Global Health Final

What is health?

A state of complete physical, mental and social well-being

• not just in the absence of disease

What is public?

• concering people as a whole/people in general

  • whole area of a nation or state

• supported by public funds and private contributions (donations) rather then earning money through commercial and advertisements

  • helps to serve the publics interest

Public Health

• preventing disease, prolonging life, and promoting health and efficiency through organized community effort

• examines factors that impact peoples health not just individuals

  • change and improve factors through policies, programs and education

  • makes community healthier and reduces risk of disease for each person

• goal to create a cost-effective and equitable health system

  • support stron health systems

  • use resources wisely

  • treat people fairly

  • everyone regardless of socioeconomic status can access affordable anf effective healthcare + preventative services

Essential Public Health Services

• Assessment

  • public health collects and analyzes information to understand the health of a population

    • figuring out what health problems exist and why

• Policy Development

  • public health uses evidence and data to create solutions and guide decisions

    • deciding how to address the problem

• Assurance

  • public health ensures services and systems are in place and accessible to everyone

    • make sure people actually get the help they need

International Health

• focuses on health issues in other countries in comparison to ones own

  • stressing the differences between nations

global health

• an area of study that places a priority on improving health and achieving equity in health for all people worldwide

  • priority of improving health and achieving equity in health for all people worldwide

  • ignoring borders altogether and bridging gaps between needs and care

• focuses on addressing transational health issues

• promoting equity through diverse workforce which come from health and non-health backgrounds

  • studying and solving health problems that affect people in many different countries and crosses borders

  • using ideas from multiple fields

Transnational Determinants

• causes or influences that affect people beyond just one country

• affecting people everywhere

Measurement of global health to…

• understand disease trends

• evaluate effectiveness of interventions

• advocate for resources and investment

• measure impact

Prevalence

Porportion of individuals in a population who have the disease / the total population

Cumulative Incidence

number of new cases during the time period of interest / the number of individuals who are disease free during the time period

Mortality

• refers to deaths

• measures the number/rate of deaths

Morbidity

• refers to illness or disease

• measures the presence/rate of disease, disability or poor health

case fatalitiy

number of people dying with the disease / number of individuals with the disease

Life expectancy

• higher for women then men

• improvements of life expectancy have been large and global

• increases at all ages

YLLs and YLDs

• YLL - years of life lost due to death

• YLD - year of life lost due to living with a disability

DALYs

• disabiltiy adjusted life years

• years of life lost due to death + years of life lived with disability

Global Burden of Disease

• year of life with disability

  • year of life lived with less than ideal health

QALY

• quality adjusted life years

• idea of how many extra months or years of life with reasonable quality a person may be able to life due to treatments

• helps inform decisions regarding resource allocation

Communicable Diseases

• Infectious diseases that are caused by microorganisms such as bacteria, viruses, parasites, and fungi

• ex. HIV/AIDS, ebola, measles

Noncommunicable Diseases

• chronic diseases that are not passed person to person

• tend to be of long duration and result of genetic, physiological, environmental, behavioral factors

• Heart disease, diabetes, cancer, stroke

Injuries

• physical damage that results to the human body

• ex. road injuries, self harm

Equality vs Equity

• equality = everyone beneftis from the same support

  • equal treatment

• equity = everyone gets support based on own individual needs

Health Equity vs Inequity

• equity = all people can achieve optimal health

  • valuing everyone equally

  • rectifying justice

  • providing resources according to need

• inequity = differences in distribution of disease, illnesses, and death that are systematic and unjust

  • associated with imbalances in political power

  • large inequity exist between countries

Social Inequities of Health

• systematic differences in health between different social groups within society

• socially determined by circumstances beyond an individuals control

Health Disparities vs Health Inequalities

• Health disparities: differences and variations in health outcomes across groups

  • occur randomly/naturally

• health inequalities: differences in distribution of disease, illness, & death that are systemic & unjust

  • associated with imbalances in political power

structural inequities

• built in unfair systems —> not random

• systemic disadvantages to one social group compared to another

  • inequalities are deeply ingrained into society and become part of how they function —> normalized

• groups of people are consistently treated unfairly by the systems that shape society

  • healthcare, education, housing

Rudolf VIrchow

• german pathologist

• came back with a report not related to biology of the disease but on social circumstances that caused the outbreak

  • abolition of feudal privleges

  • greater level of democracy

Social Determinants of Health

• social, cultural, political, economic, commercial, and environmental factors that shape the conditions in which people are born, grow, live, work anf age

