etc
-Group III- Injuries
What are some of the factors that explain the differences in health of people in Kerala relative the rest of India?
1. High emphasis on education for ALL
2. primary healthcare services for all, focus on nutrition
3. family planning
5. elevated status of women
How is poverty defined globally, and what regions of the world have the largest percent of people living in poverty?
Poverty is living on the equivalent of $1-1.25 US per day (Under $2)
-->Sub-Saharan Africa and South Asia have the largest percent of people living in poverty
How do education, income and health affect each other?
-Wealth can promote better nutrition, better housing, better access to a healthier environment, and an increase in access to education
-The more educated you are, the more likely you are to get a better job, the more likely you'll know about disease and how to prevent them
-Good health increases lifetime earnings
-Healthy workers are more productive
What do equity and health disparities mean? What are two broad areas of unfairness affecting health inequities? (Hint: one is access to care)
-Equity- fairness in distributing a resource
-Inequity- unfair difference in resources that increase disease burden
-Health disparity- differences among populations in measures of health and healthcare. Fact-based differences in health
Two broad groups: access to healthcare and demographics, public subsidies, out-of-pocket costs
TWO BROAD AREAS OF UNFAIRNESS
- poor have less access to healthcare, coverage, and benefits
- substantial out-of-pocket costs for poor in low-income countries
What are measures of the income status of a country and what do they measure?
-The two measures of income status of a country are through GDP and GINI
1. GDP- gross domestic product; total amount of goods and services produced within a country
2. GINI- index of income inequality (0.0 meaning perfect equality of income, 1.0 meaning perfect inequality of income)
How do GDP and GINI they relate to health?
Not all benefit equally from economic development
What are some of the reasons that some countries are poorer yet have good health, and others are wealthier and yet have poor health?
-Sri Lanka and China have lower income but a higher life expectancy.
-The US spends a lot on health but have a lower life expectancy.
-->They are smarter with their resources. Uses of cost effectiveness; universal healthcare
Does the health and well-being of all income groups benefit equally from economic development in a country?
No; groups are affected by inequities in access to healthcare; these people include the poor, the less educated, women, minorities, etc
What does the term "indigenous people" refer to? (see folder for Chapter 2, if you are unsure.)
Long standing relationship with a geographical area
What groups are most likely to face inequities in access to care?
Poor people, women, less educated, minorities, indigenous people, rural, sexual minorities
What percentage of the national income do high and low income countries spend on health?
High income: 9-12%, high life expectancy
Low-income: 3-6%, low life expectancy
What are public, private, and out-of-pocket expenditures for health?
1. Public- expenditure by any level of government
2. Private- expenditure by non-government (charitable organizaton)
3. Out-of-pocket- expenditure by people who are not reimbursed
What is cost effectiveness, and what are the top 4 cost effective interventions to improve global health according to the Copenhagen Consensus?
--> Cost effectiveness- cost of an intervention relative to "amount of health" purchased with that investment
1. micronutrient interventions to fight hunger and improve education
2. malaria combination treatment
3. childhood immunization
4. deworming school kids
_______ cost of an intervention relative to
"amount of health purchased" with
-how can cost effectiveness be helpful in deciding how to spend money to promote health of a population?
1. Compare alternative treatments for a
- Cheap malaria drug or expensive, effective
one (our video last week)
2. Compare different goals
- Treat diabetes versus reduce malaria
3. Help to set priorities
- Determine was is achievable with resources
What are key factors that made the eradication of Guinea worm (dracunculiasis) effective?
Solutions to Guinea worm:
1. clean water source
2. water filters
3. avoid recontamination of water supply
4. health education
1. coordination between major partners and donors
2. data gathering and reporting
3. leadership and advocacy
What are the four types of technology (and examples of each) that can answer global health needs?
1. Biomedical technologies- HAART for HIV
2. Education and Motivation- motivational interviewing
3. Food and Agricultural technologies- plumpy nut
4. Public Health Innovations- sanitaion
What are three underlying factors that affect whether technologies solve global health needs?
1. Poverty and low education
2. Poor functioning infrastructure
3. Not having health as a priority
What are barriers to development of new technologies for global health?
