Global Health Exam 1

Global Health

The study and the practice of improving health and achieving health equity for all people… more on health equity in a moment

Health disparities

preventable differences in health outcomes for disadvantaged populations vs advantaged populations

Health outcomes

changes in health, quality of life, or function as a result of medical intervention

health equity

The just and equitable distribution of the risk of suffering and of tools to lessen it is too often the unaddressed problem in global health. Removing barriers when they are present, “Fairness over someness”, Distributing the right amount and type of support where needed, Emphasis on “biosocial approach”

3 D’s of Global health

Disease (Infectious disease/epidemic spread), development (Of new technologies: treatments, diagnostics, and prevention measures), deliver (How to deliver new technologies to populations that need them the most

Elements of global health

Infectious disease control/managing and eradicating disease, Strenghtening primary care/basic health care and underlying infrastructure, Disaster preparedness/emergency management that prevent, protect, and manage global health threats (“Health Security”)

Why study history of global health?

Health is not simply about curing disease, historical factors impact present-day health contexts, social factors impact individual and group health possibilities, health is even more complicated when we consider the global scale

Driving factors of studying global health

Colonial Medicine (19th C.)	Imperial preservation & economic extraction	Protecting colonial rulers and local labor forces
Tropical Medicine (Late 19th C.)	Scientific curiosity & trade defense	Domestic port hygiene and parasitic disease mapping
International Health (Mid-20th C.)	Biosecurity, decolonization & diplomacy	Foreign aid, maternal health, and cross-border quarantine

Globalization

The circulation of people, ideas, and things around the world, across national and cultural borders. It includes social, political, and economic dimensions. Also includes an “intensification” of social, political, and economic relationships between geographically and culturally distant sites. The increased and intensified movement of people, things, ideas, and diseases. Frequency, speed, ease, impact.

Biosocial approach to health

Taking both biological and social factors into account in health conditions, including access, diagnoses, delivery, etc. Biological includes genetic, physiological, mechanisms of health condition (virus, bacteria, etc). Social factors including historical, political, economic, and other systemic/contextual factors.

Structural Violence

• Definition: Systemic, non-physical harm caused by social, economic, and political structures that prevent individuals or groups from meeting their basic needs and reaching their full potential.

• Importance to Global Health: Explains why health disparities persist along lines of race, gender, and class, shifting the focus from individual behavioral choices to systemic inequality.

Medical Tourism

• Definition: The practice of traveling across international borders to obtain medical, dental, or surgical care.

• Importance to Global Health: Highlights global inequalities in healthcare access and costs, while posing risks related to unequal local resource allocation, varying quality standards, and the spread of antibiotic-resistant pathogens.

Epidemiology

• Definition: The study of the distribution, patterns, causes, and determinants of health and disease conditions within specified populations.

• Importance to Global Health: Serves as the foundational science for identifying health threats, tracking disease outbreaks, measuring population-level outcomes, and designing evidence-based public health interventions.

Global health delivery

• Definition: The study and implementation of systems, logistics, and management strategies required to deliver effective, equitable, and sustainable healthcare interventions to populations in low-resource settings.

• Importance to Global Health: Bridges the gap between medical discoveries and real-world outcomes, ensuring that life-saving treatments and preventive measures actually reach the people who need them most.

Disability-adjusted life years (DALYS)

• Definition: A quantitative metric representing total disease burden, calculated as the sum of Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD). ($DALY = YLL + YLD$)

• Importance to Global Health: Provides a standardized measure to compare the impact of different diseases, helping policymakers evaluate global health trends and allocate resources to interventions with the highest burden reduction.

Structural

It indicates that harm, risk, or illness is embedded in the political, economic, legal, and social frameworks of a society, rather than being caused by individual choices or accidental events. EX: Economic policies (e.g., wage stagnation, lack of sick leave).

• Legal systems (e.g., discriminatory housing laws, immigration restrictions).

• Healthcare infrastructure (e.g., privatized systems that require out-of-pocket payments, geographic insurance deserts).

