127 terms



Terms in this set (...)

Why should people in the United States be concerned about the health of people in other countries?
Wrote an essay on it
Public Health vs Medicine (focus, ethical basis, emphasis, interventions)
Focus: population
Ethical basis: public service
Emphasis: disease prevention and health promotion for communities
Interventions: broad spectrum that may target the environment, human behavior, lifestyle and medical
Medicine vs Public Health (focus, ethical basis, emphasis, interventions)
Focus: individual
Ethical Basis: personal service
Emphasis: Disease diagnosis, treatment and care for individuals
Interventions: emphasis on medical care
Definition of Global health (institute of medicine)
"Health problems, issues, and concerns that transcend national boundaries and may best be addressed by cooperative actions..."
Definition of Global Health (Koplan)
"An area for study, research, and practice that places a priority on improving health and achieving equity in health for all people world-wide..."
The "Third" World
A cold war term
First used in early 1950s
Coined by a French demographer
Derived from term, "Third estate" (1st = monarchy, 2nd = church, 3rd = everyone else)
"Third World Country": Synonyms
Developing country (less developed country, under-developed country)
Low-income country
Less-wealthy country
Resource-constrained country
Emergent nations
Global South
Majority world
Examples of Global Health Issues:
emerging infectious diseases
disease eradication
environmental health
maternal and child health
nternational collaboration
vaccine - preventable diseases
chronic diseases
tuberculosis, HIV/AIDS, hepatitis
Public Health Definition (winslow)
"The science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts.......which will ensure to every individual in the community a standard of living adequate for the maintenance of health."
Definition of Public Health (IOM report)
"Public health is what we, as a society , do collectively to assure the conditions in which people can be healthy."
Defining of Health (WHO)
"A state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity"
Sciences and Professions of Public Health
Community health
Health education
Laboratory science
Leading Causes of Death-US 1900
Diarrheal diseases
Heart disease
Liver disease
Leading Causes of Death-US 2000
Heart disease
Lung disease
What are the leading causes of death in sub-Saharan Africa today?
Respiratory disease
Diarrheal diseases
Perinatal diseases
Actual Causes of Death (in US?)
Microbial agents
Toxic agents
Sexual behavior
Motor vehicles
Average Lifespan in US
1900 - 45 years
2000 - 75 years
20th Century Achievements of Public Health
Control of infectious diseases
Safer and healthier foods
Safer workplaces
Motor-vehicle safety
Healthier mothers and babies
Recognition of tobacco as health hazard
ex: penicillin
multiple drug resistant TB
extremely drug resistant TB
Core functions of Public Health
Policy development
Ten Essential Public Health Services
Monitor health status
Investigate health problems/hazards
Inform/educate people about health
Mobilize partnerships
Develop policies that improve outcomes
Enforce health regulations
Link people to needed health services
Assure a competent health workforce
Evaluate effectiveness of services
Extreme poverty is living on:
less than $1 per day
the number of people who lie in extreme poverty:
about 2 billion or roughly 25% of the world's population
________ of the global burden of disease is at least in part attributable to environmental risk factors
One third
Nutritional deficiencies contribute to increased rates of _____________
diarrhea, pneumonia, and malaria
_____ of children worldwide are underweight or stunted
MDG's basic info
issued in 2000, sponsored by the UN, endorsed by 189 countries, 8 goals
Millenium Development Goals (1-8)
Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender equality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria and other diseases
Ensure environmental sustainability
Develop a global partnership for development
Mexico: epidemic: cholera explain
(spread from river water, first case was in isolated central Mexico) - diarrheal disease, caused by bacteria
Epidemiology definition
Epidemiology is the discipline that describes, quantifies, and postulates the causal mechanisms for illness and disease within populations.
Epidemiologists measure
morbidity, injury, disability and mortality within populations.
Epidemiological Functions
Describing the health status of the population
Determining the etiology of disease
Predicting the occurrence of disease
Controlling the distribution of disease
Father of Epidemiology
John Snow determined in the mid 1800s that cholera in London was spread via a common water source (the Broad Street pump)
Eliminating the access to that water source interrupted the epidemic
ORT: Oral Rehydration treatment:
boiled water, with sugar and salt - can keep people from dying from diarrheal diseases
Excessive occurrence of a disease
Epidemic on a wide geographic scale
High prevalence of a disease in a particular geographical region.
Systematic collection, analysis, interpretation, dissemination of data.
