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Global Health Exam 1 review
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Gravity
Chapters 1,2,3, and 6
Terms in this set (99)
Health
"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
Health
Is also the social, emotional, spiritual and cultural well-being of THE WHOLE COMMUNITY
Health
a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity - WHO
Public Health
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
Clinical Care
...
Public Health
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
Global health
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
Mortality
How many DEATHS in a GROUP for what TIME
Malaria
Killer Number 1
Morbidity
How much SICKNESS/in a GROUP for what TIME
Prevalence Rate
All current cases
Incidence Rate
Just new 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
DALY
Most Used Measure of Disease Burden
Higher DALY =
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
Equity
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.)
GDP measures
Total amount of goods and services produced
GINI measures
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
Culture
a set of rules or standards shared by members of a society, which when acted upon; Produce behaviors that is acceptable by the group.
Society
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
Influenza
A viral disease
Polio
A viral disease
Malaria
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)
Epidemiology
Study of disease and its occurrence in populations: incidence, prevalence, and risk factors associated with a disease in a population
Demography
Study of populations, especially related to migration and characteristics of age, gender, and race/ethnicity
Inequities
facts that may stem from unfairness in:
- Access to care
- Social determinants affecting health
Poverty
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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