Global Health Module 3

Global Burden of Disease (GBD)

Global Burden of Disease (GBD)

A measure of total health loss from hundreds of diseases and injuries that provides insight into the health status of different populations throughout the world.

Communicable, maternal, neonatal, perinatal and nutritional Disorders (GBD)

Represents 2 out of every 10 deaths that occur globally

These conditions occur largely in low-income populations due to inadequate access to healthcare, particularly preventative care.

Although the global death rate is estimated at 20%, the rate is 50% is low socio-demographic indes (SDI) regions and only 5% in high SDI regions

Non-Communicable Diseases (NCD) - (GBD)

Account for about 7 out of 10 deaths globally. This means that out of the 3 health categories the majority of deaths are due to noncommunicable diseases. Many of the lower SDI countries do not have a rate this high. In 2019 NCDs were responsible for 41% of deaths in low S D I regions, and 88% in high SDI regions.

Injuries (GBD)

Represent roughly 1 in 10 deaths that occur globally.

This category represents the largest difference between the sexes, with injuries accounting for 12% of overall male deaths and 6% of female deaths in 2019.

SDI

Combines 3 predictive outcomes

1) average income 2) ferility 3) education

DALY that is used as a measure of GBD

Disability Adjusted Life Years (DALY) is a measure of overall disease burden, which is expressed as the cumulative number of years lost due to ill-health, disability, or early death.

Years Lived with Disability (YLD)

YLD multiplies the number of years a person has a condition that affects their quality of life. Each condition has a weighting factor between 0 and 1, 0 being perfect health and 1 being death. The rating is indicative of the degree to which a disease negatively impacts an individual’s life.

Years of Life Lost (YLL)

The second component of the DALY measure. This measure of premature mortality has two defining characteristics

Y L L = (# of Deaths) x (Life Expectancy - Age of Death

Ultimately, the Y L L equation places more weight on illnesses that result in early mortality because dying young has a bigger impact on both the individual and society at large

Communicable diseases what are they?

Communicable diseases spread from one person to another, from an animal, or even the environment, to a person. Typically this occurs through airborne droplets or bodily fluids containing a virus, bacterium, or parasite. Nutritional, maternal, and neonatal conditions are often grouped with communicable diseases in the study of GBD

Burden of Communicable Diseases

Communicable diseases such as H I V, tuberculosis, and malaria, present a significant burden for low income countries (over 50% of total DALYs in some Low S D I countries) but less than 10% for high income countries. You will often see these three diseases called “the big three”

HIV Brief

Globally, 38 million people are living with HIV as of 2019, 19% of which are unaware of their status.

Over 68,000 individuals are currently living with HIV in Canada, 14% of whom are unaware of their HIV status.

Tuberculosis Brief

In 2019, 10 million people contracted T B worldwide. In Canada there were 1,796 cases of active tuberculosis reported. Two populations - foreign-born individuals and Indigenous Peoples - accounted for the majority of cases.

Malaria Brief

In 2019, there were an estimated number of 229 million cases of malaria worldwide. The Canadian infectious disease surveillance system has reported an average of 538 malaria cases per year since 1990, and Statistics Canada reported an average of one death per year.

What is HIV and how does it work?

HIV is a disease that attacks the body’s white blood cells and weakens the body’s immune system. By the end of 2019, there were 38 million people in the world living with H I V with only 67% of them having access to antiretroviral therapy. In 2019, 690 000 people lost their lives to H I V, while 1.7 million new infections were diagnosed. To date, H I V has taken 33 million lives, making it one of the major global public health issues.

Mechanism of Action: H I V infects white blood cells called helper T cells destroying them over time and eventually causing Acquired Immunodeficiency Syndrome (AIDS).

Transmission: H I V is spread from person to person via bodily fluids (i.e. semen, vaginal fluids, blood, and, to a lesser degree, breast milk).

Treatment and Prevention: H I V is typically treated using antiretroviral therapy (ART), which can greatly prolong life and suppress symptoms, but does not cure the disease.

Prevention strategies for H I V include:

• Single condom use

• Elimination of mother-to-child spread with A R T during pregnancy and breastfeeding

• Testing and counselling services

• Harm reduction for people who use drugs, including needle and syringe programs

HIV among Indigenous Canadians

Social and economic factors have placed the Indigenous peoples in Canada at a higher risk of HIV/AIDS compared to non-Indigenous Canadians. In 2017, Indigenous Peoples accounted for only 4.9% of Canada’s total population, yet made up 20.1% of total H I V cases.

