Session 1 Chapter 1

Why study global health?

To understand:

• The progress that has already been made

• The challenges that still remain

• That diseases are not limited by national boundaries (TB, HIV, and Polio)

• That there are disparities among groups

• The health-development link

• The need for different actors to work together

progress in global health

• global life expectancy increased 37% from 1960 to 2016

• the rate of child mortality fell 62% from 1990 to 2016

• Nearly 3 billion children have been vaccinated against polio with only 22 cases in 2017

• There were 44% fewer maternal deaths in 2015 than in 1990

• Fifty-three million tuberculosis deaths were averted from 2000 to 2016 through successful diagnosis and treatment

• There were 900,000 fewer deaths due to HIV/AIDS in 2016 compared to 2005

• The number of Guinea worm cases has decreased over 99.9%, from 3.5 million in 1986 to 30 in 2017

• The global prevalence of tobacco smoking decreased from 24% in 2007 to 21% in 2015, despite population growth

remaining global health challenges

• There were 5.6 million under-5 child deaths in 2016.

• Almost half of all under-5 child deaths are related to malnutrition.

• There were 435,000 malaria deaths in 2017.

• 1.3 million HIV-negative people died from tuberculosis in 2017, in addition to 300,000 people with HIV.

• 1.8 million people became infected with HIV in 2017.

• In 2017, there were 940,000 deaths caused by AIDS

• There were 303,000 maternal deaths in 2015.

• Approximately 1 billion people are infected with roundworm.

• The prevalence of diabetes has doubled since 1980

how are diseases not limited by political boundaries

• Prior to 1960, dengue fever was concentrated largely in Southeast Asia and the coast of South America. However, cases are now seen in five continents

• The “avian flu” first appeared in East Asia, but it, too, is spreading to other regions

existing health disparities

• life expectancy in Japan is 84, but only 52 in Sierra Leone

• Hepatitis B vaccine used in high income countries but not as much in lower income countries

The important link between health and development example

Poor health of mothers is linked to poor health of babies and the failure of children to reach their full mental and physical potential. In addition, ill health of children can delay their entry into school and can affect their attendance, their academic performance, and, therefore, their future economic prospects.

intersectoral nature of global health concerns

• different actors need to work together to address them are additional reasons why we should be concerned with global health. Although locally relevant solutions are needed to address most health problems, some health issues can be solved only with a global approach.

  • some problems such as HIV/AIDS need more financial resources

global health becoming prominent worldwide

• spread of HIV, SARS scare in the early 2000s, avian flu, and outbreaks of Ebola in West Africa and the DRC have all brought attention to global health.

Orgs increasing awareness of global health

• The advocacy efforts of Doctors Without Borders

• the establishment of the Millennium and Sustainable Development Goals

• the philanthropy of the Bill & Melinda Gates Foundation

Health (WHO definition)

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

Public Health (Winslow’s definition

the science and art of preventing disease, prolonging life, and promoting physical health and mental health and efficiency through organized community efforts toward a sanitary environment

examples of public health activities

• The promotion of handwashing

• The promotion of bicycle and motorcycle helmets

• The promotion of knowledge about HIV/AIDS

• Large-scale screening for diabetes and hypertension

• Large-scale screening of the eyesight of schoolchildren

• Mass dosing of children against worms

• The operation of a supplementary feeding program for poorly nourished young children

• The taxation of tobacco and alcohol

• The regulation of industrial pollution

• The regulation of food labeling

Public health vs medicine

Global health

Different definitions: An area for study, research, policy and practice on health issues that transcend borders and require international cooperation with a focus on population health in low- and middle-income countries.

global health issues

• Emerging and re-emerging infectious diseases

• Antimicrobial resistance

• Eradication of polio

• TB

• Malaria

• HIV

• The increasing prevalence of diabetes and heart disease globally

essential global health concepts

• Determinants of health

• Key risk factors for different health conditions

• Global burden of disease

• Measurement of health status

• Importance of culture to health

• Demographic and epidemiologic transitions

• Organization and function of health systems

• Links among health, education, poverty, equity and the political economy of health

Cross sectional issues in global health

• Environmental health and climate change

• Nutrition and food security

• Women’s health and sexual and reproductive health (SRH)

• Child and adolescent health

• Humanitarian health

• Health, human rights and social justice

Urgent health challenges for the next decade

• Elevating health in the climate debate

• Delivering health in conflict and crisis

• Making health care fairer

• Expanding access to medicines

• Stopping Infectious diseases

• Preparing for epidemics

• Protecting people from dangerous products

• Investing in the people who defend our health

• Keeping adolescents safe

• Earning public trust

• Harnessing new technologies

• Protecting the medicines that protect us (AMR)

• Keeping Health care clean (1/4 lack WASH)

One health

The integrative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, and the environment.

