HS 325 - Week 3 Lectures & Readings

Debate against disease eradication

Detraction from other priorities

evolution of pathogens and risks of bioterrorism

high costs in non-endemic industrialized countries

Rinderpest

an acute infectious viral disease of cattle (usually fatal)

Declaration of Alma Ata

Emphasized and built on the success of ground-level systems of basic health care and preventive medicine (CHW).

identified primary health care as the key to the attainment of the goal of Health for All

Tightly and carefully worded.

Epidemiology

Quantitative field that studies the distribution of health conditions in a population.

Descriptive epidemiology

Describes the distribution of cases (people who got sick) in regard to person, places and time

Analytic epidemiology

examines distribution of cases in relation to exposure to determine the CAUSE of an outbreak/disease cluster.

Necessary cause

a condition that must be present for the effect to occur

Sufficient cause

a cause that can produce the effect in question, but is not the cause necessary for the effect to happen

Contributory cause

increases the probability of developing an effect, not necessary for the effect to occur

Proximate cause

Direct, immediate triggers of an event or outcome. In a medical context, could be a specific infectious agent or a direct biological interaction leading to illness.

Distal cause

Higher-level, underlying factors that influence the proximal causes. Example: could be societal issues like lack of access to healthcare or inadequate living conditions that make individuals more vulnerable to illness.

Sir Bradford Hill's Criteria of Causation

Temporality (cause precedes event), plausibility, consistency, strength of association, dose-response, reversibility, study design, evidence

T/F: cigarette smoking is one of the largest preventable causes of death today

True! Stop with the cigarettes people. It's killing yall and it's preventable!

Alice Stewart

revealed that medical X-rays of pregnant women doubled the risk of childhood leukemia and other cancers in their fetuses and children.

Her landmark study, the Oxford Survey of Childhood Cancers, faced initial skepticism from the medical establishment but was later widely accepted, leading to changes in radiological safety standards and recommendations against routine prenatal X-ray use.

Richard Doll

• A pioneer in research linking smoking to health problems.

• Praised for his discoveries even though he was involved with bribery from the companies he claimed were causing cancer.

• Better legacy than Alice (#sexistmuch??)

Morbidity

illness. Refers to people who are sickened or injured by a particular health problem.

Mortality

Death. Refers to people who are killed by a particular health problem.

Burden of disease

Involves counting the # of people affected by different health issues.

Infectious diseases

Cause by pathogens like viruses and bacteria and are transmitted person-to-person. Primarily concentrated in areas of POVERTY

chronic diseases

Caused by factors like diet and environment rather than by pathogens. Can involve long period of morbidity prior to death (measured in DALYs lost). Common in rich and poor countries.

Injuries

Includes accidents as well as intentional injuries (murder and assault). Children are especially vulnerable.

T/F: road traffic accidents are major global contributors to morbidity and mortality

True, road traffic accidents are injuries that are major global contributors to morbidity and mortality

DALYs (disability-adjusted life years)

Measure of overall disease burden. How many years of healthy life were lost to a given health issue. Considers years of life lost due to death (mortality) AND the BURDEN OF LIVING W/ A DISABILITY (morbidity).

DALY calculated

YLL (years of life lost) + YLD (years lived with disability)

• cumulative # of years lost due to ill-health.

Mental health conditions

Historically deprioritized in global health work. Significant cross-cultural variance in presentation. Significant contributor to MORBIDITY GLOBALLY.

What 2 mental health conditions are consistently found across societies?

Depression and schizophrenia

Incidence

How many new cases occur during a given period of time

Prevalence

Gives insight into the total burden of disease (includes new + existing cases).

Mortality rate

Measures death. Cause-specific = due to a specific cause. Case fatality ratio = proportion of those infected that die due to a specific cause.

Fertility rate

the average number of children a woman of childbearing years would have in her lifetime, if she had children at the current rate for her country

Why are health status indicators useful?

Finding which disease people suffer from, determining the extent to which the disease causes death/disability, practicing disease surveillance.

