Intro to global health

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  • University of Nottingham UK

  • China | Malaysia

  • Public Health Theme: Global Health

  • Instructor: Dr. Ilze Bogdanovica

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  • Public Health Theme Overview:

    • Understanding health inequalities and determinants of population health

    • Developing public health policy and programs to improve health

    • Assessing health status and needs of populations

    • Efficient use of scarce resources for health

    • Applications of Public Health Toolkit:

      • Introduction to Public Health

      • Screening

      • Environment, occupation, and health

      • Global Health

      • Communicable disease control

      • Epidemiology

      • Supporting high-quality health systems

      • Lifestyle risks

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  • Learning Outcomes:

    1. Describe global health challenges and strategies

    2. Explain health impacts of globalization

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  • Global Health Trends (University of Nottingham UK | China | Malaysia)

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  • What is Global Health?

    • Improving health and achieving equity for all worldwide

    • Focus on unfair health outcome differences between countries

    • Health issues that transcend individual nations

    • Recognition of shared problems and solutions (e.g. Ebola, Climate change)

    • Interdisciplinary Approach: Involvement of health care professionals, economists, engineers, etc.

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  • Global Trends in Causes of Death (1990-2017):

    • 41% decrease in communicable diseases and neonatal disorders

    • 40% increase in non-communicable diseases

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  • Epidemiological Transition (Omran 1971):

    • Societal development leads to:

      • Decline of infectious diseases and malnutrition

      • Rise of non-communicable chronic diseases

  • Age Patterns of Mortality:

    • Shift from younger to older age groups

      • Age of Pestilence and Famine: Life expectancy 20-40 years

      • Age of Receding Pandemics

      • Age of Degenerative and Man-Made Diseases: Life expectancy 70+ years

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  • Healthy Life Expectancy (2019):

    • Measured as average years a person can live in full health

    • Average: 63.7 years in 2019

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  • Global Burden of Disease - Nottingham

    • Leading Causes of Early Death and Disability (2017):

      • Low SDI countries:

        1. Neonatal disorders

        2. Lower respiratory infections

        3. Diarrheal diseases

        4. Malaria

        5. Congenital defects

      • High SDI countries:

        1. Ischemic heart disease

        2. Low back pain

        3. Stroke

        4. Lung cancer

        5. COPD

    • SDI: Captures income, education, and fertility.

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  • Global Health Determinants:

    • Factors influencing health outcomes at a global level

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  • Determinants of Health:

    • Living and working conditions: Employment, community, sanitation, etc.

    • Age, sex, and constitutional factors

    • Applies universally, irrespective of geography

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  • Global Health Determinants Include:

    • Urbanization

    • Migration

    • Anti-microbial resistance

    • Conflict

    • Emerging/re-emerging infections

    • Climate change

    • Weak health systems

    • Poverty/lack of development

    • Globalization

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  • (Repeat of Page 12)

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  • What is Globalization?

    • Increasingly connected cultures and economies

    • Enhanced interaction and formal collaborations among countries

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  • Globalization Impact on Health:

    • Positive: Dissemination of knowledge and economic growth

    • Negative: Spread of communicable diseases and unhealthy lifestyle promotion

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  • COVID-19 Global Impact:

    • Cumulative Cases: 617,597,680

    • Total Deaths: 6,532,705

    • Vaccine Doses Administered: 12,723,216,322

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  • Global Solutions for COVID-19:

    • Oxford AstraZeneca vaccine optimization for developing countries

    • Recognition of flawed global response to vaccination challenges

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  • Importance of Vaccine Equity:

    • 36% vaccinated with at least one dose

    • Ensures allocation regardless of economic status

    • Consequences: socio-economic recovery impact, preventable deaths, growing inequalities, prolonged pandemic

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  • (Repeat of Page 12)

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  • Determinants of Global Health - Conflict:

    • Consequences of armed conflict: injuries, food supply disruptions, mental health effects, healthcare access issues

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  • Global Consequences of War:

    • Economic growth impact: inflation, extreme poverty, food insecurity, environmental impact

    • Affects migration patterns

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  • (Repeat of Page 12)

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  • Reasons for Migration:

    • Social and Political Factors: Persecution from ethnicity, religion, or politics

    • Demographic and Economic Factors: Poor labor standards, high unemployment

    • Environmental Factors: Natural disasters, extreme weather

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  • Determinants of Global Health - Migration:

    • 281 million international migrants as of 2020

    • Contribution of migrants to health services in high-income countries

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  • Health Impacts of Migration:

    • Risks: death in transit, interrupted care for chronic diseases, overcrowding in refugee camps

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  • (Repeat of Page 12)

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  • Poverty and Health:

    • Connection to poor sanitation, overcrowding, and inability to access health care

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  • (Repeat of Page 12)

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  • Weak Health Systems:

    • Factors include leadership, health financing, workforce challenges, service delivery

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  • Weak Health Systems - Challenges:

    • Resource management, transparency, and infection control issues

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  • (Repeat of Page 29)

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  • Ebola Outbreak (2014-16) - Determinants:

    • Weak health systems shaped the outbreak: poor surveillance, insufficient workforce, and infrastructure issues

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  • Ebola Impact:

    • Severe health worker losses (7% of Sierra Leone's workforce) and increased mortality from other diseases

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  • Ebola Virus Management:

    • Specific handling requirements for deceased Ebola patients by World Health Organization

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  • Global Health Goals (University of Nottingham)

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  • Sustainable Development Goals (2015):

    • Framework addressing interconnected challenges across poverty, health, and growth areas

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  • Goal 3 - Good Health & Well-being:

    • Targets to reduce mortality, end epidemics, achieve universal health coverage, among others

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  • Global Health Architecture:

    • Involvement of UN agencies, government bodies, philanthropic organizations, and civil society in health initiatives

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  • Vertical vs. Horizontal Approaches:

    • Vertical: Focused, immediate health interventions

    • Horizontal: Comprehensive health system strengthening leading to long-term impact

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  • Vertical Approach Examples:

    • Preventative and treatment interventions targeted to reduce under-5 mortality

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  • Horizontal Approach: Strengthening Systems:

    • Emphasis on community engagement, training, and decentralization for improved health outcomes

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  • Global Health Progress Measurement:

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  • Progress in Reducing Under-5 Mortality:

    • Results from increased healthcare access, vaccinations, and nutrition

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  • Maternal Mortality Trends:

    • Downward trend influenced by skilled birth attendance access

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  • Childhood Obesity Trends:

    • Dramatic increase with projected future trends needing urgent action to meet targets

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  • Consequences of Increased Healthcare Access:

    • Rising mortality linked to antibiotic resistance, especially for drug-resistant TB

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  • Global Health Challenges:

    • Priority setting, data sufficiency, program funding, sociopolitical context challenges

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  • Conclusion:

    • Globalization's double-edged impact on health

    • Persistent inequalities in health outcomes globally

    • Influence of poverty, urbanization, conflict, and health system weaknesses

    • UN Sustainable Development Goals as vital frameworks for addressing challenges.