FMSC UNIT 1 Study
The Constitution of the World Health Organization (WHO), written in 1948, defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”
Some of the core values that guide global health can be summarized by the acronym PACES:
1.2 Population Health
Global health initiatives aim to improve health at the population level. A population is a group of individuals, communities, nations, or other entities
Population health encompasses health outcomes and the determinants of health in groups of humans at the community, regional, national, and/or worldwide level
The determinants of health are the biological, behavioral, social, environmental, political, and other factors that influence the health status of individuals and populations
Individual behaviors contribute to reducing health risks at individual level, but the ability of individuals to engage in healthy activities is partly a function of community resources
Population-based interventions related to the determinants of health enable individuals to adopt healthier behaviors that improve their own health outcomes; when the health outcomes for individuals improves, the overall health status of their communities improves
1.3 Prevention and Intervention Science
For an individual, an ideal health trajectory begins with a consenting adult becoming pregnant and ends in very old age with a gentle death that is not preceded by months or years of disability and pain, but few people achieve this ideal pathway
Actions implemented at the individual, community, and higher levels can prevent many events that decrease health status and can lessen the level of reduced health associated with them
A global health intervention is a strategic action intended to improve individual and population health status
A variety of medical, behavioral, social, economic, environmental, and other interventions and changes can help individuals and their communities make progress toward having longer, healthier life trajectories.
When interventions reach millions of people, they make a huge difference in population health, happiness, and productivity
See Figures 1.2, 1.3 and 1.4
Prevention science is the process of determining which preventive health interventions are effective at improving health status, how successful those interventions are in various populations, and how readily they can be scaled up for widespread implementation
Implementation science is the scientific study of how to increase uptake of evidence-based practices and policies after effective interventions have been identified
There are three levels of prevention that together capture the full range of health:
Primary prevention consists of protective actions that help keep an adverse health event from ever occurring
Secondary prevention is the detection of health problems in asymptomatic (not symptomatic) individuals at an early stage when the conditions have not yet caused significant damage to the body and can be treated more easily
Tertiary prevention consists of interventions that reduce impairment, minimize pain and suffering, and restore function in people with symptomatic health problems
Given the three levels of prevention, there is almost always some intervention that could improve the health of those who are vulnerable to various adverse health conditions or are already sick
Primary prevention is the preferred option, especially when a cost-effective intervention is available. When primary prevention is not possible with current technologies and when health problems are already present, secondary prevention and tertiary prevention can improve longevity and quality of life
1.4 Risk Factors
An exposure is a personal characteristic, behavior, environmental encounter, or intervention that might change the likelihood of developing a health condition
A risk factor is an exposure that increases the likelihood of experiencing a particular health outcome
An individual’s health status at any age is a function of experiences throughout the life course
A nonmodifiable risk factor is a risk factor that cannot be changed through health interventions, such as age or genetics
A modifiable risk factor is a risk factor that can be avoided or mitigated
Individuals can and should accept responsibility for their own health decisions, but there are some threats to health that can only be solved at the communal level
Many threats to health can only be resolved with global cooperation
1.5 Health Transitions
A health transition is a shift in the health status of a population that usually occurs in conjunction with socioeconomic development
One hundred years ago, most populations across the globe had similar health profiles: high birth rates, high child mortality rates, short life expectancies, and a considerable proportion of illnesses and deaths due to infections and undernutrition
During the 20th century, high-income nations transitioned to having longer life expectancies and lower rates of infection and chronic hunger
Because low-income countries did not undergo the health transitions observed in high-income countries, gaps in health equity increased
The risk transition is a health transition characterized by a shift from exposures like undernutrition, unsafe water, and indoor air pollution that increase the risk of childhood infectious diseases causing most preventable morbidity and mortality in a population to exposures like obesity, physical inactivity, and tobacco use that increase the risk of chronic diseases being the most prominent risk factors
Some health and risk transitions are not wholly favorable ones
People who live in high-income countries often live to old age, but many older adults are disabled by chronic diseases and experience a lot of pain
Increasing rates of obesity and sedentary lifestyles among younger adults are likely to exacerbate the burden from noncommunicable diseases in “post-transition” countries in coming decades
Everyone will eventually die of something, but a population is healthier when the typical age at death is 85 years rather than 65 years
Transitions that shift the burden of death and disease from children and young adults to older adults are considered to be population health successes
A health disparity (aka health inequality) is an avoidable difference in health status between population groups
Health disparities can be observed between countries and within countries
GPH aims to reduce health disparities by increasing the health status of disadvantaged populations through interventions. Minimizing health disparities by reducing the health status of advantaged populations would not be a global health gain
1.6 Global Health History and Functions
Modern transportation accelerated the speed at which pathogens can spread through international travel and trade. The field of tropical medicine was established in the late 1800s and early 1900s to protect settlers and visitors in tropical colonies from parasitic and infectious diseases and to ensure that the workforce in those areas was healthy enough to be productive
Tropical medicine was the precursor for the field of international health, a term that in current usage usually describes efforts to alleviate poverty-related health conditions in lower-income countries
Many international health programs have humanitarian origins and aims that overlap with commercial and diplomatic motivations
One of the criticisms of some traditional ways of doing international health is that partnerships between high-income donor countries and lower-income recipient countries perpetuate power hierarchies rather than promoting true equity among partners
Decolonizing Global Health (we will come back to this later in the semester)
Calls to “decolonize” global health push for wider recognition of how colonialism and settler-colonialism (which occurred when European immigrants to the United States, Canada, Australia, and other places participated in a systematic process that displaced Indigenous populations and took possession of their lands) have harmed and continue to harm individual, public, and global health.