• affect people in different ways

• all woven together and reinforce one another

• can infleunce health and wellbeing in many ways and influence health behaviors

Health System

• all actors, organization, institutions, and resources that undertake health actions

Healthcare system vs Health Systems

• HealthCARE system: limited to personal healthcare services

• Health Systems: Encompass wider determinants of health

Components of HealthCARE system

• patients

• providers

• purchasers

• payers

• policymakers

Goals of Health System + 6 building blocks

• improve population health

  • provide health services

  • stewardship (govern, regulate, and oversee the system)

• respond to peoples needs and expectations

  • generate resources

• ensure fairness in paying for healthcare

  • financial care (collect and spend money on health)

1. service delivery

2. health workforce

3. health information (data used to guide decisions)

4. medical products + technologies

5. health financing

6. leadership + governance

Health Financing

• mobilization

  • getting the money

  • raising funds for healthcare

• accumulation

  • pooling the money

  • collecting and saving money so it can be shared across the population

• allocation

  • spending the money

  • deciding how to use the money

Beveridge Model

• tax-financed health system

• government run national health service

  • funded by taxes

  • universal access based on citizenship

  • mostly public providers

  • free at point of use

• ex. UK and Spain

Bismark Model

• social insurance system

  • funded by mandatory contributions from workers and employers

  • health coverage is tied to employment

  • everyone pays based on income

  • care is based on need, not ability to pay

  • wealthier = healthier

    • help pay for others

• Ex. Germany

Single-payer model

• one government-run insurance program

• care delivered by public and private providers

• funded through taxes

• government pays bills sometimes (depending on if doctors/hospitals are private)

• Ex. Canada

Out-of-pocket/Private Model

• healthcare is treated as individual responsibility

• no universal national system

• people pay directly or buy private insurance

• Ex. United States

Core Elements of HealthCARE system

1. Cost/Financing

• balancing growing health needs with limited resources

2. quality (doing the right thing)

• how well health services improve health outcomes

3. access (getting care when needed)

• whether people can actually obtain the health services they need

  • affordability

  • availability

  • accommodation

  • accessibility

  • acceptability (patient comfort with providers)

Universal Health Coverage

• everyone gets health services they need without suffering financial hardship

  • covers all people

  • covers essential health services

  • protect people from high out-of-pocket costs

Universal Access

• people can use healthcare when needed

Spanish Healthcare System

• New Spanish Consitution (1978) gave all Spaniards the right to health protection and a regional organizational framework

• Use the Beveridge Model

  • people can get private insurance if they want for extra services

• high number of doctors, fewer nurses

• population mainly in cities and coastal areas

  • aging population

  • low birth and fertility rates

  • high immigration

• Major health issues

  • chronic diseases: cancer, heart disease, stroke, Alzheimers

  • Lifestyle Risks: smoking, poor diet, alcohol, low physical activity, air pollution

Famous Historical Pandemics

• black death

  • killed 75 million people

  • 1918 Spanish Flu

    • infected 1/3 of thw worlds pop.

    • killed up to 50 million people

Key Pandemic Terms

• Isolation - separates people who are sick

• quarantine - separates people who MIGHT be sick

Why Pandemics are more likely today

• global travel + trade have increase

• disease evolution

• climate change

  • new environments for disease spread and replicate in areas it may have not been able to before

    • higher populations

Cluster

group of cases in one area number may or may not be unusual

Outbreak

• sudden increase in cases of a disease

• limited to a small area or group

• short-term

• used for localized events

epidemic

• a larger increase in cases than expected

• affects a wider geographic area (ex. state) or populatoin

• lasts longer than an outbreak

• ex. seasonal flu

Pandemic

• epidemic that spreads across several countries/continents

  • 5 countries or more

Endemic

• the constant presence or usual prevalence of a disease in a given geographic area

  • becomes normal/common in a place

• ex. malaria

Why investigate Outbreaks?

• identify cause and stop spread

• severity and potential for spread

• public concern and political pressure

• availability of effective control measures

• improve scientific knowledge

Steps of Outbreak investigation

1. confirm

2. descrive

3. determine cause

4. control

1. confirm

• verify diagnosis and confirm outbreak exists

• peprare for fieldwork

• ask questions

  • are cases higher than usual

  • is there a cluster

  • is there an increase in actual numer of cases or due to improvement in diagnosis and surveillance methods?

• People involved in the outbreak identified by person, place or time.

