Exam 1 Zambia

LDC

Least Developed Countries

LIC

Lowest income countries

LMIC

lower-middle income countries

HIC

High income countries

OECD

Industrialized countries

• Organization for Economic Cooperation and development “country club of Nations”

Catorgizing countries

In the course, the, use of low-income is even though called “Developing world.”

Currently favored term is Global South (be

Gross National Income

Gross National income is the value of income also called output or national output, produced by a countrys residents (both citizens and foreign residents) Within its geographical borders, plus net receipts of income (wages, salary, and property income) from abrad

Inshort, GNI is a measure of all moeny, goods, services and investments that come into or stay in the country

Zambia (Bank Income Groups) vs USA

Lower- Middle and High

Global income

Gross National Income per Capita:

• Low income and lower middle income countries also are teh Least Developed Countries, and they have the lowest health

Developed defintion

What shall I eat? raither than Will I eat?

Preamble to the WHO Constitution of 1948

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

(Messiah Revision) Health is a state of complete physical, mental, social, and spiritual well-being and not merely the absence of disease or infirmity

Global health

A field of acedemic study, research, and applied practice that seeks to improve population health world wide

Global two meanings

• Worldwide

• Comprehensive

Public Health is

Population focused efforts

Global health initiatives

aim to improve health at the population level

Population health

Encompasses health outcomes and determinants of health in groups and humans at the community, regional, national, and/or wworldwide level

Population

Can be a group of individuals, communities, nations, or other entities

Determinants of health

• Individual behaviors

• Population -based intervetnions enanle idividuals to adopt healthier behaviors

• Improving outcomes of individuals improves the overall health status of their communities

• Addressing political and environmental factors may be more complete

Complete lifespan focus

conception to healthy birth, through to gentle, agony-free death

Ideal health

Countries with High income

can afford high income interventions

Public health vs Medicine

Public Health: Population, Public service, Disease prevention and health promotion for communities, Broad spectrum that may target the environment, human behavior, lifestyle, and medical care

Medicine: Individual, personal service, Disease diagnosis, treatment, and care for individuals, Emphasis on medical care

Motto of John hopkins Bloomberg School of Public Health

Protexting Health, Saving Lives- Millions at a time

Medicine is the practice of

Preventing, diagnosing, and treating health problems in individuals and families

Intervention, treatment of existing problems

Public Health encompasses

The actions taken at the population level to promote health and prevent illnesses, injuries, and early deaths

Emphasizes on prevention

P.A.C.E.S

Populations- (focuses on Preventable deaths)

Action- (Prevent illness)

Cooperation- (Prevent)

Equity- (Prioritizing the needs of low income)

Security-

Risk Factor

an exposure that increases the likelihood of experiencing a particular health outcome

Major Risk Factor DOES NOT EQUAL major cause of death

Health Transition

A health transition is a shift in the health status of a population that usually occurs in conjuction with socioeconomic development

One hundered years ago (health transitions)

Most populations across the globe had similar health profiles: high birth rates high chold mortality rates, short life expectancies, and a considerable proportion of illnesses and deaths due to infections and undernutrition

During the 20th century (Health transitions)

high income nation transitioned to having longer life expectancies and lower rates of infection and chronic hunger

Gaps in Health equity have

Increased

Health → wealth

Globalization

Process of countries around the world becoming more integrated and interdependent across economic, political, cultural, and other domains

Can be both good and bad

Globalization contributes to…

favorable and unfacorable health transitions,

• Increasing access to health technologies

• encouraging urbanization

• Changing social and cultural practives

• Accelerating environmental changes

• Exploitation ( can also happen)

Global Health security

• Public health interventions protect populations from threats to health and safety

• Implemented by governmental and military personnel in collaboration with other stakeholders

• Countries participating in global health activities reap the benefits of self-protection in addition to the humanitarian gains and goodwill that these activities may generate

Example: Pandemic preparedness and response capabilities

Funding in health interventions

Funding available for health interventions is limited

Advocates for various health problems and solutions

must compete for attention and support, and only the proposals that garner buy-in from well resourced groups are able to move forward

Funding agencies

Each funding agency applies its own criteria for the types of activities that it will support

Priotitization based on

• Burden of Disease for/ of particular condition

• Statistics: Causal conditions and prevalence

Best Buys

• Help many people make meaningful gains in health status

• Low cost per person or at a low cost per adverse event averted by the intervention

In general, low-cost primary prevention activities are the most cost-effective interventions

Millennium Development Goals (MDGs)

• established in 2000 to be achieved by 2015

• Eight Goals with 15 targets

• To fight AIDS, TB, and Malaria

MDGs

• Eradicate extreme poverty and hunger

• Achieve universal primary education

• Promote gender equlity and empower women

• Reduce child mortality

• Inprove matemal health

• Combat HIV/AIDS, malaria and othe r diseases

• Ensure environmental sustainablitliy

• Develop a global partnership for development

Focus on MDGs

• Half of extreme poverty and hunger: 1.2 billion people still live on less than $1 a day. (1/2)

• Reduce Under-Five Mortality by Two-thirds (2/3)

• Reduce maternal mortality by three-quarters (3/4)

• Reverse the spread of diseases, especially HIV/ AIDS and Malaria

Sustainable Development Goels (SDGs)

• 2015

• Seventeen Goals (169 targets

• meet goals by 2030

All realte to health; directly or indirectly

SDG Goals

• Mixed goals for poverty reduction with other targets

• SDGs treat health as both a necessary prerequisite for and an outcome of economic growth