Decolonizing global health requires rethinking global health concepts and practices as well as improving diversity, equity, and inclusion within the global health workforce.
Global health interventions include partners from many countries across the income spectrum (rather than being sponsored by one high-income country), emphasize how globalization processes affect the health of all people (rather than focusing exclusively on the most disadvantaged populations), and apply interprofessional and multisectoral lenses to the development and implementation of public health interventions.
Chapter 2: Global Health Priorities
Globalization is the process of countries around the world becoming more integrated and interdependent across economic, political, cultural, and other domains. Globalization contributes to the favorable and unfavorable health transitions that are occurring in many parts of the world by increasing access to health technologies, encouraging urbanization, changing social and cultural practices, and accelerating environmental changes
You do not need to know from sections 2.1 or 2.2 for the exam
2.3 Prioritization strategies (we will come back to this later in the semester)
The amount of funding available for health interventions is limited. Advocates for various health problems and solutions must compete for attention and support, and only the proposals that garner buy-in from well-resourced groups are able to move forward. Each funding agency applies its own criteria for the types of activities that it will support.
2.4 Millennium Development Goals
The Millennium Development Goals (MDGs) were a set of eight goals endorsed by the United Nations and hundreds of partners aimed at reducing global poverty between 2000 and 2015
Many of the eight goals had direct links to health, including ones seeking to eradicate extreme poverty and hunger (MDG 1), reduce child mortality (MDG 4), improve maternal health (MDG 5), combat HIV/AIDS, malaria, and other diseases (MDG 6), and ensure environmental sustainability (MDG 7)
One of the reasons the MDGs were so influential is that they provided a clear strategy for evaluation by defining sets of goals, targets, and indicators
A goal is a desired future outcome
A target is a specific, measurable objective that contributes to achieving a desired future outcome; targets point toward the actions that should be taken to demonstrate progress toward achieving goals
An indicator is a variable used to measure performance, achievement, or change
The MDGs facilitated remarkable improvements in health status and quality of life for the world’s lowest-income populations. Some concerns were raised about how well the MDGs promoted equity, sustainability, local ownership of priorities, and holistic development.
