Global Health Exam 1 review

Terms in this set (99)

"a dynamic state of well-being; complete physical, mental, and social well-being; culture influenced; a universal human right; not merely the absence of disease or infirmity

Is also the social, emotional, spiritual and cultural well-being of THE WHOLE COMMUNITY

a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity - WHO

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

Monitors health of countries
Controls communicable diseases
Educates the public about health
Provides population interventions... Vitamin A & immunizations
Maintains safety net for vulnerable populations

Public Health vs. Medicine

- Population focus
- Greatest good for
greatest number
- Emphasis on preventing disease and promoting health of communities
- Interventions target environment, behavioral lifestyles, and medical care

vs

- Individual focus
- Needs of individual more important than needs of group
- Emphasis on diagnosing and treating diseases
- Interventions are medical

Health problems, issues, and concerns that TRANSCEND NATIONAL BOUNDARIES and may best be addressed by cooperative actions

Why study global health?

Understand the progress made and remaining global health problems
Many health problems require global solutions and international cooperation

Millennium Development Goals

Established in 2000 at the UN Millennium Summit

Why study global health?

Diseases cross borders
Ethical responsibility to address health disparities (social justice)
Health is basis for economic and social development
Health promotes global security and freedom
Learn how to improve US health

# of MDGs and core targets

8 MDGs with 15 core targets

Eradicate Extreme Hunger and Poverty

Target 1. Cut in half from 1990 the proportion of people whose income is < $1/day
Target 2. Cut in half from 1990 the proportion of people who suffer from hunger

Achieve Universal Primary Education

Target 3. Ensure that boys and girls everywhere will be able to complete a full course of primary school

Promote Gender Equality and Empower Women

Target 4. Eliminate gender disparity in primary and secondary education by 2005 and in all levels of education by 2015

Reduce Child Mortality

Target 5. Reduce by two thirds the under 5 years old mortality rate of 1990

Improve Maternal Health

Target 6. Reduce by three quarters the maternal
mortality ratio from 1990

Combat HIV/AIDS, Malaria, and Other Diseases

Target 7. halt and reverse the spread of HIV/AIDS Target 8. Halt and reverse the incidence of malaria and other major diseases.

Ensure Environmental Sustainability

Target 9. Integrate the principles of sustainable development into country policies and programs and reverse the loss of environmental resources.
Target 10. Cut by half the proportion of people without sustainable access to safe drinking water and basic sanitation
Target 11. By 2020 significantly improve the lives of at least 100 million slum dwellers

Develop a Global Partnership for Development

Target 12. Develop an open, rule-based predictable, and non-discriminatory trading and financial system.
Target 13. Address the special needs of the Least Developed Countries
Target 14. Address the special needs of landlocked developing countries and small island developing states
Target 15. Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term

What made smallpox eradication successful?

No animal vector
Easily diagnosable
Vaccine available - no refrigeration needed
Available technology - Bifurcated needle allowed easy application, small amount of vaccine
Lifetime immunity

Smallpox eradication - Lessons learned

Success depends on single person responsible for eradication
Ability to motivate large numbers of staff people
Frequent exchange of information
Flexibility to adapt to new situations
Use of existing healthcare systems
Forced many countries to improve health services - more general benefits, multiple vaccines at a time
Benchmarks and monitoring system Good publicity helps!

Select Examples of Global Health issues

STDs in young women, Eradication of polio, Malaria, HIV/AIDS, TB

5 most populous countries in the world

1. China 2. India 3. USA 4. Indonesia 5. Brazil

Determinants of health

...contribute directly or indirectly to many health conditions, diseases, and disabilities

Examples of Determinants of health

Physical environment
Employment & working conditions
Access to health services
Individual characteristics
Health behaviors
Healthy [prenatal &] child development
Social [& economic] environment (Chapter 3)
Governance, policies, & interventions

Physical environment

Water & mosquito breeding..West Nile virus
Poor sanitation..cholera epidemics
Air pollution..great smog of London, 1952*