• Two of the 17 SDGs focus specifically on health (SDG 3) and nutrition (SDG 2)

• using 2015 levels as benchmarks

SDG 3

Good health and Well-beig

SDG #2

Zero hunger

Eradicate

• world-wide elimination

• Cannot return

Smallpox

Eliminate

• controlled well in a defined geographic area

• Sufficiently to prevent epidemic

example Polio

1998 Pediatric Mortality Macha Mission hospital

Total Deaths= 192

• 30.13%

2005 Mach childrens ward deaths

Malaria 7%

Anteatal

Pre-natal

Perinatal services

Pregnacy- 1 year

Post Patum services

delivery - 6/8 weeks

Vital Statistics

Population level quantifications

• Birthds

• Deaths

• Other relevatn and useful life events

• Numbered affects by disease/ disorder

Vital registrationsystems

• Births

• Deaths

• Casuse of death

Important Health indicators

• Infant Mortality rate

• Under Five Mortality rate

Infant Mortality Rate

Number of deaths of infants under age 1 per 1,000 live births in that year

Life expectancy at birth

Average number of years a newborn baby could expect to live if current mortality trends continue for the rest of teh newborn’s life

Maternal morality rate

Number of women who die as a reslut of pregancy and childbirth complication per 100,000 live births in a given year

Neonatal mortality rate

Number of death of infants under 28 days in a given year per 1,000 lives births in that year

Under 5 mortality rate (child mortality rate)

Probability that a newborn baby will die before reaching age 5, expressed as a number per 1,000 live births

Birth rate (annual cride live birth rate)

Number of births occurring in a defined population during a year/ number of people in that population at midyear of the same year

• Times Hungry

• You NEED an accurate census

Mortality

Easier tomeasure the diseases

• 98% of all children deaths

Verbal Autopsy

look and say what it is

Infant Mortality rate (annual infant mortality rate, IMR)

Number of deaths under one year of age in a defined population during a year / Number of live births occurring in that population during the same year

Times 1,000

• It is widely accepted as a good indicator of the health at the POPULATION level

Live birth

is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after such separation, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not theumbilical cord has been cut or the placenta isattached; each product of such a birth isconsidered live-born regardless of gestational age

Zambia IMR vs USA IMR

• 36.6 (2023)

• 4.9 (2023)

Under five mortality rate (U5MR)

Number of deaths under five years of age in a defined population during a year / Number of live births occurring in that population during the same year

• 1,000

Maternal mortality Ratio

Number of death from pregnacy (childbirth) in a defined population during a year / 100,000 live births in that population during the same year

Incidence

Used to indicate the burden of a disease over time (usually one year)

The number of new cases of a condition occurring in a defined population (in a year) / Number in that population at midyear of the same year

• K

Prevalence (or Point Prevalences)

Indicates burden of disease as a onetime “snap-shot”

Number of cases of a specified condition existing in a defined population at a particular point in time / Number in that population at the same point in time

• times K

Epidemiology

• Concept of “age or population pyramids”

• These help us understand population growth and what factors may influence population growth

• Allow for early recognition of changes in life expectancy

Morbidity

Effect by disease

YLL

Years of life lost due to premature mortality

YLD

Years lived with disability

DALY

Disability-adjusted like year

• Deaths before old age

• Nonfatal cause of reduced health status

QALY

Quality-adjusted life year

• Positive metric

• Used to measure effectiveness of interventions

Personal level

• genes

• Gender

• age

• social

• environment

• educational level

• Health practives and behaviors

• health care service availability

Populations are healthiest when

The ability of their members to be healthy is not inhibited by income level, educational level, gender, employment, race, ethnicity, immigration status, or other socioeconomic and political factors.

The Goal of health equity is to:

• Reduce the health disparities between low and high-income population

• While improving health status in all population groups

Socioeconomic Status (SES) of Socioeconomic Position (SEP)

• Individuals standing in a society

• Based on individual and houshold income, education, gender, occupation, ethnicity and race, and other characteristics

Individuals

Much variability in health status

Populations and SES

Lower SES populations have significatnly lower heatlh status

Health equity principle

Everone should have an equal opportunity to be as healthy as possible

Social determinants of health

• Personal factors and community conditions that enable or hinder access to health

• Summarized by the acronym Progress

PROGRESS

• Place of residence

• Race and ethnicity

• Occupation and employment status

• Gender and sex

• Religion

• Education

• Social capital

• Other (Socioeconomic indicators)

Social Justice Principle

Moving toward greater equality in the distribution of income and wealth, opportunities for education and employment, access to health and security, and involvement in civic and political activities is valuable for human flourishing

Health inequality (real disparity)

Difference between groups; can be remedied

Health inequity

Whent the differnce remains due to unjust/ unfair circulstance

Globalism

Can exacerbate difference and provide opportunities

• all benefit via cooperation

Guiding Thesis of Health Equity

When the health status of lower-income countries improves, those health equity gains yield benefits for overall world health

Socioeconomic Determinants

• Economics

• Education

• Gender / sex

• Employment

• Culture (views related to health)

• Discrimination

• Movement / Immigration Status (Migrants, Refugees, Internally Displaced Persons

• Governments

Income is the

amount of take home pay

wealth is the

accumulated worth of a household resources

Extreme poverty

less then $3

Decreased from 35% in 1990 to 10% in 2025

Relative poverty

occurs when people are living on less than the nationally defined poverty line in their own countries

Multidimensional Poverty Index (MPI)

• United Nations Development Programme

• Index captures various dimensions of poverty

• MPI increases proportion of people classified as living in poverty in lower income countries