2.5 Sustainable Development Goals
The Sustainable Development Goals (SDGs) are a set of seventeen goals endorsed by the member nations of the United Nations at the end of 2015 that aim, by 2030, to end poverty, protect the planet, and promote prosperity and peace
The 17 goals are operationalized through 169 targets and more than 230 indicators
The SDGs mix goals for poverty reduction with a lengthy list of other targets that apply to countries across the economic spectrum
Like the MDGs, the SDGs treat health as both a necessary prerequisite to and an outcome of economic growth
A benchmark is a standard or a point of reference for comparison. Most of the SDG targets have 2015 as the baseline benchmark for evaluating improvements by 2030
2.6 Vital Statistics
As more resources have been devoted to global health efforts, it has become increasingly important to:
quantify population health concerns
identify major modifiable risk factors for diseases and other adverse health conditions
assess the impact of new public health interventions
monitor changes in the health status of populations over time
A variety of measures provide an evidence base for making policy and funding decisions
A statistic is a measured characteristic of a sample population
Vital statistics are population-level quantifications of births, deaths, and other life events
A census collects demographic data about every individual in a population
A ratio is a comparison of two numbers
A proportion is a ratio in which the numerator (the top number) is a subset of the denominator (the bottom number)
A percentage expresses a number or ratio in units of “per one hundred”
A rate is a ratio in which the numerator and denominator have different units; the denominator for a rate often expresses a measure of time
The birth rate is the number of births per 1,000 people (or other units) in a population over a one-year period
Life expectancy is the average number of additional years of life an individual of a particular age can be expected to survive based on population mortality patterns
Life expectancy at birth is the average number of years a newborn in a population can be expected to survive based on population mortality patterns at the time of birth
Life expectancy at birth captures the burden from infant and child deaths in addition to the average age at death of adults
In places with high infant mortality rates, the life expectancy at birth is often in middle adulthood, because there are a large number of child deaths and a large number of deaths among older adults
Life expectancies have increased over time in most countries, but they remain much higher in high-income countries than in low-income countries
Healthy life expectancy (HALE) is the average number of additional years an individual of a particular age in a population can expect to live without disability
The typical adult can expect to experience about 10 years of poor health before dying
Global health aims to increase life expectancies and increase HALE, so that people live to older ages without experiencing extended periods of disability prior to death
2.7 Mortality
Epidemiology is the study of the distribution and determinants of health and disease in human populations
Biostatistics is the science of analyzing health data and interpreting the results so that they can be applied to solving public health problems
Mortality means death. The mortality rate is the number of all-cause or cause-specific deaths per 1,000 people in a population during a stated period of time.
Mortality rates in low-income countries often must be estimated based on incomplete registries
Higher-income countries usually have older populations than lower-income countries, so they usually have higher all-ages mortality rates than lower-income countries
When age-specific mortality rates are compared, the opposite trend is observed
The lower age-specific mortality rates in higher-income countries allow more residents to live to old age, and then the higher proportion of older adults in higher-income countries makes the all-ages mortality rate higher
2.8 Morbidity
Morbidity is the presence of nonfatal illness or disease, whether mild or severe
Incidence is the # of new cases of a disease in a population during a specified period of time
Prevalence is the percentage of members of a population with a given trait at a particular time
Prevalence is usually used to describe the frequency of chronic (long-lasting) exposures and diseases in a population
2.9 Burden of Disease: YLLs, YLDs, DALYs and QALYs
Premature mortality is any death before a selected target survival age
Years of life lost (YLLs) is a burden of disease metric used to quantify population-level reductions in health status due to premature mortality
Diseases that kill children, who would have had decades of productive life remaining if they had survived, generate more YLLs per case than diseases that primarily affect older adults
The leading causes of YLLs globally include cardiovascular diseases, cancers, injuries, maternal and neonatal disorders, and lower respiratory infections
Years lived with disability (YLDs) is a burden of disease metric used to quantify population-level reductions in health status attributable to nonfatal conditions
In most burden of disease models, disability refers to any short- or long-term reduction in health status. Some of the most frequent causes of YLDs worldwide are musculoskeletal disorders (such a back pain and arthritis), mental health disorders (such as depression and anxiety), sense organ disorders (such as age-related hearing and vision loss), neurological disorders (such as migraines and Alzheimer’s disease), and injuries
The main criticism of YLDs is the need to assign weights to the amount of disability caused by various illnesses and impairments
A disability-adjusted life year (DALY) is a burden of disease metric that is quantified as the sum of years of life lost (YLLs) to premature death and years lived with disability (YLDs) in a population