Socioeconomic factors that may contribute to the increase the risk of H I V/AIDS in Indigenous Peoples include domestic violence, stigma, discrimination, and injection drug use. Additionally, the mistrust and lack of health services further perpetuates poor HIV and health outcomes within this population

HIV risk factors among Indigenous Canadians

Among the total Indigenous population, Indigenous youth are at a greater risk of contracting HIV/AIDs. Unfortunately, a lack of health education services and denial of this crisis has resulted in a low perceived risk of the virus in youth.

Furthermore, substance use, particularly injection drug use, is strongly associated with H I V infection among Indigenous youth in Canada. Indigenous youth report a higher likelihood of sharing equipment and less access to risk reduction programs such as methadone clinics or needle-exchange programs, putting this population at 22 times more at risk of H I V than the general population

Barriers to substance use harm reduction programs

Barriers to receiving methadone treatments includes the lack of on-site methadone treatment and the need to travel to off-site methadone programs. This would mean long distance travelling and a lack of counselling and support for these Indigenous methadone patients.

Not only do Indigenous Peoples have lower access to risk reduction programs, many Indigenous communities also have a stigma around treatment programs. In a 2016 study conducted with members of the First Nations communities in New Brunswick, Canada, it was found that abstinence based therapy is the preferred treatment method. This is because many members of the communities view methadone treatments as “replacing one drug with another”. This stigma developed due to the lack of health education services and access to information regarding medication-assisted treatment in these communities. Those who have participated in the methadone treatment programs have reported experiencing discriminatory behaviours from others in the community.

Canadian Aboriginal Aids Network (CAAN)

Fortunately, there are programs and services being created with a holistic approach to HIV and AIDS, other communicable diseases, and co-morbidity issues. One such service is the Canadian Aboriginal Aids Network (C A A N), which is a not-for-profit established in 1997 that represents over 340 member organizations and individuals to ensure access to H I V and AIDS related services.

The CAAN promotes a Social Determinants of Health Framework through advocacy, and provides accurate and up to date resources on these issues in a culturally relevant manner for Aboriginal Peoples wherever they reside.

What is Tuberculosis and how does it work?

Tuberculosis (T B) is caused by Mycobacterium tuberculosis; a bacterium that has infected one quarter of the world’s population. However, only 5-15% of those infected will develop an active T B infection. The risk is higher in people with a compromised immune system, such as those who are malnourished or co-infected with HIV. In 2019, T B infected 10 million people and was responsible for 1.4 million deaths

Mechanism of Action: TB usually attacks the lungs (pulmonary), but can also affect other parts of the body (extra-pulmonary), including lymph nodes, kidneys, urinary tract, and bones. When an individual has M. tuberculosis bacteria in their body but does not feel sick or show symptoms, they have latent TB (LTB). If LTB goes untreated, approximately 5-10% of infected individuals will develop active TB. Individuals with active TB show signs and symptoms, and are considered infectious.

Transmission: TB is primarily an airborne disease that is spread through the air from person to person. When a person with infectious TB coughs or sneezes, droplet nuclei containing M. tuberculosis are released into the air and if another person inhales air containing these droplet nuclei, they may become infected.

Treatment and Prevention: LTB can be treated and cured with antibiotics as a means to prevent active TB from developing. When individuals have active T B, they have to take multiple antibiotics for 6-9 months to kill all the bacteria (compared to 3-4 months for latent infection). Like with any other antibiotic treatment, there is variable adherence, with many individuals stopping the antibiotics early. Such behaviour has caused drug resistance to become a major global health concern. If someone is exposed to or infected by an individual with multi-drug resistant TB(MDRTB), preventative treatment may not be an option.

TB among Indigenous Canadians

Indigenous communities have struggled with high and persistent TB infections rates. In most of Canada, the risks of developing active TB are low, however, amongst Indigenous communities the risks are much higher. For instance, TB infection rates among First Nations individuals living on reserve is more than 40 times that of the non-Indigenous Canadian population.

Indigenous individuals are at greater risk of contracting and developing active TB often due to lack of health promoting conditions. These conditions include living in overcrowded and poorly ventilated homes, lack of food security, and comorbidities such as diabetes, HIV, etc.