HIV in Africa...

...remains the continent with the highest burden of HIV infection globally

Low SDI countries and global causes of death

the primary causes of death in recent years have included communicable diseases like lower respiratory infections, diarrhoeal diseases, and HIV/AIDS, although NCDs are an increasing burden.

LMIC countries and global causes of death

noncommunicable diseases such as cardiovascular diseases, cancers, and chronic respiratory diseases are the leading causes of death globally and significantly impact these countries

Classic Demographic Transition Model

describes a 4-stage shift from high birth and death rates to low birth and death rates in a society as it industrializes, resulting in a period of rapid population growth followed by a slowdown and stabilization.

Stage 1 classic demographic transition model

Pre-industrial, both birth and death rates are high and relatively equal. Population growth is slow, fluctuating due to factors like disease and famine.

Stage 2 classic demographic transition model

Death rates begin to decline due to improved sanitation and healthcare. Birth rates remain high, leading to rapid population growth.

Stage 3 classic demographic transition model

Birth rates start to fall due to factors like urbanization, increased education (especially for women), and access to family planning. Population growth slows as birth and death rates become more balanced

Stage 4 classic demographic transition model

Both birth and death rates are low and stabilize. Population growth slows to zero or becomes very minimal.

cost effective analysis

Compares the costs of a given health intervention to the impacts of that intervention on a health outcome (cost per DALY averted).

The demographic transition is closely related to the ______ transition

Epidemiologic

Neolithic Revolution -> 19th century Europe

Agriculture, dense population, less diverse diet, close animal contact → worse health and increased infectious diseases

SHIFT

socioeconomic changes. → decreased ID, increased life expectancy, and chronic diseases

2nd epidemiological transition

Industrialization, death rates fell, birth rates fell, resulting in a rapid rise in population that then levels odd. Poor nations population increased and death rates increased.

Epidemiologic Transition

The process of change in the distinctive causes of death in each stage of the demographic transition

Double burden of disease

when conditions associated with both poverty and wealth exist side-by -side in one community, such as undernutrition and obesity

3rd epidemiological transition

Post industrial world. Spread of infectious diseases, evolution of ANTIBIOTIC RESISTANT STRAINS OF DISEASE.

The leading cause of death in the United States is

Ischemic heart disease (including heart attacks) followed by strokes, lower respiratory diseases, neonatal preterm birth complications, and diarrheal diseases.

Top causes of DALYs

Cardiovascular disease, diarrhea, neoplasms

A disease with a high DALY ranking btw low YLL count is characterized by a...

...significant long-term non-fatal burden of a population

Metrics to guide global health decision making

• What works (and what doesn't), and what is cost-effective.

• Use epidemiological/economic evidence to make decisions, requires good data and some agreement about the goals of global health.

10 global health best buys

• child immunization

• monitor children to treat malaria/diarrhea/ pneumonia

• tax tobacco produce to reduce rates of cardiovascular/respiratory disease/cancer

• prevent HIV via promoting condom use/treating concurrent STIs/providing antiretroviral drugs to HIV/providing antiretroviral drugs to HIV

• give children/pregnant women essential nutrients

• provide insecticide treated bed-nets/household spraying of insecticides/preventable treatment during pregnancy to reduce malaria

• enforce traffic regulations and add speed bumps at dangerous intersections

• treat TB patients w/ short term meds

• teach moms to keep newborns warm/clean

• promote the use of aspirin to prevent heart attacks

3 delays that lead to maternal mortality

Recognizing a need to seek care, reaching facilities, receiving care @ facilities.

Data is socially constructed, meaning...

It's created by humans, bonded by bias in sampling, changed by operational definitions, inflected by competing priorities, swayed by the fact that people lieee

Why was Blessing's death not counted?

She died in transit after leaving the clinic. Not @ the clinic. So she wasn't counted. If she was, the hospital would have doubled their death toll for that month cus they only had 1.

An intervention is cost effective per...

...DALY averted is less than the per capita GDP in a country