A quality-adjusted life year (QALY) is a metric used in health economics to represent the additional duration of life and quality of life conferred to populations by effective public health interventions
A DALY is a bad thing to be avoided (the loss of a healthy year of life), while a QALY is a good thing to save
2.10 Global Burden of Disease
The Global Burden of Disease (GBD) project is a massive collaborative effort to quantify the epidemiologic profiles of every country in the world. According to GBD estimates, the leading modifiable risk factors worldwide include behavioral risks such as malnutrition and tobacco use, environmental and occupational risks such as air pollution and unsafe drinking water, and metabolic risks such as unmanaged high blood pressure and high blood sugar levels
You do not need to know from sections 2.11 or 2.12 for the exam
Chapter 3 Social Determinants of Health
3.1 Health Equity and the SDGs
Socioeconomic status (SES), also called socioeconomic position (SEP), describes an individual’s standing in a society based on individual and household income, education, gender, occupation, ethnicity and race, and other characteristics that exist within broader cultural, social, political, and policy environments
At the individual level, there is a lot of variability in health status
At the population level, lower SES populations have significantly lower health status than wealthier socioeconomic groups
The personal factors and community conditions that enable or hinder access to health are collectively called the social determinants of health
These determinants can be summarized using the acronym PROGRESS: place of residence, race and ethnicity, occupation and employment status, gender and sex, religion, education, social capital, and other socioeconomic indicators
Health equity is the principle that everyone should have an equal opportunity to be as healthy as possible
Social justice is the principle that moving toward greater equality in the distribution of income and wealth, opportunities for education and employment, access to health and security, and involvement in civic and political activities is valuable for human flourishing
A health inequality (or health disparity) is a remediable difference in health status or access to health services between population groups
Inequity - When an inequality is considered to be unfair and unjust,
Globalization has exacerbated some health disparities within and between countries, but it has also created opportunities to close those gaps by improving the health status of disadvantaged populations even as the healthiest populations continue to make progress on extending the years of healthy life that their residents enjoy. When the health status of lower-income countries improves, those health equity gains yield benefits for overall world health
3.2 Economics
Income is the amount of take-home pay earned by household members in a week, year, or other time period
Wealth is the accumulated worth of a household’s resources
When someone in a high-income or wealthy household has a health concern, that person usually has the resources to immediately access high-quality medical care
Low-income households generally have very little wealth, so they have few resources to draw on when someone in the household is injured or develops a severe illness
3.3 Literacy
Literacy is the ability to read and write and apply those communication skills
Functional literacy the ability to understand written words well enough to complete routine daily tasks
Health literacy is the ability to access, understand, and apply health information
Both the ability to read and a higher number of years of formal education are correlated with higher health status for adults and their children
Improved access to education in recent decades has enabled most boys and girls to learn how to read, but there are still gaps in educational access
Children not in school miss critical opportunities for learning and healthy development
3.4 Gender
Sex refers to the biological classification of people as male or female based on genetics (such as the presence of XY or XX sex chromosomes), reproductive anatomy, body chemistry, hormones, physiology, and brain function
Gender refers to social, cultural, and psychological aspects of expressing maleness or femaleness
Gender roles describe how a cultural group expects men and women to behave based on their genders
Men and boys encounter different health challenges than women and girls because of both biological characteristics related to sex and social structures related to gender
The goal of health equity requires identifying and reducing the numerous preventable health issues that disproportionately affect women and girls and, at the same time, taking action to reduce the burden from avoidable health conditions that disproportionately burden men and boys (see Figure 3.6)
3.5 Employment
Economic security, educational level, and employment and occupational category are inextricably linked to each other and to health status. An improvement in any one of these dimensions of SES can lead to increased health
Not all jobs are equally beneficial for health. People working as manual laborers have higher mortality rates than people of the same age who are working in nonmanual professional jobs or as managers or in other professional positions. Among people doing manual labor, unskilled workers have higher mortality rates than skilled workers
Unemployment is the inability of a person who is not working for pay to secure a paid position despite actively seeking a paid job
Underemployment typically describes a situation in which a person is involuntarily working part-time rather than full-time or is a low-wage worker whose earnings are below the local poverty level even after working long hours
All-cause mortality rates are higher among unemployed men and women than employed people of the same age