In response to the alarming TB rates among Indigenous Peoples in Canada, communities and governing bodies have taken action.

Steps aimed at reducing TB rates in Indigenous Communities

In early 2018, an explicit commitment was made to eliminate TB among Inuit in Inuit Nunangat by 2030, with an interim reduction in the reported rate of active TB of at least 50% by 2025. By the end of 2018, the Inuit Tapiriit Kanatami released an Inuit Tuberculosis Elimination Framework.

1) Enhance T B care and prevention programming

2) Reduce poverty, improve social determinants of health and create social equity

3) Empower and mobilize communities

4) Strengthen TB care and prevention capacity

5) Develop and implement Inuit specific solutions

6) Ensure accountability for TB elimination

What is Malaria and how does it work?

Malaria is caused by the parasite Plasmodium, which can be transmitted between humans by mosquitoes. Malaria is more prevalent but less deadly than H I V, with 229 million cases and 409 000 deaths in 2019. The W H O Africa region carries the greatest burden from malaria having 94% of all global cases in 2019, with six countries accounting for almost half of all deaths worldwide. These countries are: Nigeria, the Democratic Republic of the Congo, United Republic of Tanzania, Burkina Faso, Mozambique, and Niger. In 2019, children under five accounted for 67% of all malaria deaths worldwide.

Mechanism of Action: After a dormant period in the liver, Plasmodium enters the bloodstream and infects the red blood cells, often causing them to burst. There is also evidence that Plasmodium impairs the ability of key cells of the immune system to trigger an efficient immune response, which might explain why patients with malaria are susceptible to a wide range of other infections and fail to respond to several vaccines. Symptoms may include headache, abdominal pain, chills, shaking, fever, and sweats. Malaria can cause seizures, anemia, jaundice, heart failure, kidney failure, coma, and even death.

Transmission: Plasmodium is transmitted through mosquito bites that allow the parasite to enter the bloodstream.You cannot get malaria just by being near a person who has the disease.

Treatment and Prevention: Fortunately, malaria is curable using anti-malarial drugs, and preventable using insecticide-treated mosquito nets and indoor sprays.

Perceptions of Accessible Malaria Preventions

Insecticide-treated mosquito nets are one of the most effective prevention strategies for malaria, reducing infection up to 80% in some regions. However, access to these nets are the leading barrier to their use. Take some time to think about why, despite a proven effectiveness, some populations develop the discussed attitudes towards the prevention strategies? How might distribution, accessibility, and education play a role in the perception of effectiveness?

Attitudes: A combined site analysis indicated that not using an available bed net was associated with the attitudes that taking malaria drugs is easier than using a bed net and that use of a bed net will not prevent malaria.

Ease of Use: In addition, individuals with an unused bed net in the household were more likely to indicate that bed nets are difficult to use, that purchased bed nets are better than freely distributed ones, and that bed nets should only be used during the rainy season.

Causes of Communicable Disease

HIV

• Lack of regular H I V testing and

  counselling

• Limited access to antiretroviral therapy

  (ART) for mothers and children in rural

  regions

• High level of stigma surrounding H I V,

  particularly for pregnant women

TB

• T B is exacerbated by malnutrition and

  tobacco smoking, which are common in

  India

• Early T B detection and drug adherence

  are not emphasized in India’s healthcare

  system

Malaria

• Africa is an ideal climate for mosquitos,

  with long warm spells and intense rainy

  seasons

• Human immunity can be relatively low in

  these regions of Africa

Other Group 1 Conditions

Although maternal, neonatal, and nutritional conditions are not technically communicable diseases they are grouped with communicable diseases. One of the many reasons why they may have been grouped together is because there is a significant interplay between these conditions and communicable diseases. The conditions can either exacerbate the symptoms of communicable diseases or completely mask them, increasing the Public Health concern. The condition itself can be a result of a communicable disease (i.e. malnutrition can be the result of intestinal worms). Additionally, this grouping makes sense because maternal, neonatal, and nutritional disorders are seen more frequently in low SDI countries, much like communicable diseases.

Nutritional Deficiencies

Account for nearly 2% of total DALYs. They include protein energy malnutrition, iodine deficiency, dietary iron deficiency and vitamin A deficiency. The 2 most common nutritional condition are iron deficiency and protein energy malnutrition

Iron Deficiency

The most common nutritional disorder in the world.