Epidemiologic Triad
Host - Agent - Environment
A ratio in which time is a factor
Mortality Rate
number of deaths within a population usually within a year
Neonatal Mortality Rate
mortality rate among infants younger than 28 days
(Number of neonatal deaths per 1000 live births within a year)
Infant Mortality Rate
mortality rate among infants younger than 365 days
(Number of infant deaths per 1000 live births within a year)
Highest: Africa, Eastern Mediterranean Southeast Asia
Child Mortality Rate
mortality rate among children younger than 5 years
(Number of <5 year-old deaths per 1000 live births within a year)
Sub- Saharan Africa, South Asia, Middle East and North Africa
Maternal Mortality Rate
mortality rate associated with pregnancy and childbirth
(Number of deaths per 100,000 live births within a year)
Sub- Saharan Africa
Prevalence Rate
number (percentage) of cases of a disease /condition at a specific time
Incidence Rate
rate of development of new cases
Risk factor
a behavior, exposure, inherited trait that is associated with a health condition/disease
Life Expectancy
average number of years expected to live (starting with a specific age)
not a static number - it varies
Low and Middle Income Countries leading factors for the Burden of Disease
Deaths -------------------------------DALYS
High blood pressure-------------- Childhood Underweight
Childhood underweight---------- Unsafe sex
Smoking ---------------------------High blood pressure
High cholesterol--------------------smoking
Unsafe sex -------------------------Unsafe water sanitation & hygiene
Low fruit and vegetable Intake-- Alcohol use
Disability-adjusted Life Year (DALY)
Measures # of years lost due to premature death AND
Measures # of years chronically ill or disabled during normal life expectancy
Health Surveillance
Estimates the magnitude of the problem
Determines the geographic distribution
Establishes the natural history of disease
Detects epidemics
Evaluates control measures
Monitors changes in infectious agents
Detects changes in practice
Facilitates planning
What are Africa's big health problem right now?
fish market:
women will have sex with fisherman to guarantee fish, spread of HIV becomes easy in this way
people don't believe ___________, but believe________
AIDS spreads through sexual stuff
AIDS happens to people when they break customary law
Determinants of Health (US)
Human biology - genetics, susceptibility to disease or not, gender, organs, ethnicity, country of origin (5th)
Habits and behaviors- smoking, drinking, exercise, hygiene (largest)
Environment - urban (access to health facilities), pollution, food security, the built environment (2nd)
Socio-economic factors - wealth/health relations (3rd)
Health Care - access or not (4th)
What are determinants of Health
The economic and social conditions that influence the health of individuals and communities
They contribute to the determination of whether individuals stay healthy or not.
They determine the extent to which a person possess the physical social and personal resources to identify and achieve personal aspirations, satisfy needs, and achieve health in the broadest sense
They reflect the quantity and quality of a variety of resources that society makes available to its members
social and political circumstances affect what?
life and well-being and health
there is a major relationship between health and _______
What does it show: Life Expectancy for Men by Neighborhood Income Quintile
Uniform increase of life expectancy with increase in income
What must all sectors do to act effectively for promoting health?
All sectors must take responsibility for promoting health
To address increasing global threats to health, health protection must use ____________-
health promotion skills of health education and public communication
More needs to be done to reorient the healthcare sector to take greater responsibility _____________
for health promotion and chronic disease management
WHO Conference on Social Determinants of Health
Follow-up to the report of the WHO Commission on the Social Determinants of Health (Chaired by Sir Michael Marmot)
representative organizations: UNICEF for example
Policy recommendations for WHO Conference on Social Determinants
Reform of health governance- Need for intersectoral action
New culture of participation-Engaging non-governmental organizations (NGOs)
New role for the health sector-Focus on primary health care and universal access
Coordinated action-Need to go beyond national borders. Involve international, multilateral partners.
Quality health data-Must be able to reveal the social gradient of health
65th World Health Assembly, May, 2012
Priority setting
Operationalize policy recommendations
Joining forces with NGOs and academia
Generating evidence on health inequities
Connecting all stakeholders
What does health and education of parents affect?
Both health and education of children
What do malnutrition and disease affect?
Cognitive development
What is the level of education related to?