• Social hierarchies (e.g., institutional racism, sexism, or caste systems).

clinical medicine

Focuses on the individual patient, emphasizing personal diagnosis, immediate symptom relief, and individualized biological treatment (e.g., prescribing antibiotics for an ear infection in a clinic).

Global health in comparison to clinical

Focuses on entire populations, emphasizing prevention, equity, systemic health drivers, and cross-border solutions (e.g., redesigning sanitation infrastructure or lowering drug pricing to prevent infections across a country).

Clinical approach

Treats disease strictly as a biological breakdown inside the body—focusing on pathogens, organ dysfunction, genetics, and pharmaceuticals.

Biosocial approach

Views disease as a product of both biology and social forces, asserting that clinical medicine alone cannot solve health problems if conditions like poverty, structural racism, and poor housing remain unaddressed.

How globalization intensified movement of people, things, ideas, and diseases

• People: Expanded global supply chains, international air travel, and labor migration move millions of travelers, refugees, and workers across borders daily.

• Things: Global trade networks ship pharmaceuticals, medical equipment, and food across continents—alongside harmful commodities like ultra-processed foods, tobacco, and industrial pollutants.

• Ideas: Digital communication and global media rapidly spread medical research, public health campaigns, and health policy standards—as well as medical misinformation.

• Diseases: High-speed, interconnected transportation networks mean a localized outbreak (like SARS-CoV-2 or Ebola) can travel around the world in hours rather than months or years.

What to learn from personal stories

• Shows structural complexity: Personal stories translate abstract statistics into lived human reality, demonstrating how poverty, social stigma, and policy failures collide in a single life.

• Exposes health system failures: Stories highlight where systems fail—such as showing how a patient might follow their doctor's medical advice perfectly, but still succumb to illness because they lack transportation, clean water, or affordable medicine.

• Prevents patient-blaming: Narrative context proves that bad health outcomes are rarely caused by non-compliance or poor personal choices, but rather by insurmountable socio-economic barriers.

Why people die from conditions that are treatable

• Lack of access and affordability: Essential medicines, vaccines, and basic clinical facilities are often out of reach due to exorbitant costs or long travel distances.

• Systemic poverty and inequality: Poor living conditions (un safe drinking water, overcrowding, poor nutrition) constantly expose vulnerable populations to disease vectors.

• Resource allocation priorities: Global and national political choices prioritize high-tech specialized urban care over primary health infrastructure in low-income or rural communities.

Why global health practitioners study worldwide trends

• Identifies disparities: Tracking metrics like life expectancy or cause of death across regions, age, and sex reveals where health inequalities are most severe.

• Guides resource allocation: Population data informs governments and non-governmental organizations where to deploy limited funds, medical equipment, and health workers for maximum impact.

• Measures progress: Tracking these indicators over time shows whether specific global health initiatives (such as vaccination drives or anti-poverty programs) are actually working.

Ecological Imperialism

the concept—coined by historian Alfred Crosby in 1986—that European colonization succeeded not just through military force or technological superiority, but primarily through the deliberate and accidental introduction of European plants, animals, and pathogens to indigenous ecosystems.

Pathogens: European settlers brought diseases (smallpox, measles, influenza) to which Indigenous populations had no immunity, wiping out up to 90% of local populations in parts of the Americas and Oceania.

• Flora (Weeds and Crops): European grasses, clover, and agricultural crops aggressive overran local flora, transforming landscapes to support European-style farming and livestock grazing.

• Fauna (Animals): Horses, cattle, pigs, sheep, and rats rapidly reproduced, consuming native vegetation, disrupting local food webs, and altering land ecology permanently.
  Why it matters?

• Historical Roots of Vulnerability: Demonstrates how structural violence began historically—ecosystems and Indigenous health networks were systematically destroyed, laying the foundation for long-term health inequities.

• Environmental Determinants: Highlights how ecological alteration directly dictates population health, showing that human health cannot be separated from ecosystem stability (a core biosocial insight).