Planetary health

Planetary Health, in simple terms, is the idea that human health and the health of the planet are directly linked — you can't have one without the other.

It has two connected parts:

1. The human side — Are we running our political, economic, and social systems in ways that let people everywhere reach the best possible health, well-being, and fairness?

2. The natural side — Are we staying within the Earth's environmental limits (clean air, stable climate, functioning ecosystems) that make human life possible in the first place?Planetary health is the achievement of the highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the human systems—political, economic, and social—that shape the future of humanity and the Earth’s natural systems that define the safe environmental limits within which humanity can flourish. Put simply, planetary health is the health of human civilisation and the state of the natural systems on which it depends.

planetary health = the health of human civilization and the health of the natural systems we depend on. If we damage the planet's natural systems past a safe point, human health eventually suffers too — so the two have to be managed together, not separately.

Planetary health is the achievement of the highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the human systems—political, economic, and social—that shape the future of humanity and the Earth’s natural systems that define the safe environmental limits within which humanity can flourish. Put simply, planetary health is the health of human civilisation and the state of the natural systems on which it depends. 2

One health vs planetary health

It may be helpful to think of One Health as focusing on the interconnectedness of animal, human, and environmental health; whereas Planetary Health has a greater focus on the health of the environment and the connections between that and human and animal well-being

World Bank Regions (7)

• East Asia and Pacific

• Europe and Central Asia

• Latin America and the Caribbean

• Middle East and North Africa

• North America

• South Asia

• Sub-Saharan Africa

WHO 6 regions

• Africa

• The Americas

• Southeast Asia

• Europe

• Eastern Mediterranean

• Western Pacific

World Bank 4 Income groups

• Low-income economies ($1,035 or less)

• Lower middle-income economies ($1,036 and $4,045)

• Upper middle-income economies ($4.046 and $12,535)

• High-income economies ($12,536 or more)

Low-income countries

• Afghanistan

• Ethiopia

• Haiti

• Mozambique

• Neal

• Zimbabwe

Lower Middle-Income countries

• Bangladesh

• Bolivia

• Cameroon

• Egypt

• India

• Morocco

• Philippines

• Swaziland

Upper-Middle-Income

• Botswana

• Costa Rica

• Jamaica

• South Africa

• Turkey

• Venezuela

High-Income

• Argentina

• Belgium

• Canada

• Denmark

• Italy

• Netherlands

• Portugal

• Singapore

SDGs

• Formulated in 2015

• 17 SDGs

• Countries that signed pledged to meet goals by 2030

• All relate to health, whether directly or indirectly

What are the 17 SGDs

• no poverty

• zero hunger

• good health and well-being

• quality education

• gender equality

• clean water and sanitation

• affordable and clean energy

• decent work and economic growth

• industry, innovation, and infrastructure

• reduced inequalities

• sustainable cities and communities

• responsible consumption and production

• climate action

• life below water

• life on land

• peace, justice, and strong institutions

• partnerships for the goals

Central messages of this chapter

• Strong links among health, human development, labor productivity, and economic development

• Health status determined by variety of factors

• Enormous progress in improving health status over last 50 years

• Much progress is the result of public hygiene, better water and sanitation, and better education

• Enormous disparities in health status and access to health services within and across countries

• Some health problems can only be solved through “international cooperation”.  Examples?

• Each of us should be concerned with the health of others for humanitarian, personal health, as well as for economic and security reasons.

• People and communities have the ability to enhance their own health status; what is often missing is the capacity.

• Low-income countries should focus on
  “…burying old people, instead of young people, making the transition as fast as possible, and doing so at least cost”

• The health goals for all countries are to enable their people to enjoy the maximum possible health at the least cost and in fairly  distributed ways.

Small Pox eradication

• Background: 1966 — smallpox in 50+ countries, ~10–15M cases/year, ~2M deaths/year, up to 30% fatality.

• Intervention: Enabled by mass-producible heat-stable vaccine + bifurcated needle (cheap, reusable, easy to use). WHO campaign launched 1959, gained real traction in 1965 with U.S. support; used a "search and containment" strategy (ring vaccination) rather than trying to vaccinate everyone.

• Impact: Eliminated in Latin America (1971), Asia (1975); last natural case in Somalia (1977); declared eradicated in 1980 — first disease ever eradicated.

• Costs/benefits: ~$23M/year (1967–79); total ~$298M from donors + endemic countries combined; U.S. recoups its entire investment every 26 days in avoided vaccination/treatment costs.

• Lessons learned: strong leadership/partnership (WHO + CDC), dedicated in-country staff, flexibility, monitoring, community participation, publicity driving donations, and side benefit of building routine immunization systems.

• Why smallpox was eradicable: no animal reservoir, direct transmission only, easy-to-spot rash, lifetime immunity in survivors, severe symptoms limited spread — features not shared by every disease (hence not every disease is a good eradication candidate).