HUM AN DEvelopement chapter 25

WHO defines social determinants of health as the conditions in which people are born, grow, work, and age.
They influence health outcomes and inequities; used as guiding framework for this chapter.

Key threats include air pollution, noncommunicable diseases, infectious disease pandemics, fragile settings, antimicrobial resistance, vaccine hesitancy, dengue, HIV, Ebola, weak primary health care.

$90\%$ of the world population breathes polluted air.
Risks: cardiovascular disease, stroke, lung cancer, COPD, pneumonia.
About one third of deaths from CVA, CHD, and lung cancer linked to pollution.
US policy history: Air Pollution Control Act (1955); Clean Air Act (1963); EPA (1970).
China is the world\'s largest emitter of greenhouse gases.

Global warming: temperature rise, ice melt, sea level rise, increased ocean acidity.
Affects water cycle and weather; can alter biodiversity.
Paris Agreement (2015) to mitigate climate changes.
Individual lifestyles impact energy and food consumption.

Four main types: cardiovascular, cancer, chronic respiratory, diabetes.
Risk factors: tobacco, inactivity, diet, alcohol, hypertension, obesity, high blood glucose, high cholesterol.
Poverty constrains health-promoting behaviors.
Life-course approach: critical stages, transitions, and settings.

Communicable diseases are transmitted person-to-person or animal-to-human.
WHO identified three threats: influenza pandemic, dengue, HIV.
COVID-19 pandemic originated in China and spread globally.
Pandemics occur about every 10 years; examples: SARS (2003), H1N5 (2007), H1N1 (2009), MERS (2012), Ebola (2014), COVID-19 (2019).

Fragile states lack capacity to manage political, social, economic, and security risks.
Risks include lack of clean water, safe food, adequate housing, and healthcare.
Telemedicine networks and SDGs promote health in crisis.
Five dimensions of fragility: economic, environmental, political, security, societal.

Antibiotics no longer fully effective; drug-resistant TB; HIV and malaria at risk; gonorrhea resistance.
Overuse of antibiotics contributes to resistance.
CDC strategies to reduce resistance:
1) Know your personal risks and follow recommendations
2) Maintain universal precautions and handwashing
3) Manage vaccination regimen
4) Monitor health and report symptoms
5) Maintain appropriate use of antibiotics with health providers
6) Maintain healthy habits with animals
7) Use food safety guidelines
8) Be vigilant when traveling
9) Use safe sex practices

Causes reduced participation in vaccination programs and herd immunity.
WHO Tailoring Immunization Programs (TIP) guides national or local strategies.
Drivers are multiple; multi-pronged, locally based approaches are most effective.

Part 1: What people think and feel—perceived risk, worry, confidence, trust, safety concerns; social processes; provider recommendations.
Part 2: Practical issues—vaccine availability, convenience, costs, service quality, consent, scheduling; addressing hesitancy.
Goal: Improve vaccination demand and address hesitancy.

First point of contact; should provide comprehensive, affordable community-based care throughout life.
Backbone of universal health coverage; increased emphasis on primary care NPs and telehealth.
Primary Health Care Performance Initiative (PHCPI) is a global partnership to measure and improve PHC.

Primary Health Care Progression Model (started 2015) by Gates Foundation, WHO, World Bank.
Targets middle- and low-income countries; 32-measure tool; applicable elsewhere.
Pilot countries: Argentina, Ghana, Rwanda, Senegal, Tanzania.
Vital Signs Profile (2019) summarizes PHC capacity.