--"For-profit" entities the major developers of new technologies
--Major profits derived from drugs sold in high income countries
--Only 10% of expenditures for research and development is related to diseases of developing countries
What are the ideal characteristics of a new health product for global health? Be able to apply this to an example.
easy to use, safe
requires little training to use
Pap tests are too expensive, use diluted vinegar to swab cervix
What is "jugaad" and who is developing it?
"Jugaad" - frugal innovation (clever solution born in adversity), examples all around the world
ex. In Peru - billboard that takes in humidity and creates water
Be-Bound -> connect to internet w/ sms
Compte-nickel- France, international debit card/ account
UCLA - Global Health lab
Define culture and society; how are these different
-defined as a set of rules or standards shared by members of society, which when acted upon produce behaviors
-defined as a group of people who occupy a specific locality and share the same cultural traditions
What are components that culture encompasses?
1. Family and social values
2. Beliefs, practices (diet)
3. Art & music
5. Politics & law
7. Customs (birth, death, marriage, greetings)
8. Communication (language, relationships, names)
1. Evaluating another culture from one's own cultural perspective (causes someone to think their culture is superior to another)
2. Evaluating another culture by that culture's standards even if aspects are harmful
3. Awareness that knowing another's culture is a long, evolving process (cultural competency)
2. Cultural relativism
3. Cultural humility
What is medical pluralism? What are key types of theories and methods comprise medical "science" systems?
-Medical pluralism- distinct medical 'science' systems coexistence
-->Traditional system and Western system
What are examples of beliefs of illness causes, esp. in non-Western settings?
-An individual's interpretation or reaction to disease or discomforts or symptoms
-How he/she describes symptoms of an illness
-May have a culturally recognized name for the description of symptoms
-Varies across cultures
Why is it important to study the relationship between culture and health?
Culture influences perceptions of health and illness
utilization of health services
health practices and medical treatment
What were beliefs in rural Mauritania that supported forced feeding of girls?
The women were more beautiful if they were obese; they gain weight to prep for marriage
How do the concepts of illness and disease differ?
-An illness may or may not be caused by disease, but be a culturally based
-->Illnesses are normally focused in traditional systems
What are the 3 broad categories of health care providers in global health?
- Shaman, Priest, Midwives
2. Western biomedical
- Physician, Nurse, NP
3. Other medical system
What are the key concepts of the ecological theory, the health belief model, and diffusion of innovation? How well is culture's influence on health incorporated into these theories?
1. Ecological Theory - multiple levels to approach change
2. Health Belief Model - aimed to use fear to arouse action
3. Stages of Change- focuses on readiness (precontemp...)
4. Diffusion of Innovation- communication promotes social change, success depends on opinion leader
5. Positive deviant approach - emphasizes local solutions (who has good health even with limited means)
____ are built on understanding, respecting, empowering and collaborating with communities, and their socio-cultural environment
• Shaped by understanding and utilization of local knowledge and culture
Culturally appropriate solutions
What are key principles of culturally appropriate solutions to health problems?
1. Community involvement & empowerment
--> Local advisory committee; teach skills
2. Socioculturally-tailored techniques
--> Shape solutions to local culture, society
3. Community evaluation and feedback in real-time
--> Keep local community engaged by sharing information on progress toward goals
4. Utilization of local communication techniques
--> Have "cultural brokers" who know preferred local communication
5. Use both the spoken word and the local tongue
--> Use local meaningful words and symbols
6. Aim at sustainability & community-health autonomy
-->Plan how change can last after you are gone.
What are examples of community strategies for changing behaviors?
1. Community mobilization- get all engaged
2. Mass media
3. Social marketing
4. Health education
5. Conditional cash transfers
What were key ideas in the video about Torres Strait Islanders and health?
Culture of others is important in order to adequately treat their illnesses
How did culture affect spread of the Ebola virus (Brief at the end of Chapter 6)?
-Culture is related to Ebola outbreaks in several unique ways, including through burial practices, caregiving practices, and societal stigma.
-Bodily fluids of deceased patients remain contagious many days after death, religious rites could be performed in where family members touch the body. Women are more likely affected because they're the ones who take care of the sick patients
What are key axioms and principles of culturally appropriate solutions to health problems? Be able to identify examples of these principles.
- Built on understanding, respecting, empowering, and collaboration with communities...
- Shaped by understanding and utilization of local knowledge and culture
What is the focus of the "cultural domain"? Why is it important to study the relationship between culture and health?
Will this fit in with the culture?
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