Disease prevention
Good health increases _______- and _________
Life expectancy and lifetime earnings
Health indicators within countries are largely, but not completely, related to _____________
variations in per capita income
Most countries have significant variation in health indicators across various population groups
Low- or middle-income countries generally have poor health indicators
High-income countries with significant disenfranchised minorities may also have_________
poor health indicators
Income gaps have an impact on
"Being born ________is dangerous to your health"
Women face health concerns related to their diminished place in many societies
Female infanticide
Lower enrollment in school
Violence against women
Association between ethnicity and:
Health status
Linked to association with less power, lower education, and less income
maternal mortality rate is a good surrogate for looking at community information
How much % of GDP do High income and low income spend on health?
High-income countries which spend 9-12% of GDP on health have higher life expectancies
Low-income countries which spend 3-6% of GDP on health have lower life expectancies
Examples of outliers
Sri Lanka and Cuba spend relatively little, but achieve higher life expectancies
Cost Effectiveness of Health Interventions
Compares cost of intervention with the amount of health that can be "purchased" with that investment
Compares different interventions to assist health investment choices
Can help to set priorities among different ways of achieving a health goal
Health and Development
Good health promotes economic development
Higher levels of economic development also promote better health
Low- and middle-income countries must adopt policies that speed achievement of health goals even with constrained incomes
The Foundation for Health as a Human Right
Universal Declaration of Human Rights (1948)
"Everyone has the right to a standard of living adequate for the health and wellbeing of himself and his family...."
Has led to legally-binding multilateral treaties, but it is not legally binding
Other Multilateral Treaties Related to Health
Covenant on Economic, Social and Cultural Rights (1966)
"Recognizes the right of everyone to the enjoyment of the highest attainable standard of physical and mental health."
Covenant on Civil and Political Rights(1966)
Health as a Right (written in how many constitutions?)
115 countries
Universal access to healthcare
Focus on improving population health
Addressing social determinants of health
Human Rights and HIV Infection
-Stigma and discrimination
affected mostly young people
people were one of 4 categories: homosexuality, hymopheliac, heroin uses, Haitians
-Protecting the rights of HIV-positive people
-Ensuring access to care
Blood transfusions really worried people
as soon as they could test for HIV they tested blood banks first
-Testing policies
people began going to blood banks because they would tell you if you had it, so they set up voluntary/anonymous testing
brought people away from blood banks and made it become more normalized
-Standard of practice/opting out
suggesting to take the test had a bad stigma - as if telling them they were drug abusers, etc
Human Rights and Human Subjects Research
-Research studies may not benefit the participants
-Ethical concerns about putting participants at risk for the sake of others
-The Tuskegee Study:
men who had cyphillus were told that they were getting treated when they were not even 30 years after the cure was found (penicillin)
-AZT "Short course" trials:
happened in the 90s - done in Sub Saharan Africa - one thought there might be a shorter treatment, so firstly people (women) were not asked, and it was short course vs. no treatment vs. what usually should be short course vs. best possible known solution
Responses to improper Human Subject research
The Declaration of Helsinki (1964)
Scientific validity
Risk vs. benefit
Use of placebos
(most countries adhere to these)
Responses to improper Human Subject research
The Belmont report (1974)
Respect for persons
Informed consent
Risk vs. benefit
Selection of subjects
Allocation of Health Resources
Limit on resources/"rationing"
Government agencies must decide how to allocate resources
Making choices based on explicit, publicly justified criteria
Governed by one or more of these ethical principles:
Health maximization
Priority to the worst off
Personal responsibility
Health System Components
Regulatory agencies (FDA)
Financing agencies
Preventive services
Clinical services
Specialized components, e.g. educators, pharmaceutical companies
(USA doesn't really have one health system - components make up system)
Health System
The WHO Helath System Framework
System buildingblocks
Service delivery
Health workforce
Medical products, vaccines and technologies
Leads to Access coverage and quality safety
Overall goals and outcomes
Improved heath
Social and financial risk protection
Improved efficiency
Health System organization
Service level (who, what) - primary, secondary, tertiary
Outcomes (inconsistently measured)
Variations on Approach
National Health Insurance:
National Health Service -
Global Models
Low-income countries-mixed approach
Middle-income countries-most have national system through publicly supported payments