3.6 Culture and Health
Culture is a way of living, believing, behaving, communicating, and understanding the world that is shared by members of a social unit
Culture frames the ways that health, illness, and sickness are experienced across the life span. Culture shapes health beliefs, affects health behaviors, and steers decisions about when and where to seek healthcare services
3.6 Discrimination and Health
Prejudice is a perception about an individual based solely on preconceived notions about a sociocultural group to which that person belongs
Racism, sexism, classism, ageism, and ableism (prejudice against people with disabilities) are all forms of prejudice
Discrimination encompasses the actions taken against an individual because of that person’s membership in a sociocultural group
Prejudice is a set of beliefs and attitudes; Discrimination is a set of practices and behaviors. While not all people who hold prejudicial beliefs act on them, prejudiced thoughts are the basis for discrimination
People who belong to minority racial, ethnic, tribal, religious, or other groups may systematically be treated less favorably than members of majority groups in the workplace, the marketplace, and the healthcare system
Prejudice and discrimination are often related to race and ethnicity
Ethnicity is a social grouping based on many dimensions of cultural heritage, nationality, language, religion, tribal affiliation, and other factors
Race refers to superficial categories that group individuals based primarily on physical attributes like skin color; significant cultural and genetic diversity is present within most racial groups
Significant differences in health status often exist between different racial and ethnic groups within the same country. Health equity for all groups is achievable
Culture, Discrimination and Health
An Indigenous population is a group that has maintained unique cultural traditions (and often also languages) for many generations after the colonization or domination of their traditional homeland by another group. More than 400 million people worldwide identify as members of indigenous communities. Indigenous populations usually have morbidity and premature mortality rates that exceed the national averages in their countries of residence
3.7 Migrants, Refugees and Health
An international migrant is a person who has moved across an international border and is residing in a new country. By 2020, there were nearly 270 million people worldwide who were living in a country that was not their original homeland
An immigrant is a person who has settled in a new country and intends to stay there permanently
An expatriate is a person who is temporarily living in another country and intends to return to his or her home country
Most migrants voluntarily move from one country to another to be closer to family, start a new job, or pursue educational opportunities. The typical voluntary international migrant moves from a middle-income country to a high-income destination country where the prospects for economic prosperity are greater. Voluntary migrants tend to be healthier than the general population
Some migrants are forced to move because of violence, persecution, or natural disasters. Many migrants encounter new health challenges as they settle into their new places of residence
Trafficking is the crime of arranging for a person to relocate with the intention of forcing that migrant into sex work, debt bondage, slavery, or other types of forced labor
Acculturation is the complex process of adopting the practices, traditions, values, and identity of a new community after migrating. Acculturation generally brings improved ability to navigate the healthcare system of the host country and access the tools for health
A refugee is a person who has been forced to move across an international border because of security concerns like war, civil conflict, political strife, or persecution based on race, tribe, religion, political affiliation, or membership in some other group
Refugees typically secure permission to move to a new country prior to arriving in that country. To be classified as a refugee or asylum seeker, an involuntary migrant must cross an international border
An asylum seeker is an involuntary migrant who asks for protection from a host country after arriving in that country rather than waiting for a refugee application to be processed prior to traveling
There are currently more than 25 million refugees worldwide who are living outside their home countries, about 40% of whom are children and adolescents. About 75% of refugees move from their country of origin to a neighboring country. Nearly all refugees originate in low- or middle-income countries, and about 85% are hosted by low- or middle-income countries
An internally displaced person (IDP) is a person who fled his or her home community because of civil war, famine, natural disaster, or another crisis, but did not cross into another country
There are an estimated 50 million IDPs worldwide, of whom about 90% were displaced by conflict and violence and about 10% were displaced by natural disasters
3.8 Governance and Politics
Access to health care and other services is associated with wealth, education, and employment, and it is also related to power
Power is the authority to control or influence the actions of others. Power can be conferred by political position, socioeconomic advantages, and cultural systems. In many countries, some people have the power to secure health for themselves and their families while others without power have limited or no access to the resources they need to be safe and healthy
Governance consists of the processes and structures that enable governments to set policies, provide services, and protect human rights
Corruption occurs when politically powerful people abuse their positions for personal gain. Lower-income countries tend to have less functional governance structures