The effects of iron deficiency anemia range from impaired development in children to decreased work productivity in adults.

Although rarely fatal, iron deficiency is so common that it has a staggering impact on entire economies, sucking the life out of development.

An example of the link with communicable diseases is that two very common infections in Africa, malaria and intestinal worms, are significant contributors to anemia.

Protein Energy Malnutrition

Protein Energy Malnutrition (PEM) is a form of severe calorie or protein deficiency (in other words, starvation).

This kind of malnutrition has a particularly large impact on children due to their lower protein intake, especially once they stop breastfeeding.

PEM is less common but more severe than iron deficiency, leading to significant developmental impacts and 6 million deaths each year.

Maternal Conditions

Much like nutritional conditions, material conditions have an impact on DALYs. Maternal health refers to the health of women during pregnancy, labour, and breastfeeding.

Maternal hemorrhage

• Maternal sepsis and other infections

• Maternal hypertensive disorders

• Obstructed labour and uterine rupture

• Maternal abortion miscarriage

• Ectopic pregnancy

• Indirect maternal deaths

• Late maternal deaths

• Maternal deaths aggravated by H I V

Impacts of Maternal Conditions and Maternal Health

It is important to understand the three main impacts of maternal conditions and maternal health. These include impacts on children, economic impacts and social justice impacts

Impact on Children

• 70% those who live in absolute poverty are women

• Women are more likely to spend what they make on their family

• Maternal deaths are rooted in women’s powerlessness and their unequal access to:

  • Employment

  • Finances

  • Education

  • Basic health care

Economic Reasons

• Poor care and/or nutrition of the mother often leads to:

  • Decreased stability in the home

  • Poor health/death of child

  • Low birth weights

• Motherless children are:

  • Less likely to get an education

  • More likely to die

Social Injustice

• Building a woman’s trust in healthcare increases preventative care for the whole family

• Maternal health interventions are among the most cost effective in health

• Building solid maternal health services strengthens the whole health care system

• Empowering women leads to more equal access of power and resources and leads to positive change

Neonatal Health

Accounts for only the first 28 days of life, and it is during this period when providing appropriate care is crucial to ensure a newborn’s chances of survival and further lay the foundations for a healthy life. However 40% of child deaths still occur during this period

3 Main Causes of Neonatal Death

• infections - 36%

• pre-term - 28%

• birth trauma - 23%

Some Interventions Aimed at Improving Neonatal Health Include

• Prenatal visits

• Skilled birth attendants

• Emergency care

• Postnatal care

Indigenous Canadians and COVID-19

COVID-19 is classified as a communicable disease. Communicable diseases typically affect low income countries and populations disproportionately. However, in Canada, while many people feared that remote Indigenous communities would be disproportionately affected by COVID-19, the exact opposite occurred.

As of August 6th, 2020, the percentage of people living on First Nations reserves who have tested positive for COVID-19 was one-quarter that of the general Canadian population. Of the total 422 cases of COVID-19 on reserves, more than 80% have recovered. With only six deaths, the fatality rate of First Nations communities sits at one-fifth of the general population. Extraordinary public health measures taken by the Indigenous communities have attributed to the low numbers according to health officials

Indigenous Communities Resilience during COVID 19

Indigenous communities fared better than the rest of Canada in the first wave of the COVID-19 pandemic despite facing major challenges in the control of other infectious diseases. Many Indigenous communities immediately recognized the severity of the situation and swiftly instituted their own versions of public health measures, often learned and passed down through centuries of elders' oral histories. In addition, many communities asked people to go back to their roots and care for their neighbours like they are family.

Non-Communicable Disease

Non-communicable diseases cannot be spread from one person to another, although in some cases, the behaviours that lead to them can be thought of as “contagious”. Non-communicable diseases account for the highest burden of disease worldwide (64% of DALYs in 2019) and are usually prevalent in high, middle, and low-income populations. In this section you will explore three types of non-communicable disease: cardiovascular disease, cancer, and mental illness.