Employment & working conditions

Injuries and deaths of workers from unsafe conditions Mining accidents (eg. Chile)
Exposure to harmful substances with
insufficient protection
Silica dust (--> silicosis, deadly lung condition) in South African gold mines

Access to health services

Emergency care...survival of injuries or health crises
Primary care...basic health services Public health...focused on population health
Health education
- Safety net programs - Vaccinations - Health monitoring

Individual characteristics

Genetic make up Age Sex

Health behaviors

Smoking
Safe vs. risky sexual behaviors
Driving while intoxicated
High fat dietary habits
Sedentary lifestyle

Healthy Prenatal & child development

Poor prenatal & infant nutrition: may cause organ changes that lead to later chronic disease: obesity, heart disease, diabetes
Early stress: may reprogram the nervous system to high stress response...heart disease, etc.
Secure infant relationships: set the foundation for later relationships (vs. Romanian children's mental distress)

Governance, policies, & interventions

Unstable government with armed conflict Somalia
Standards for worker safety
Exposure to harmful substances with insufficient protection
Silica dust (--> silicosis) in So. African gold mines
Intervention programs - "ABC" campaign in Uganda

How many DEATHS in a GROUP for what TIME

Killer Number 1

How much SICKNESS/in a GROUP for what TIME

Prevalence Rate

All current cases

Disease Burden Indicators

Estimates of how much life expectancy/quality is lost by mortality, morbidity, & disability

Two disease-burden indicators

Health-adjusted life expectancy (HALE)
Disability-adjusted life years (DALY)

Health-adjusted life expectancy (HALE)

Average years that a person can expect to live in "full health" taking into account years lived in less than full health due to disease and/or injury.
Less used measure of disease burden

Life Expectancy at Birth

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

Infant Mortality Rate

= Number of infant deaths (0-364 days) \ Number of live births during the year
X 1000
= death per 1,000 live births in a year

Neonatal Mortality Rate

= Number of neonate deaths (0 to < 28 days) / Number of live births during the year
X 1000
= neonatal death per 1,000 live births in a year

Maternal Mortality Ratio

The number of women who die as a result of pregnancy and childbirth complications per 100,000 live births in a given year

Under Five Mortality Rate

Probability that a newborn baby will die before reaching age 5

Cause-specific Mortality and Mortality Rate

Proportion of deaths linked to a specific disease (e.g., type of cancer) in a given year per 100,000 population

Prevalence Rate (ALL Cases)

= Number of all ill people / Average population or total in group (during a time period)

Incidence Rate (NEW cases)

= Number of new cases / Total population at risk (minus "old" cases)
X multiplier (e.g. 100) during a period of time

Higher HALE is better

Disability Adjusted Life Years (DALY)

Health lost due to particular illnesses &
disabilities in a particular year in a particular population compared with the healthiest possible population

Most Used Measure of Disease Burden

A society with more premature death, illness, and disability

Lower DALY is better ↓

DALY v. Mortality

Measures loss of ability to work/care for self or for children v. Affects population size

Demographic transition

Age shifts in populations

Epidemiological transition

Shifts from communicable to non-communicable diseases

Factors that explain the health of people in Kerala

- Education
- Widespread health services
- Role of women; seen as assets

Fairness in distributing a resource
(such as conditions for a healthy life)

Health disparities

All differences among populations in measures of health and healthcare are considered disparities

Sources of unfairness affecting health inequalities

- Access to care
- Social determinants affecting health
• Poverty (cost of transport, services)
• Education (underutilize health care)
• Gender
• Culture
• Location: rural vs. urban

Relationship between education, income, and health

Wealth Removes Barriers to Health
• Reduces financial barriers to education
• Limits financial barriers to health care
• More nutrition
• Better living conditions
• Access to a healthier environment, eg., water

Why some poor countries have good health

Some low income countries spend relatively little on health but have relatively higher life expectancy
- Cuba, Costa Rica, Sri Lanka, China

Why some wealthy countries have poor health

The US spends a lot on health but
has lower life expectancy than other developed countries

Do all income groups benefit equally from economic development in a country?