None of the other SDGs can be achieved when functioning governance systems are not in place to ensure that everyone has access to clinical health services, education, clean drinking water, and other tools for health
Chapter 11 Reproductive Health
Sexual health is the enjoyment of safe, voluntary, and nonviolent sexual experiences
Reproductive health encompasses issues related to fertility and infertility, pregnancy and childbirth, contraception, the prevention and treatment of sexually transmitted infections, and other aspects of gynecological and urological health
Sustainable Development Goal 5 (SDG 5) focuses on gender equality, and one of its targets is to “ensure universal access to sexual and reproductive health and reproductive rights”
Reproductive rights describe the freedom for women and their partners to decide how many children they want without interference from governments or other organizations. Reproductive rights remains a hot topic in global health because of the lack of unanimity about the value of contraceptive use, reproductive rights, and gender equity
Maternal and child health (MCH) is an area of public health practice that focuses on the health of mothers, infants, and children who are less than five years old in order to help children get their healthiest start in life. Maternal health programs support the health of women and adolescents during pregnancy, childbirth, and the weeks after delivery
Universal access to sexual and reproductive health will require comprehensive, affordable, culturally acceptable, high-quality services to become available to all adolescents and adults
11.2-11.5 We will talk about this later in the semester
11.6 Healthy Pregnancy
Safe motherhood programs promote healthy pregnancies from the months prior to conception through the postpartum period
Antenatal care check-ups, also called prenatal care, are routine preventive healthcare consultations during pregnancy that allow clinicians to identify potential health problems in a woman or fetus. Postnatal care ensures that mothers are recovering and babies are healthy
Childbirth occurs in three stages: (1) labor, when contractions dilate the cervix to about 10 centimeters in diameter, (2) the delivery of the neonate, and (3) the delivery of the placenta, or afterbirth, which is the organ that lines the uterus during pregnancy and provides oxygen and nutrients to a fetus during fetal development
Several medical problems in the first trimester of pregnancy may require clinical treatment
Ectopic pregnancy - when a fertilized egg implants in a fallopian tube or another location outside the uterus
Miscarriages may cause hemorrhage or infection
Placenta previa - when the placenta covers part or all of the cervix and causes bleeding
Placental abruption - when the placenta separates from the uterine wall prior to delivery, may necessitate extended periods of bedrest or emergency delivery
Preeclampsia is a combination of worsening hypertension in the final months of pregnancy along with the presence of protein in the urine that can progress to organ damage, seizures, and death; up to 5% of pregnant women develop preeclampsia
A skilled birth attendant (SBA) is an obstetrician or gynecologist, another type of physician, a midwife, a nurse, or another licensed clinician who is proficient in recognizing and treating potential complications of women and newborns during and after labor and delivery. About 80% of births are now attended by SBAs, including nearly 100% of deliveries in higher-income countries but only 60% in low-income countries
A traditional birth attendant (TBA) is a lay midwife who has been trained through an apprenticeship rather than a formal educational program. A TBA may be able to handle uncomplicated births but does not have the training to safely manage complications
11.7 Maternal Mortality
Maternal mortality is the death of a woman from a pregnancy-related cause during pregnancy, childbirth, or the six weeks after delivery
The number of maternal deaths per year dropped from more than 500,000 women in 1990 to about 300,000 in 2015. Most of these deaths were preventable. Without timely access to obstetric services, pregnancy and delivery complications can cause a rapid death or lead to permanent disabilities
Obstructed labor is an obstetric complication that occurs when the unborn baby is wedged so tightly into the birth canal that blood flow to surrounding tissues is cut off and the tissues start to die. Obstructed labor can cause an obstetric fistula, a hole between the rectum or bladder and the vagina that constantly leaks urine or feces; more than 1 million women worldwide maybe living with an obstetric fistula
The most frequent causes of maternal mortality include hemorrhage, eclampsia and other types of maternal hypertension, and sepsis
Postpartum hemorrhage is severe bleeding within several hours after giving birth
Eclampsia involves dangerously high blood pressure
Sepsis, sometimes called “blood poisoning,” is inflammation in the body that is triggered by the chemicals released by the body’s immune system in response to an infection
The perinatal period extends from roughly 22 weeks of gestation through seven days after a live birth
Emergency obstetric and newborn care (EmONC) is a core set of actions that can save the lives of women and neonates during the perinatal period
A cesarean section, “C-section,” is the surgical delivery of a neonate through an incision in the mother’s abdomen and uterus. Most low-income countries have very low C-section rates; some middle- and high-income countries have very high C-section rates
The maternal mortality ratio (MMR) is the number of women who die of pregnancy-related causes per 100,000 live births. The MMR decreased from about 385 per 100,000 live births worldwide in 1990 to about 220 per 100,000 in 2015