• notifiable diseases.= any infectious illness that health providers are legally required to report to public health authorities

2. describe

• case definition = define and find cases

  • name

  • demographic data

  • risk factors and exposures

  • symptoms and signs

  • who reported the info

  • confirmed or pending lab results

Types of Cases

• suspected cases: person who has suspicion of having disease but not strong evidence or laboratory confirmation

• probable case: suspected case where there is strong evidence for infection

• confirmed case: there is a definite clinical confirmation that they are a case

Active vs Passive Surveillance

• Passive Surveillance: health authorities wait for reports

  • relies on routine reporting

  • used for notifiable diseases

• Active Surveillance: actively searching for cases

  • staff contacts hospitals, albs, or community

  • resource-intensive

  • used during outbreak investigation

Epidemic Curve

• shape of curve gives info about the source of the outbreak

• shows number of cases over time

  • source of outbreak

  • exposure period

• common point source: one-time exposure (sharp peak)

  • over a limited period of time (usually 1 incubation period)

• propogated source: person-to-person spread (multiple waves)

3. determinant cause

• develop hypothesis based on descriptive dsata

• test using analytical epidemiology

Case Control study: when population at risk is unknown

Retrospective Cohort Study: An acute outbreak that has a well defined population

4. Control

• control measures implemented in a way that interrupts one or more of the elements in the “chain of infection”

• isolation, quarantine, treatment, vaccination

• monitor situation and determine if prevention and control measures are working

What is reproductive health?

• complete state of physically, mentally and socially health in relation to the reproductive system

  • not just in the absence of disease

• implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce

  • have freedom to decide when and if they if they want to

Reproductive Health Issues

• menstruation

• sexual education

• sterilization

• pregnancy

• childbirth

• abortion

• contraception

Unintended Pregnancy & Abortions Worldwide

• unitended preganancy rate has decline from 1990-1994

• global abortion rate has decreased slightly between 1990-1994 and 2000-2004

  • has since returned to levels last seen in the 1990s

What is abortion?

• induced abortion is simple and common healthcare procedure

• almost half of all pregnancies are unintended

• abortion is safe when it is carried out using method recommended by WHO

• ensuring women and girls have access to abortion care is important

  • includes being safe, respectful and non-discriminatory

  • SDGs 3 & 5

Abortion Laws around the world

• abortions happen even where it is restricted

• unintended pregnancy rates are highest in countries that restrict abortion

  • lowest where is broadly legal

• in restricted countries abortion still occurs

  • proportion of untended pregnancies ending in abortion has increased

• in places where abortion is broadly legal abortion rates tend to decrease b/c of better access to contraception

The Global Tobbaco Epidemic

• tobacco use is one of the leading preventable causes of deaths worldwide

• tobacco industry continues to market aggressively especially in low-middle income countries

• overall smoking prevalence is decling but there is still more than 1 billion smokers in the world

  • tobacco linked to many health issues

  • tobacco killed over 8 million people/year

    • increases poverty bc of money spent on healthcare costs

Cigarette Consumption during the 20th Century

• smoking peaked globally in the mid-20th century

  • cigaretttes became mass produced and marketed as “modern” and “healthy”

• declined after 1960s

  • scientific evidence that linked smoking to cancer/heart disease

  • public health policies (warnings, labels, taxes, bans)

  • shifts in cultural attitudes

• Smoking declined in wealthier nations

  • tobacco companies expanded heavily into Asia, Africa, Eastern Europe, and Latin America

Cigarette Consumption in Spain

• Spain had high smoking rates particularly among men

• Cultural normalization after WWII

• decline in late 1990s

  • anti-smoking campaigns

  • public smoking bans

  • higher taxes

  • graphic warnings

• adult smoking prevalence is lower today

smoking among adolescence

• teens are major targets

  • most smokers begin before 18

• influencing factors include social pressure, marketing, e-cigs and vaping

• cigarette smoking among teens has decreased in many countries

  • vaping has rapidly increased esp. in North Africa and Europe

  • Nicotine is just shifting from cigs to vaping

Tobacco Health Effects

• 8.7 million due an early death due to tobacco use

• 7.7 million from direct tobacco use

• 1.3 million dying from second-hand smoke

• Causes respiratory system diseases + cancers

• increase the risk of getting/dying from tuberculosis and risk of becoming diabetic

Why do people smoke?