No.
Urban vs. Rural
Male vs. Woman

Risk factors for equities

- Gender?
- Location?

What part of the national income do HIGH income countries spend on health?

9-12% spent on health and have high life expectancy

What part of the national income do low income countries spend on health?

3-6% spent on health and have low life expectancy

Public expenditures for health

Expenditure by any level of government or government agency

Private expenditures for health

Expenditure by sources other than the government such as a non- governmental organization

Out of pocket expenditures for health

Expenditure by individuals that is not covered or reimbursed by an insurance program

Top 4 cost effective interventions to improve global health according to the 2008 Copenhagen Consensus

1. TB treatment
2. Acute heart attack treatment with low cost drugs
3. Malaria treatment and prevention
4. Child health initiatives (breastfeeding, Vit. A supplementation, etc.)

Total amount of goods and services produced

1/2 the average of the absolute differences between all pairs of incomes within a distribution, normalized on mean income.
• Interpretation:
0.0 (perfect equality of income in country)
1.0 (perfect inequality of income in country)

Term that described the process of fattening up women in Mauritania

a set of rules or standards shared by members of a society, which when acted upon; Produce behaviors that is acceptable by the group.

A group of people who occupy a specific locality and share the same cultural traditions

Why it's important to study the relationship between culture and health

Influences:
- perceptions of health & illness
- health behaviors
- health beliefs
- utilization of health services
- health practices & medical treatment

Some beliefs about the causes of illness/disease

Body out of balance
▪ hot and cold
Supernatural
Emotional stress
Sexual matters

Determinants of health in "A walk to Beautiful"

Location, Education, Culture..??

Theories/Models used to improve health behaviors

Ecological Perspective
Stages of Change Model (Transtheorectical Model)
Diffusion of Innovations Model

Approaches for changing health behaviors among populations

Community Mobilization
Mass Media
Social Marketing
Health Education
Conditional Cash Transfers
Social Assessment

Causes of death (and DALYs): Low & Middle vs. High income countries

HIV/AIDS/Malaria/TB/Diarrheal diseases
vs.
Throat & lung cancers/Diabetes mellitus

W.H.O. Cause of Death Classification

Group I: Communicable, maternal, perinatal, nutritional
Group II: Non-communicable
Group III: Injuries

Levels of Prevention

Primary
General Health Promotion
Specific Protection, e.g.,
Immunizations
Hygiene and Sanitation
Secondary
Screening
Early diagnosis and Treatment
Tertiary
Rehabilitation and supportive care

Determinants of Culture

Ethnicity, Group membership (clubs/organizations), Gender, Age, Knowledge, beliefs, religion, art,
music, law, politics, morals, custom, communication

A viral disease

A viral disease

A protozoan disease

Perinatal conditions

Those during the time surrounding birth (in the US includes pregnancy through 28 days after birth)

Schistosomiasis

Parasitic worms that are transmitted by snails.... Eggs shed by the adult worms that do not pass out of the body can become lodged in the intestine or bladder, causing inflammation or scarring. Children who are repeatedly infected can develop anemia, malnutrition, and learning difficulties. After years of infection, the parasite can also damage the liver, intestine, spleen, lungs, and bladder

Indigenous people

Populations who have resided in a geographic from "time immemorial" See State of the World's Indigenous Peoples:

Health disparities

An unfavorable health difference between one or more populations and a "reference" population (in the US, usually White non-Hispanic populations)

Study of disease and its occurrence in populations: incidence, prevalence, and risk factors associated with a disease in a population

Study of populations, especially related to migration and characteristics of age, gender, and race/ethnicity

facts that may stem from unfairness in:
- Access to care
- Social determinants affecting health

Living on the equivalent of $1 US /per day

Gross Domestic Product

- Total amount of goods and services produced within a country by its own and foreign corporations during a specified period of time
- Includes consumer spending, investment, government spending, exports

OECD Countries (Organization for Economic Cooperation and Development)

A historical outgrowth of the Marshall plan for economic development of Europe after WW II. Today, generally higher income countries of the world with an aim of global development. - Often used as a group for comparisons

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