Global Health Issues: Week 3

What are two reasons why the term “two-thirds world“ is sometimes used instead of third world?

1. To show that 2/3 of the world live in extreme poverty and can be considered third world or worse

2. Third world has become stigmatized

Determinants of Health

Range of personal, social, economic, and environmental factors that determine the health status of individuals or populations.

Social Determinants of Health

Specific group of social and economic factors within the broader determinants of health. These relate to an individual's place in society, such as income, education or employment. Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups such as Indigenous Peoples, LGBTQ and Black Canadians

When the determinants of health and social determinants of health overlap, what is it called?

Intersectionality

The Social Gradient

the phenomenon whereby people who are less advantaged in terms of socioeconomic position have worse health (and shorter lives) than those who are more advantaged

How many DOHs does Canada have?

12.

Name 5 of Canada’s DOHs

Income and Social Status

Employment and working conditions

Education and Literacy

Childhood experiences

Physical environments

Social supports and coping skills

Healthy behaviours

Access to health services

Biology and genetic endowment

Gender

Culture

Race/Racism

What is HALE and how is it calculated?

Health-Adjusted Life Expectancy

Calculated by weighting the number of years of ill health according to severity, subtracted from the overall life expectancy. HALE = Life expectancy - years lived with disability.

Not a health gap measure.

What is DALY and how is it calculated?

Disability-Adjusted Life Year. Used to quantify disease burden. 1 DALY = 1 lost year of healthy life.

Calculated by subtracting the age at which one dies and one’s life expectancy at that age. or,

Years of life lost + years lived with disability.

Health gap measure.

What are the 3 groups of burden of disease by cause of death and DALYs?

1. Communicable, maternal, perinatal conditions, nutritional disorders (SSA mainly)

2. Non-communicable (higher income)

3. Injuries (higher income)

*Ischemic heart disease THE BIGGEST problem everywhere

Low-income leading cause of death: Under-5

Malaria

According to the demographic divide, higher income countries have ___ fertility, ___ populations, and ___ aging populations.

low, declining, aging

According to the demographic divide, lower income countries have ____ fertility.

High fertility

The demographic transition (gradient) describes…

the nature in which first world countries have LOW fertility and mortality, while third world countries have HIGH fertility and mortality. Improved hygiene and nutrition create decrease in mortality and in fertility.

The epidemiologic transition describes…

How countries shift from high to low mortality:

-Starts high and fluctuating,

-then progressive decline as epidemics become less frequent,

-finally increase in life expectancy and predominance of non-communicable diseases.

Diarrhea to Alzheimer’s.

Some factors of burden of disease, along with the DOHs:

economic development, scientific and tech change, climate change, political stability, emerging and re-emerging infectious disease.

Risk factors for deaths and DALYs in high income countries is largely…

behavioural

Risk factors for deaths and DALYs in low income countries is largely…

nutritional issues, water sanitation, pollution, tobacco

What are some components of Health Systems

·        Agencies that plan, fund, and regulate health care

·        The money that finances health care

·        Those who provide preventive health services

·        Those who provide clinical services

·        Those who provide specialized inputs into health care, such as the education of healthcare professionals and the production of drugs and medical devices (pacemaker)

3 goals of health systems

1. Good health

2.        Responsiveness to the expectations of the population

3.        Fairness of financial contribution

4 functions of health systems

1.        Provide health services

2.        Raise money that can be spent on health, referred to as “resource generation”. Places like CHEO that do fundraising because govt funding isn’t enough.

3.        Pay for health services, referred to as “financing”

4.        Govern and regulate the health system, referred to as “stewardship”

3 categories of health services and some example countries

National Health Service: UK, Cuba

National Health Insurance: Canada, France

Pluralistic: USA, India

Three levels of care and examples

Primary: Family doc

Secondary: General surgeon

Tertiary: CHEO, specialized hospitals (rare in rural)

Public sector roles

·        Stewardship of the system

·        Raising the funds for the health system

·        Making decisions about allocating those funds

Establishing approaches to health insurance

Private (for-profit) sector roles

·        Involved in the provision of services including non-licensed “medical practitioners”

·        Involved in the operation of health clinics, hospitals, services, and laboratories

·        Can partner with the public sector or work under contract to the public sector

·        Is involved in all countries

NGO roles

·        mission-driven advocacy or service orgs in the nonprofit sector.

community-based efforts to promote better health through education, improved water, and sanitation

7 issues in the health sector

1.        Demographic and Epidemiologic Change

2.        Stewardship

3.        Human Resource Issues

4.        Quality of Care

5.        Financing of Health Systems

6.        Financial Protection and Provision of Universal Coverage

7.        Access and Equity

Universal health care in Canada in…

1984

The 5 criteria and 2 conditions in the Canada Health Act

Criteria:

1. Public administration

2. Comprehensiveness

3. Universality

4. Portability

5. Accessibility

Conditions:

1. Information from gov to min of health

2. Recognition by gov of fed financial contributions