The SDGs aim to reduce the MMR to fewer than 70 deaths per 100,000 live births (SDG 3.1). Higher-income countries already have rates that are lower than the SDG target, but most lower-income countries have rates that are above the SDG target
The Ending Preventable Maternal Mortality initiative has established 5 targets for improving maternal survival:
at least 90% of pregnant women have 4+ antenatal care visits
at least 90% of births are attended by skilled health personnel
at least 80% of women receive routine postnatal care within two days of delivery
at least 60% of people can access EmONC health facilities within 2 hours of travel time
at least 65% of women are able to access the information and services they need to make decisions about their own reproductive health
Biology
Couples mate that produce children
Sociology
Traditional view
More expansive view
Culture
Socially constructed
Language, beliefs, values, behavior
Families generally teach culture to children
Society
A group organized within a territory to carry out functions of daily life
Provides food, shelter, and basic needs
Institutions take care of social needs
Culture is a reflection of society, People define themselves through culture, conforming to society’s shared values (what everyone is doing around you)
Marriage
Socially constructed rules
Love, arranged, same-sex marriages
Formal ceremonies and established norms about mating
Monogamy, polygamy, serial monogamy
Marriage and Power
Patriarchy
Authority held by eldest male in the family
Males dominate females
Egalitarian societies
Power and decisions are shared
Matriarchies
Authority held by eldest female in the family
Power is often subtly held by men
Expection: daughters will care for aging parents
Marriage & the Household
Bilineal
Trace parentage through mother and father’s lines
Patrilineal
Woman marries into husband’s family and children become members of his family, woman moves into the house of the husband
Dowry
Woman’s family provides goods for husband’s family
Bride price
Husband family provides gifts to the woman’s family
Matrilineal
Lineage and inheritance comes through mother’s line
Tuesday, Sep 3
Seven functions of family
Procreation - children are born and raised, variability of joy
Socialization - process of learning who people are supposed to be in their society
Race, class, gender, culture
Gender norms
Emulation of people around us
Division of labor
Specialized economic activity that people do in society
Derived from socialization
Regulation of sexual behavior
Controlling premarital sex, prohibition or very open
Focus is usually on females’ activity
Care and economic provision
Resources sand how they are used
Affectional and emotional needs
Strucutred to provide affection, basic human desire
Status giving qualities
Race, class, ethnicity come together and push toward status quo
Positions recognized by society
Ascribed
Height, birth order, race
Achieved
Wealth, education, marital status
Thursday, Sep 5
Social Determinants of Health
Medicine is individual, public health is population
Conditions in which people are born, grow, live
Shaped by money, power, resources
Risk Groups
Low income
Unemployed/underemployed
Immigrants/refugee
Voluntary/involuntary
May face health risks during transition: language barriers, poverty, unhealthy work environment
Prison
Infections, injuries, undernutrition, mental health
Low education
Alllows readers to acquire health information and navigate health system
Functional literacy
Health literacy
Education literacy
SES - indicator of a person’s standing in society
House holds with low income/wealth have fewer resources to use
Social Capital
Isocial relationships can provide access to resources
Institutions, relationships, norm
Ethnocentrism
Judgement of another according to stsandards of one’s own culture
Tuesday, Sep 10
Definitions
Health inequalties: differences in health status
Health inequity: inequalites that are unjust
Health disparities are used to meausre progress towards health equity (social justice in health)
Maternal Health:
Underlying medical causes of maternal death is social, political, and economic barriers that prevent women from getting proper treatment
High maternal death rate - inadequate health care, violation of women’s rights to life and health
Somaliland:
Declared independence from Somalia in 1991
Widespread poverty and unemployment
Dramatic changes in health outcome since Edna Adan hospital
Thursday, Sep 12
Maternal mortality: death while pregnant or within 6 weeks of termination of pregnancy
Placenta: organ that lines uterus & provide O2 and nutrients to the fetus
Obstructed labor: unborn baby wedged tightly in birth canal, cutting of circulation
Obstretric fistula: hole between rectum or bladder or vagina that leaks urine/feces
Tuesday, Sep 17
Social strafication: distinctions among people that create a hierarchy of social order
Gender, race, class, ethnicity
Unequal distributions of opportunities has consequences
Life expectancy
Basic quality of life
Discrimination continuum
Prejudice (attitude)
Belief that another group is inferior
Misinformation taught through socialization
Discrimination
Acting out of prejudice
Behavior follows attitude, leads to unfair treatment
3 Levels of Racism
Institutionalized racism - inaction in the face of need; different access to resources
Person-medited racism - maintains structural barriers b/c involves acts of prejudice and discrimination
Internalized racism - when the stigmatized race believes what society has assumed about them
Cultural competency
Awareness
Knowledge
Communication skills
Thursday, Sep 26
Violence against women throughout the life cycle
Prebirth: abortion due to sex
Girlhood:
Womanhood: violence in relationship, forced prostitution
Why trafficking exists?
Low risk: lack of gov enforcement, ineffective law, social blaming
High profits
Root: acceptable for those of higher power to take advantage of those with less power (women and children)
Solution
Political will, inspect brothels, holding gov accountable, empower sex workers, putting buyers in jail