How did technologies of transportation contribute to the spread of people and of disease?

• Speed and Volume: Innovations like steamships, railways, and eventually commercial aviation drastically shortened travel time. Pathogens that previously died out mid-transit during long, slow sea voyages could now travel across oceans and continents before an infected person showed symptoms.

• Reaching New Environments: Railroads and modern maritime shipping carved access into previously isolated inland regions, transporting both infected workers and global disease vectors (like Aedes aegypti mosquitoes aboard ships) into naïve ecosystems.

What are two ways that diseases were used as weapons or justifications for violence?

• Biological Warfare (Weaponization): Disease was sometimes intentionally used as an agent of war. A prominent example occurred in 1763 at Fort Pitt, where British officers intentionally gave smallpox-contaminated blankets and handkerchiefs from an isolation hospital to Native American diplomats to spread fatal infection among hostile tribes.

• Moral Justification ("Manifest Destiny" and Scientific Racism): Colonizers weaponized disease ideologically by interpreting mass Indigenous deaths from introduced pathogens not as a tragedy, but as "divine providence" or proof of European racial superiority. Colonizers argued that Indigenous populations were inherently "immunologically frail" or "racially careless," using these dying populations to justify seizing land that was allegedly "destined" for European settlement.

How did resistance vs vulnerability to disease play a role in colonialism and imperialism?

• Vulnerability in the Americas (European Expansion): In the Americas, Indigenous populations had no prior exposure to Afro-Eurasian pathogens (smallpox, measles, typhus), rendering them immunologically "naïve". Combined with the destruction of social structures, forced labor, and famine caused by colonial conquest, up to 90% of local populations died. This collapse allowed Europeans to conquer and settle vast territories with minimal military resistance.

• Resistance in Sub-Saharan Africa (The "White Man's Grave"): For centuries, European imperialism was halted in inner Africa because local African populations possessed acquired or genetic resistance (such as the sickle cell trait) to tropical diseases like malaria and yellow fever. European troops died in massive numbers, earning the region the nickname "White Man's Grave." Imperialist control over Africa was only made possible in the late 19th century after the extraction and industrial production of quinine (a malaria treatment) allowed Europeans to survive the continent's disease environment.

Besides roads, what were some other common means of exploring and coming into

contact with other cultural groups in the early years of exploration ( before 1200 -

1700s)

Non-Road Exploration Means (1200s–1700s)

• Ocean Sailing: Caravels, dhows, and outrigger canoes using seasonal monsoon winds.

• River Navigation: Canoes navigating inland waterways (e.g., Amazon, Congo) to reach interiors.

• Overland Caravans: Pack animals (camels, llamas) traveling unpaved desert and steppe routes.

How did local conflict or instability in indigenous groups around the world contribute to colonial and military conquests from Europe?

• Strategic Alliances: Europeans joined rival tribes to defeat major empires (e.g., Cortés + Tlaxcalans vs. Aztecs).

• Divided Defenses: Civil wars and political rivalries prevented Indigenous groups from forming a united front.

• Native Logistics: Local allies provided critical supplies, intelligence, translators, and combat forces.

Germ theory

• Definition: The scientific framework proving that specific micro-organisms (pathogens like bacteria, viruses, and fungi) cause specific infectious diseases.

• Significance: Replaced the "miasma" (bad air) theory, enabling modern sanitation, sterilization, vaccines, and antibiotics.

Vector Science

• Definition: The study of organisms (like mosquitoes, ticks, and snails) that transmit pathogens from one host to another.

• Significance: Enables disease control through environmental interventions (e.g., mosquito nets, pest control) rather than relying solely on individual medical treatment.

Proximate Causes

• Definition: The immediate, direct biological mechanism that causes an illness (e.g., the malaria parasite in the bloodstream).

• Significance: Highlights the distinction between direct biological triggers and "distal/ultimate causes" (like poverty or lack of housing) that lead to exposure in the first place.

