Global Health - Final

Cap

limit on the amount that the insurance company will pay per year or lifetime

copayment

an amount the insured is responsible for even when the service is covered by insurance ($25 to see a physician, $35 for medication)

coinsurance

the percentage of the charges that the insured is responsible for paying (80-20 or 90-10)

deductible

the amount an individual or family is responsible for paying before being eligible for insurance coverage

eligible

criteria that an individual might need to meet to be able to participate in certain plans

premium

the price paid by the purchaser for the policy on a monthly or yearly basis ($188 per month regardless of use)

out-of-pocket

amount the insured has to pay, or the amount not covered

how much does the US spend on healthcare

$4.1 trillion per year
19.7% of the GDP
$12,500 per person/year

how much do other countries spend on healthcare

1/2 as much as US per person
10% or less of GDP

types of insurance

government-financed
employment-based
health insurance exchanges

medicare basics

federal government program
-funded by payroll tax
-ppl 65 and up, disabled ppl, end-stage renal disease
-50 mil americans are eligible

medicare part A

covers hospital care, skilled nursing care, home health care after hospitalization, hospice care

medicare part B

voluntary supplemental insurance that covers diagnostic and therapeutic services

medicare part C

program designed to encourage medicare beneficiaries to enroll in prepaid health plans

medicare part D

prescription drug plan open to individuals enrolled in parts a and b

medicaid basics

federal plus state program
-pay for health services for specific categories of poor ppl and other designated groups (disabled, children, pregnant women, etc)
-covers 50% of births, 40% of children, 50% of custodial nursing home care
-provides for individuals in the designated groups who are below the poverty line (current level for fam of 4 is $25,000/year

medicaid detail

states can choose to offer other services such as drugs, eyeglasses, transportation, etc and the federal gov will provide matching funds
-reimbursement rates to clinicians are comparatively low

health insurance exchanges

mechanism available to obtain insurance for those not otherwise eligible for health insurance
-provides a competitive marketplace to help increase access and control the costs of health insurance

affordable care act

aka obamacare
-plans offered thru website
-plans split into medals: platinum, gold, silver, bronze
-cost of plans based on: income, # of children, age, smoking status, geography
-removed pre-existing conditions
-can remain on till age 26

being uninsured in the US is like...

-less preventative care
-later diagnoses
-less treatment
-use ER for routine care
-increased mortality rate

HIV/AIDS acronym

H- human
I- immunodeficiency
V- virus

A- acquired
I- immune
D- deficiency
S- syndrome

how many ppl in US are HIV+

1.2 million

HIV virus

-HIV is the virus that causes AIDS
-virus is microscopic particles only seen thru electron microscope
-other viral STIs= herpes, HPV, hepatitis

HIV

-lower CD4 cells, more likely to get sick
-lowered immune system more likely to develop an opportunistic infection or disease

HIV stats: ppl w HIV worldwide

38 million

HIV stats: new infections

1.7 million

HIV stats: deaths in 2019

770,000

HIV stats: infections in US

1.1 million

HIV stats: infections in E & S Africa

19.4 million

Since 1981...

74.9 million ppl infected
32 million died

HIV reduction rate

since 1998, new HIV infections reduced by 40%
-since 2010, new HIV infections reduced by 23% (2.1 mil to 1.7 mil)

AIDS mortality reduction rate

-AIDS-related deaths reduced by 60% since peak in 2004
-declined by 39% since 2010

HIV strains

HIV 1: majority of cases
HIV 2: only in africa

what subgroup of HIV accounts for most worldwide cases

HIV 1 Group M accounts of 90% of worldwide cases

what contributed to conspiracy theories and paranoia around HIV

sex panic

HIV conspiracy theories

-UFOs: release "new organism" to wipe out humanity
-biological warfare: Soviet Union believe HIV/AIDS result of usa biological warfare
-ethnic cleansing: Wangari Maathhai said created by scientists for the purposes of mass extinction
-sex with chimps
-domestic cats
-contaminated vaccines (polio)

tuskegee syphilis experiment

1930s-1970s sponsored by US gov
-make AA reluctant to try experimental HIV treatments

"The River"

book written by Edward Hooper
-a journey to the source of HIV/AIDS
-hypothesized that a Belgian lab housing chimps was the source of HIV (tested and chimps didn't have SIV)

HIV Vaccine Hypothesis

led by Worobey and Hamilton

current theoretical origins of HIV

researcher Beatrice Hann: majority of HIV cases evolved from a simian immunodeficiency virus (SIV) found in chimpanzees
-nobody knows when it started, likely around 1960s or 1908

current theoretical origins of HIV pt 2

SIV from chimpanzees in southeastern Cameroon gave rise to HIV 1 group M (principal cause of AIDS pandemic)

HIV patient zero

a hunter in Cameroon hunted a chimp who had eaten 2 other monkeys who were each infected with another subgroup of SIV and the new hybrid infection "spilled over" into a human infection
-spillover resulted in a human becoming infected with HIV subgroup M

new HIV strain

HIV 1, group M, subtype L

first documented case of HIV

bantu man, 1959, who lived in Kinshasa of the Democratic Republic of Congo
-A single infected person down the Sangha river onto the Congo River and into Kinshasa, which is the largest city in Central Africa with the size and density to enable the pandemic, could be
responsible

4 Hs in the US

haitians, homosexuals, heroin users, hemophiliacs

what enabled the pandemic

-a variety of factors enabled the virus to circulate thru the world

HIV incubation period

can be as long as 10 years - virus likely infected many people before 1980s

AIDS dissidents/denialists

individuals who believe HIV does not cause AIDS

Christine Maggiore

-wrote "what if everything you thought you knew about aids was wrong"
-believed ppl who died from AIDS really died from prescription or recreational drug use