Cardiovascular Disease (CVD)

Researchers and physicians alike define CVD as synonymous with ischemic heart disease (heart attacks); however, the WHO tends to describe CVDs as a large category that includes multiple conditions. The large increase in the prevalence of C VD is partly due to people living longer lives and partly because of changes in lifestyle leading to increased CVD risk factors. Some EX include:

• Coronary Heart Disease

  • Disease of the blood vessels supplying the heart muscle.

• Cerebrovascular Heart Disease

  • Disease of the blood vessels supplying the brain

• Peripheral Arterial Disease

  • Disease of the blood vessels supplying the arms and legs.

• Congenital Heart Disease

  • Malformations of heart structure existing at birth.

• Rheumatic Heart Disease

  • Damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria.

CVD Risk Factors and Interventions

80% of worldwide CVD deaths occur in low and middle income countries because of their larger populations. CVD typically develops mid-life, which impacts the socioeconomic status (SES) of the person and by extension family and country. Those with low SES tend to have more risk factors for CVD, and thus higher morbidity and mortality.

Some interventions include:

• Access to Medication

  • Innovative public health research is in progress to improve access to CVD drugs for primary and secondary prevention. These drugs are widely available worldwide, but remain expensive for many people. Generic versions could be cheaper to increase accessibility

• Education and Accessibility

  • Increased education as well as stronger public policy and awareness toward healthy living, will help lower rates of C V D. In some communities, there are additional barriers to physical activity and healthy

    food such as geographical location, unaffordability, and lack of programming that make it increasingly difficult to live a healthy and active lifestyle

Introduction to Cancer

Cancer is an umbrella term for the collection of disease where the body’s cell begins dividing uncontrollably without cell death, which eventually can begin to spread to other parts of the body.

The most common types of cancer found worldwide are lung, breast, colorectal, prostate, skin, and stomach cancer.

Cancer research is expensive. In 2011, the Canadian Cancer Society dedicated $48,886,000

Cancer and GBD

The Global Burden of Disease Cancer Collaboration, which includes collaboration from over hundreds of researchers, published the article, Global Burden of Cancer 2017. This article concluded many key findings.

Some of the key points from this study are:

• Cancer is ranked 2nd in global deaths, YLL, and DALYs.

• Fifty-one percent of cancer cases occurred in countries of high SDI, but only 30% of cancer deaths and 24% of cancer DALYs.

• The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability.

• Globally, the odds of developing cancer during a lifetime (ages 0-79 years) were 1 in 3 for men and 1 in 4 for women. These odds differ substantially among SDI quintiles, ranging from 1 in 7 at the lowest SDI quintile to 1 in 2 at the highest SDI quintile for both sexes.

Global cancer prevention strategies

• Tabacco

  • Raising tobacco taxes.

  • Requiring by law 100% smoke free environments in all indoor workplaces and public spaces.

  • Put health warnings on all tobacco packaging.

  • Establishing a national cessation program in health care facilities.

• Obesity

  • Developing national dietary and physical activity guidelines.

  • Promoting public awareness campaigns about the links between cancer and obesity, unhealthy

    diet, and physical inactivity.

• Alcohol

  • Raising public awareness, especially among young people, about alcohol related health risks,

    including cancer, using gender specific messaging.

  • Developing and implementing a national policy aimed at reducing the overall level of alcohol

    consumption.

• Infections

  • Implementing universal immunization using one of the recommended immunization schedules.

• Carcinogens

  • Stopping the use of asbestos.

  • Ensuring safe drinking water.

  • Identifying workers, workplaces, and worksites with exposures to carcinogens.

• Radiation

  • Provide information about sources and effects of all types of radiation

  • Ensure regular safety training of all radiation workers

  • Promote UV risk awarness and UV protection actions

Mental Illness

Mental illnesses are another form of non-communicable diseases. They can take many forms, just as physical illnesses do. Mental illnesses are still feared and misunderstood by many people, leading to stigmatization.

Various global mental health facts.

• GBD and Economic Impact

  • Mental, neurological and substance use disorders make up 10% of the global burden of disease and

    30% of non-fatal disease burden.

  • The global economy loses about $1 trillion U S D per year in productivity due to depression and

    anxiety.

• Childhood Rate and Onset

  • Around 1 in 5 of the world's children and adolescents have a mental health disorder and about half of

    mental health disorders begin before the age of 14

• Depression

  • Depression is one of the leading causes of disability, affecting 264 million people

• Suicide

  • Almost 800,000 people die by suicide every year; 1 person dies from suicide every 40 seconds. Suicide

    is the second leading cause of death in individuals aged 15-29 years.