• In early adolescence

  • desire to assert adulthood

  • low self-esteem, poor academic achievement and who are overweight

  • family structure, parental occupations and deprivation

• Chemical dependency reinforced by social factors

  • emotional state, personal beliefs and resources, habit and chemical dependency, global and local capital markets

• related to socioeconomic status as well

  • influences to quit as well

• nicotine is very addicting

Targeted Advertising

• tobacco advertising is more prevalent in low income and ethnic minority neighborhoods

Social Norms

• smoking appears as expressing identity and belonging

  • helps to bind people together

smoke-free environments

• effective smoke-free polcies save lives by…

  • denormalizing smoking

  • inspiring smoke-free homes

  • encouraging people to quit

  • preventing the initiation

MPOWER

• Monitor (tobacco use and prevention policies)

• Protect (people from tobacco smoke)

• Offer (help to quit tobacco use)

• Warn (about the dangers of tobacco)

• Enforce (bans on tobacco advertising, promotion, and sponsorship)

• Raise (taxes on tobacco) 

Tobacco Industry Interference

• munipulating research and science

  • fund biased studies to promote tobacco use

• influencing public opinion

  • uses front groups and third parties to appear credible

  • leverage social media and sponsored events

  • runs ineffective youth anti-tabacco campaigns

• economic & policy manipulation

  • misrepresents costs of regulation

  • diverts attention to less effective tobacco control measures

  • intimidates gov. and exploits legal loophols

• legal and campaign tactics

  • uses litigation to delay or block policies

  • runs campaigns to undermine public health measures

Drivers of Diabetes

• social norms and values

  • cultural habits and belieds affect what people eat and how active they are

• sectors of influence

  • government - policies and regulations

  • land use and community design

    • access to healthy foods and places for physical activity

  • media and advertising

  • public health and educaiton

  • social safety net

    • support for low-income populations

• behavioiral settings

  • schools, healthcare, communties

    • where habits form and are reinforced

• individual facots

  • personal knowledge, preferences, lifestyle choices and biology

Policy Intevention: Sugar Taxes

• taxing sugar-sweetened beverages can reduce consumption and help lower obesity and diabetes rates

  • SSBs =soft drinks, enhanced water, sweetened drinks, energy drinks

• Challenges

  • some people feel government regulation limits personal choice

    • healthier options are more expensive

    • sugar drinks are more accessible and convenient

Urbanization

• urban population has been rising in Spain

  • rural areas stay the same but decrease over time

• Half the worlds population living in urban areas

• urbanization invovles migration, natural growth, and reclassification

Oppurtunities & Challenges in Urban Areas

• opportunities

  • more jobs and economic opportunities

  • better access to health care —> long life expectancy

• Challenges

  • higher density = more pollution

  • increased violence and social inequality

  • health disparities between richer and poorer areas

Neighborhood & Health

• neighborhood = area people are willing to travel for daily activities

  • size varies by population

  • density of unhealthy food stores affects local diet

  • walkability

  • low socioeconomic status

    • rely more on public transportation

Compositional Effects

characteristics of individuals in the neighborhood

• income, education, behaviors

Contextual Effects

• characteristics of the neighborhood itself

  • infrastructure, services, pollution, social environment

Greenhouse Gas Effect

• natural process where gases in the atm. trap heat to keep Earth warm

• Human activities add more gases —> more heat trapped —> climate change

Climate Change

• Earths atm. acts like a blanket trapping heat

  • leads to hurricanes, rising sea levels, fires/droughts, irregular weather patterns

Climate Change and Human Health

Direct impacts

• heat realted illnesses

• increased sea levels —> flooding

• extreme weather events —> injurires

• water and food borne diseases

Indirect Impacts

• reduced agricutlure —> food insecurity

• mass migration —> overcrowding, poor sanitation

• Civil unrest and socio-economic instability

Disease Spread

• warmer climates expand habitats for vectors —> more infectious diseases

Climate Change Affect on Health

Climate change —> environmental changes —> direct exposures —> strain on social infrastructure —> health systems response —> health outcomes

Determinants of Vunerabiltiy

• exposure

  • level of contact with climate hazards

  • low-income pop = more exposed

• sensitivity

  • how affected someone is

  • ex. pregnant women

• Ability to adapt

  • capacity to reduce harm

  • ex. older people less able to

Mitigation

actions to reduce cliamte change

ex. reduce emissions, create walkable cities

adaptation

actions to adjust to climate impacts

ex. build sea wall, emergency prepardness

Global Action: Paris Agreement

• Goal: limit global temperature rise to below 2 degrees Celcius

• stregthen countries abilities to adapt and build climate resilience

• encourage low-emission development