High-income countries-almost exclusively have universal systems for financing and/or delivery (USA is the exception)
Tiers of Health Delivery
Primary care: initial point of entry and service
Secondary care: some medical specialties; community hospitals
Tertiary care: all specialties; medical centers
Declaration of Alma-Ata (1978)
Health as a human right
Primary care is essential
All should have access to primary care
Central tenet of global health initiatives
Health System Entities
Public-public health, regulation, healthcare delivery
Private (for profit)-providers, facilities, systems
Private (not-for-profit)-providers, facilities, systems; often engaged in community outreach and partnerships
Health costs as percentage of GPD
Indonesia 2, Pakistan 2.9, Bangladesh 3.5, sudan 3.6
Health costs as percentage of GDP
Nigeria 6.8, afghanistan 7.3
Health System Models
Social insurance model-Germany - work provides insurance
Government insurance-Canada
Socialized system-Great Britain
everything about health is covered/owned by government
Lack of any system-Some developing countries
Performance Measures
Life expectancy
Mortality rates
DALYs lost
Performance Rankings:
France - 1
Germany - 25
USA- 37
Cuba - 39
Afghanistan - 173
Health System Issues
Human resources
Insufficient numbers of health workers
Demographic changes
Important contributors to global burden of disease:
Unsafe water, hygiene, and excreta disposal
Urban air pollution
Indoor smoke from household use of solid fuels
Leading causes of death from environmental factors:
3rd-Lower respiratory infection
6th-Chronic obstructive pulmonary disease (COPD)
7th-Diarrheal disease
Working definition of Environment Health (McMichael)
"external physical, chemical, and microbiological exposures and processes that impinge upon individuals and groups and are beyond the immediate control of individuals"
Environmental Health (world bank)
Efforts that are "concerned with preventing disease, death, and disability by reducing exposure to adverse environmental conditions and promoting behavior change."
Environmental Health Facts
25-35% of global burden of disease linked to environmental factors
Increase in prevalence and mortality of asthma in last four decades has approached 80%
About 1.5 billion people breathe air that does not meet WHO quality standards
Environmental factors contribute to the increased rates of cervical, prostrate and breast cancer
Typical environmental Health Issues: Determinantes
Unsafe water, sanitation, waste disposal etc.
Imporper water resource management, poor drainage
Climate change
Ozone depletion
Typical Environmental Health issues: Health Consequences
Diarrhea, vector related disease, such as malaria, dengue
Vector related diseases (malaria etc.), Respiratory disease
Injury/death, extreme heat/cold floods and fires
Aggravation of respiratory disease, population dislocation
Global Environmental Health Issues
Indoor air pollution
Big in developing world
Indoor cooking
Outdoor air pollution
Big problem (50% of population in cities)
Climate change
Access to clean water
Chemicals and radioactivity in the environment
Other Global Health Issues with an Environmental Component
Food safety
Solid waste disposal
Occupational health and safety
Unintentional injuries
Indoor Air pollution short term problems
Conjunctivitis, upper respiratory infection, acute respiratory infection, carbon monoxide poisoning
Indoor air pollution long term problems
Cardiovascular disease, chronic obstructive pulmonary disease, cancer
Effects of Indoor Air Pollution (developing countries)
Cause of ~4% of all deaths
3rd most important risk factor
~60% of all deaths attributable to indoor air pollution are among females
Indoor Air pollution Interventions
Improve cooking devices
Use of less polluting fuels
Reducing need for fuels by using solar cooking and heating
Mechanisms for venting smoke
Keeping children away from cooking area
Public policies and education that encourage safer practices
Water and Sanitation
Only 60% of people in the world have access to improved sanitation
Poor sanitation leads to increase in pathogens through oral-fecal route, spread of parasitic worms, and trachoma
One billion people lack access to safe water sources
Waterborne pathogens are associated with diarrhea and other gastrointestinal problems
Effects of Poor sanitation
Burden falls primarily on the poor and less well-educated people
Unsafe sanitation, unsafe water, poor hygienic practices and burden of diarrheal disease are
closely linked
Improved Sanitation and Clean Water: Interventions
Simple methods of sanitation and excreta disposal are low-cost and relatively effective
Barriers include lack of knowledge, construction material, local politics, poor policies
Government subsidies and regulations for installing latrines
Promotion through public-private partnerships headed by NGOs
Hygiene promotion can lead to a 33% reduction in diarrhea morbidity
Focus should be on simple messages about hand washing and enabling hand washing
Epidemiology is concerned with
the distribution of disease and the determinants of health
High Income Countries leading factors for the Burden of Disease
Deaths DALYS
1 Smoking - Smoking 2 High blood pressure - HBP
3 High cholesterol - overweight & obesity
4 Overweight obesity - High cholesterol
5 Physical inactivity - Alcohol use