Peter Duesberg

-wrote "inventing the aids virus"
-first scientist to discover a cancer gene
-tenure at UC Berkeley
-believe AIDS is caused by recreational drugs and/or AZT
-accused of data falsification

Duesberg and Mbeki

Mbeki - former president of south africa
-believe poverty was the correlate of AIDS
-ban on the use of anti-retroviral therapy drugs in state hospitals until 2002
-south africa 5.7 mil HIV infections

HIV/AIDS v Covid

violence against women stats

-1 in 3 women experience violence
-200 million girls have experienced female genital cutting
-250 mil women married before 15
-71% of human trafficking victims are women

intimate partner violence

-38% of murders of women are committed by a male intimate partner
-women more likely to experience IPV if low education or exposure to previous abuse

cultural practices that perpetuate VAW

-economic abuse
-dowry-related violence
-femicide
-honor-based violence
-female infanticide
-political violence
-forced and child marriage

female genital cutting/mutilation (FGC/M) types

-pricking, piercing, or scraping
-labia minora or majora may be cut
-cliterodectomy
-infibulation

how many women have undergone FGC/M procedures

200+ million girls
-mostly in Africa, Middle East, and Asia

FGM type 1

clitoridectomy: partial or total removal of the clitoris

FGM type 2

excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora

FGM type 3

infibulation: this is the narrowing of the vaginal opening through the creation of a covering seal - formed by cutting and repositioning the labia minora or majora, sometimes through stitching with or without removal of the clitoris

FGM type 4

this includes all other harmful procedures to the female genitalia for non-medical purposes (pricking, piercing, incising, scraping and cauterizing the genital area)

potential health consequences of the FGM

-infection
-hemorrhage
-chronic pain or inflammation
-risk for sterilization
-difficulty with menstruation and sex
-difficult and dangerous childbirth

why ppl practice FGC/M

-rite of passage
-eligibility for marriage and family life
-virginity or purity
-beauty or cleanliness
-cultural practice that has significant importance in that culture

to make lasting change to FGC/M you need...

-elders and community leaders
-men to publicly announce they wont marry circumcised girls
-buy-in from mothers
-appropriate alternative practices that are created by the community

FCG/M declining in...

eritrea, liberia, kenya

FCG/M remains prevalent in....

somalia and mali

economic violence

denying access to financial resources, property, healthcare, education, access to the workforce, unequal pay or economic decision-making

how many female health workers comprise the health and social workforce worldwide

70%
-yet half of women's contributions are in the form or unpaid care roles (equivalent to $3 trillion annually).

most common forms of women's violence

-unequal distribution of household resources
-land conflict
-domestic violence
-marital rape
-rape and sexual assault
-early marriage

strategies for resolving economic violence:

-loan and finance programs
-education and vocational training
-ensuring legal deeds to property
-support groups
-providing maternity leave

improving what will lead to improvements in women's health?

education

acronym to improve maternal health (WHO)

safe-
effective-
timely-
efficient-
equitable-
people-centered-

sex-selective abortion

the practice of aborting a fetus after a determination that the fetus is an undesired sex, typically female

what percentage of abortions are safe

only about 60%

unsafe abortions are associated with what percentage of maternal deaths

13%

how many unsafe abortions are there each year

25 million

selective abortion - skewed ratios (m:f)

india: 112 males;100 females
china: 11 males;100 females

what has lead to sex-selective abortion

rising incomes and levels of education

how many maternal deaths in 2013

289,000

what percentage of all maternal deaths occur in 10 countries (india, nigeria, pakistan, kenya...)

60%

obstructed labor accounts for what percentage of maternal deaths

28%

direct causes account for what percentage of maternal deaths

80%

chances of maternal death in rich v poor country

1:3,700 vs 1:38 chance

maternal mortality highest in what countries

1. europe and central asia
2. east asia and pacific

obstetric fistula

-an injury in the birth canal that allows leakage from the bladder or rectum into the vagina (leaves a woman permanently incontinent)
condition in which a hole opens up between the vagina and either bladder or rectum

how many women suffer a fistula in a year

50k-100k

how many women live with untreated obstetric fistula in asia and sub-saharan africa

more than 2 million

social determinants of women's health

-male preference
-less nutritious food
-low social status
-poverty
-poor household conditions

top 5 global leading causes of death in females 15-49

1. HIV/AIDS
2. maternal disorders
3. self-harm
4. tuberculosis
5. road injury

top 5 global leading attributable risk factors for death in females 15-49

1. dietary risks
2. high blood pressure
3. alcohol use
4. high body-mass index
5. intimate partner violence

who represents the majority of ppl w HIV

women

who is more susceptible to STIs

women

how many cases of HPV are there per year

350,000 cases

how many deaths due to cervical cancer a year

275,000 deaths

ways to address maternal mortality

-provide appropriate post-abortion care
-improve adolescent and maternal nutrition
-provide effective family planning
-ensure skilled birth attendants

critical needs after a natural disaster

-water, sanitation, and hygiene (WASH)
-food
-shelter and personal-care items
-essential health services

scale of critical incidents

1. crisis (capacity > demand)
2. emergency (capacity = demand)
3. disaster (demand> capacity)
4. catastrophe (demand >> capacity)

essential support functions

1. transportation
2. communications
3. public works and engineering
4. firefighting
5. emergency management

emergency preparedness 4 r's

-reduction (of risks)
-readiness (preparedness)
-response (to threat)
-recovery (rebuilding

impact of disasters

-lead to increased death, illness, and disability
-large economic impacts