• Severe Mental Disorders

  • Around 1 in 9 people in geographical locations affected by conflict have a moderate or severe mental disorder.

  • People with severe mental disorders die 10 to 20 years earlier than the general population.

• Mental Health Workers

  • Rates of mental health workers vary from below 2 per 100,000 population in low-income countries to over 70 per 100,000 in high-income countries.

• Policies

  • Less than half of the 139 countries that have mental health policies and plans report having these aligned with human rights conventions.

Injuries

The GBD defines injuries as death or disability due to the direct or indirect result of a physical force, immersion, or exposure, including accidental, interpersonal, or self-inflicted forces as well as war, conflict, violence, and natural disasters.

Injuries account for the smallest portion of deaths, contributing to 7.6% of all deaths. Injury death rates are higher in males (2.94 million) than females (1.36 million). The top causes of death due to injury in 2019 were falls, road injuries, self-harm, and interpersonal violence. From 2010 to 2019, the age-standardized death rate due to injuries decreased by 19.4%.

Injuries by Geographic Areas

The rates of a particular cause of injury varies between geographic areas.

For example, in 2013 it was recorded that the DALY rate for road injuries is 9.7 times higher in boys living in central sub-Saharan Africa compared with high-income Asia Pacific.

Suicide

Around 800,000 people die by suicide every year, a tragedy that reverberates through families, communities, and entire nations, producing long-lasting emotional effects on those that are left behind. Shockingly, in 2018, it was the leading cause of death for children ages 10 - 14 and it was the second leading cause of death for those between the ages of 15 - 34 in Canada. Suicide rates are also significant in populations that experience isolation and discrimination, including the LGBTQ2s+ population, refugees and migrants, and Indigenous Peoples

Although suicide is prevalent in high income countries, 79% of global suicides in 2016 occurred in low and middle income countries. Note that while suicide is part of the injuries category, it is very closely tied to mental illness, which is part of the non-communicable diseases group.

Canada’s Indigenous Suicide Crisis

In 2011, it was found that the Indigenous population dies by suicide at a rate three times higher than non-Indigenous Canadians. During the “Sixties scoop” and when Residential Schools were established, Indigenous communities, families, political structures, and economic foundations were shattered. Indigenous Peoples have been subjected to intergenerational trauma, marginalization, and systemic racism since colonization. These factors are suggested to be associated with the higher rates of suicide. Although the impact of suicide varies between Indigenous communities, suicide is more prevalent in smaller communities where those within the community are either related or experience similar trauma

Transmission Models for Intergenerational Trauma

Intergenerational trauma occurs when trauma experienced by one generation is passed down to other generations.

• Sociocultural Model

  • Explains intergenerational trauma through parenting styles and exposure to environmental factors that may impact a child’s development. This model is based on the assumption that children are directly influenced by the home environment they are raised in. Many Indigenous children were raised in the residential schooling system where they were subjected to abuse, neglect, and high levels of stress

  • This model explains that as these children grow and become parents, they may lack the skills and knowledge to create a nurturing family environment and to support their own children. A cycle of negative parenting behaviours then ensues and results in intergenerational trauma.

• Psychological Model

  • explains intergenerational trauma based on the understanding that a child’s brain development can be significantly impacted if during the early years of development they are subjected to harsh conditions. The model suggests that a child’s brain development, and ability to self regulate, may be affected if their basic needs are not met. In the residential schooling system, many children were unable to develop a sense of trust and security with the majority of people around them

  • As such, this theory suggests that children raised in poor conditions may develop cognitive delays and negative coping strategies that can heavily impact their lives in the future. In addition, a culture lacking

    trust and security may be instilled and passed from generation to generation.

• Physiological Model

  • The physiological model explains intergenerational trauma through biological factors and predisposed genetic factors. It suggests that when a child is subjected to excess levels of stress, there are abnormal levels of cortisol, dopamine, and serotonin, which may affect brain development. These changes can affect the ability to process and handle stressful environments, and can potentially lead to heightened activity levels and/or learning disabilities.

  • Epigenetic theories suggest that high levels of maternal stress can influence in-utero development and actually alter the function of some genes in the offspring. It is thought that these changes in gene function can occur preconception, affecting the germ-line (from either parent) or in-utero due to high maternal stress during pregnancy, and can result in negative responses to stress in the offspring.