Missionary medicine

• Definition: Healthcare delivered by religious organizations in non-Western or colonized regions, combining clinical care with religious conversion efforts during the 19th–20th centuries.

• Significance: Built much of the early medical infrastructure in developing nations, but often promoted paternalistic models aligned with colonial interests.

Alma-Ata

• Definition: A historic international conference in Kazakhstan that declared health as a fundamental human right and set the goal of "Health for All by the year 2000."

• Significance: Reoriented global health away from top-down medical technology toward comprehensive, community-based health equity.

Primary care

• Definition: Essential, universally accessible healthcare that provides first-contact clinical care, disease prevention, and basic treatment within a community.

• Significance: Serves as the foundation of sustainable health systems, yielding better population health outcomes and greater equity than hospital-centric models.

Changes of the 20th century

• Rapid Urbanization & Industrialization: Cities grew overcrowded and lacked proper sanitation infrastructure, creating breeding grounds for pathogens.

• Global Connectivity: Steamships and railways sped up global travel, carrying infected people and disease vectors across continents before symptoms appeared.

• Scientific Breakthroughs: The rise of germ theory, microbiology, and vector science transformed disease tracking and medical technology.

Importance of broad street pump and soho cholera outbreak

Birth of Modern Epidemiology: John Snow mapped cholera cases to a single contaminated water pump, proving disease could be waterborne.

Shift from Miasma: Disproved the dominant theory that disease spread via "bad air," proving that environmental mapping and targeted sanitation could control outbreaks.

Yellow fever in cuba

• (a) How It Was Spread & Prevented: Walter Reed and Carlos Finlay proved yellow fever was transmitted by mosquitoes (Aedes aegypti), leading to vector control (destroying mosquito breeding grounds, screening windows) rather than quarantine of goods.

• (b) Underlying Motivations: Interventions were driven heavily by military and economic interests—namely, protecting U.S. soldiers during the Spanish-American War and safeguarding trade routes/Panama Canal construction.

Proximal vs structural causes and examples

• Difference: Proximate causes are the immediate biological or physical mechanisms causing illness. Structural causes are the political, economic, and social systems that dictate who gets exposed.

• Proximate Intervention Example: Giving antibiotics to cure a bacterial tuberculosis infection.

• Structural Intervention Example: Passing housing laws to eliminate overcrowding and expanding public transit so workers can access affordable, clean housing.

Motivations for a wealthy population

• Motivations: Protecting labor forces, securing international trade, building soft power/reputation, and promoting market-friendly economic stability.

• Rockefeller Example: The Rockefeller Foundation funded hookworm eradication and global medical schools to create a healthier, more productive labor force in the U.S. South and abroad, while standardizing Western-style medical education worldwide.

Hygiene Conferences and Missionary Societies

• Shift to Global Health: They established the precedent that health was an international concern requiring cross-border cooperation and standardized policies.

• Significance: International Sanitary Conferences created early international health regulations to protect trade, while missionary societies built the physical health infrastructure (hospitals, clinics) in colonized areas that formed early global health systems.

Events from Post-WWI to 1950s Shaping Global Health

• 918 Influenza Pandemic: Exposed the vulnerability of interconnected global populations to respiratory viruses.

• Creation of the League of Nations Health Organization & WHO (1948): Established formal international bodies to coordinate global health policy, disease surveillance, and standardization.

• Post-WWII Decolonization & Penicillin: Mass production of antibiotics and decolonization shifts spurred vertical, disease-specific eradication campaigns (e.g., smallpox, malaria).

Goals and Impact of the Alma-Ata Conference (1978)

• Major Goals: Achieved "Health for All by the Year 2000" by framing health as a fundamental human right.

• Core Policy: Championed Primary Health Care (PHC)—community-based, preventive, and equitable healthcare integrated with local development.

• Shift in Delivery: Shifted the field away from top-down, high-tech, hospital-centric Western models toward sustainable, community-driven health systems.