Suicide Rates in Various Indigenous Groups

• First nations

  • With 24.3 deaths per 100,000 person-years at risk, the rate of suicide for First Nations people are

    3x higher than the non-Indigenous rate.

  • Suicide rates are 2x higher for First Nations people living on reserve compared to those not living

    on reserve.

  • In First Nations communities, there is a significantly higher percentage of suicide amongst the

    lowest income quintile compared to Métis and Inuit communities.

  • Geographic location, household income, labour force status, level of education, and marital status

    account for 78% of the excess risk of death by suicide in First Nations communities.

• Metis

  • With 14.7 deaths per 100,000 person-years at risk, the rate of suicide for Métis people is 2x higher

    than the non-Indigenous rate.

  • The labour force status profile of Métis is similar to non-indigenous people, so this factor contributes a smaller excess risk of suicide in Métis communities compared to the First Nations and Inuit communities.

• Inuit

  • With 72.3 per 100,000 person years at risk, the suicide rate for Inuit people is 9x higher than the non-Indigenous rate.

  • Suicide rates within Inuit communities are highest in youth, especially males living in Inuit Nunangat

  • Substance use, depression, post-traumatic stress disorder, and romantic relationship breakups are suicide risk factors that significantly impact the Inuit population.

Resiliency Factors within the Indigenous Communities

Protective factors for Indigenous youth may include:

• High community knowledge of the Indigenous language

• Secure Indigenous titles to traditional lands

• Self-governance, leading to control over essential services (such as health care, education, police, fire department)

• School attendance

• Sustainable employment

• Easy access to social support and tailored mental health services

Ending the Stigma

• Language

  • The words used to describe suicide may themselves be stigmatizing. For example, using language such as “committed suicide” comes from the repealed law that stated taking one’s own life was a criminal act. In Canada, and many parts of North America, suicide is no longer recognized as a criminal act, and should be discussed through terms such as “took their own life” or “died by suicide”

• Respect

  • It is becoming more common and safe for people to share their experiences with suicide. Although this is undoubtedly a good thing, one important consideration for reducing stigma is respecting the decisions of individuals who choose not to discuss their experiences. Not all people are eager to talk about their experience, and that should not impact the level of support they receive.

• Advocate

  • An easy way to help reduce the stigma around suicide is to use your voice. People who are experiencing a mental health problem or survivors of suicide should not be expected to navigate advocacy by themselves. Using our voices to tackle the stigma and prejudice around mental illness is a part we can all play.

Suicide Prevention

• Policy

• Media

• Access

• Stigma

• Follow-Up

Millennium Development Goals

• 1: Eradicate Extreme Poverty and Hunger

  • To halve the proportion of people whose daily income is less than $1.25.

  • To achieve full and productive employment, as well as decent work for all, including young people and women.

  • To halve the proportion of individuals suffering from hunger in the period between 1990 and 2015

• 2: Archive Universal Primary Education

  • To ensure that children universally - including both boys and girls - will be able to complete a full course of primary education by 2015.

• 3: Promote Gender Equality and Empower Women

  • To eliminate gender disparity in primary and secondary education by 2005, and in all levels of education by 2015.

• 4: Reduce Child Mortality

  • To reduce the under-five mortality rate by two-thirds in the period between 1990 and 2015

• 5: Improve Maternal Health

  • To reduce the maternal mortality ratio by 75 percent.

  • To achieve universal access to reproductive health

• 6: Combat H I V / AIDS, Malaria, and Other Diseases

  • To halt and start to reverse the spread of H I V / AIDS by 2015.

  • To achieve global access to treatment for H I V / AIDS for those who need it by 2010.

  • To have ceased and started reversal of the incidence of malaria and other major diseases by 2015

• 7: Ensure Environmental Sustainability

  • To integrate the principles of sustainable development into every nation’s policies and

    programmes, and also reverse the depletion of environmental resources.

  • To reduce biodiversity loss and achieve a substantial reduction in the rate of loss by 2010.

  • To halve the proportion of the universal population without sustainable access to clean and safe

    drinking water and basic sanitation by 2015.

• 8: A Global Partnership for Development

  • To further develop an open, predictable, rule-based, non-discriminatory trading and economic system.

  • To address the special needs of the least developed countries.

  • To deal exhaustively with the debt problems of developing nations.

  • To provide access to affordable essential drugs in the developing world - in collaboration with pharmaceutical companies.

  • To avail benefits of new technologies, especially information and communications, in collaboration with the private sector

MDG 2015 Report Success

• A significant decline in global poverty; the number of people living in extreme poverty declined by more than half.

• An increased primary school net enrolment rate in the developing regions.

• A decline in the under-five mortality rate globally, by more than half.

• A decline in the maternal mortality rate worldwide.

• An increase in the number of girls attending school globally and elimination of the gender disparity in primary, secondary, and tertiary education.

MDG 2015 Report Challenges

• The persistence of gender inequality.

• Big gaps between the poorest and richest households, and between rural and urban areas.

• The persistence of conflict as the biggest threat of human development.

• The disproportionate impact of climate change and environmental degradation on people living in poverty results in great suffering, and undermines the progress achieved.

• The millions of people still living in poverty and hunger, without access to basic services.

MDGs and the Social Determinants of Health

The MDG Report emphasizes the critical role that social determinants of health (SDH) play in influencing the well-being of the most vulnerable populations.

Gender Inequality: Compared to men, women face greater discrimination in:

• Access to work

• Access to economic assets

• Participation in private and public decision making

• Women are also more likely to live in poverty then men

Income Gap: There is a large income gap between the least wealthy and most wealthy households

• Children from the poorest 20% of households are more than twice as likely to be developmentally stunted as those from the wealthiest 20%.

• Children in this poorest 20% are four times as likely to not be enrolled in school compared to the brichest households.

• Under-five mortality rates are almost twice as high for children in the poorest 20% of households compared to children in the richest.

Sustainable Development Goals SDG’s

• No poverty

  • Extreme poverty is defined as living on less than $1.25 a day. The goal is to halve the number of people living in poverty by 2030.

• Zero Hunger

  • End world hunger by 2030 by advancing sustainable agriculture and striving towards food security

• Good Health And Well Being

  • Provide every person the available resources to achieve a long and healthy life

• Quality Education

  • Ensure inclusive and quality education for all and promote lifelong learning. Education enables upward socioeconomic mobility and is a key to escaping poverty.

• Gender Equality

  • To achieve gender equality and empower all women and girls in addition to ending all forms of discrimination against all women and girls everywhere

• Clean Water and Sanitation

  • Diseases caused by contaminated water kill more people every year than all forms of violence, including war. Prioritizing clean water will improve the lives of millions of people

• Affordable and Clean Energy

  • Clean energy is not just about improving the environment. 4.3 million people die every year from pollution, and these deaths are entirely preventable. The goal is to make sure every person has access to renewable energy by 2030

• Decent Work and Economic Growth

  • 190 million people are unemployed worldwide. This can be addressed by increasing job availability and equal wealth distribution

• Industry, Innovation, Infrastructure

  • Provide the right infrastructure and technology so developing countries can maximize their human and natural resources

• Reduced Inequality

  • Reduce the inequalities between age, sex, disability, race, ethnicity, origin, religion, and economic groups.

• Sustainable Cities and Communities

  • Almost 60% of the global population will live in urban areas by 2030. SDG 11 strives to ensure that human settlements are resilient and sustainable

• Responsible Consumption and Production

  • The global population is projected to reach ten billion by 2050. S D G 12 promotes sustainable lifestyles to ensure future access to food, water, energy, medicine, and more

• Climate Action

  • Climate change has the potential to threaten other efforts towards sustainable development by changing weather patterns and altering food production. S D G 13 aims to increase awareness and convey urgency to world leaders to instigate policies to combat climate change.

• Life Below Water

  • Marine biodiversity sustains the lives of more than 3 billion people. SDG 14 addresses the need to conserve and protect marine resources and habitats.

• Life on Land

  • Preserving biodiversity in plants and animals will prevent land degradation, ecosystem imbalance, and food insecurity.

• Pace, Justice and Strong Institutions

  • Reducing crime, violence, and war will greatly reduce the burden of disease around the world. SDG 16 strives towards this goal by stopping the illegal arms

• Partnerships for the Goals

  • Increasing collaboration will help attain all of these goals. SDG 17 aims to revitalize the global partnership for sustainable development.