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WHO global health definition
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Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
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public health definition:
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grounded in a few principles: 1) use of evidence (disease surveillance and stats) to inform decisions 2) focus on population (not individual) 3) promotion fo social justice and equity 4) work towards preventing poor health, rather than simply curing illness after it manifests
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international health
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focused on health work abroad, especially in lower income countries. often concerned with infectious disease and maternal/child health. complex global and local forces that impact health patterns in these settings, sometimes refers to work done by international health orgs (like WHO)
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different actors in global health:*
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scientific researchers, epidemiologists in public health, industry/pharmaceutical professionals, health journalists, political leaders, diplomats, anthropologists and other social scientists, policy makers, Humanitarians
• Business leaders
• Philanthropists
• Business leaders
• Philanthropists
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factors that shape global health patterns today
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globalization, the problems we face today are inherently global in nature (pandemics, climate change don't respect national boundaries)
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morbidity*
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a state of poor health
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mortality (death) rate*
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frequency of occurrence of death among a defined population during a specified time interval
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Disability Adjusted Life Year (DALY)
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A DALY = years of life lost because of premature mortality (YLLs) + years of healthy life lost due to disability (YLDs)
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illness is universal, access to care is not
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medical doctors per 1000 people varies between countries
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WHO Constitution: *
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adopted in 1946, entered into force in 1948, preamble reads:
• Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
• The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.
• The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States.
• The achievement of any State in the promotion and protection of health is of value to all.
• Unequal development in different countries in the promotion of health and control of diseases, especially
communicable disease, is a common danger.
• Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.
• The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.
• Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.
• Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.
• Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
• The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.
• The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States.
• The achievement of any State in the promotion and protection of health is of value to all.
• Unequal development in different countries in the promotion of health and control of diseases, especially
communicable disease, is a common danger.
• Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.
• The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.
• Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.
• Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.
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Two main funding sources of the WHO
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1) Country membership dues, <1/4 of funding. 2) Voluntary contributions from members and their partners; account for more than 3/4 of funding
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Critiques of WHO
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Competing ideologies (verticalists vs. horizontalists), too bureaucratic (inefficiency, lack of transparency, politicization, irrelevance), without flexible funding, lose control of priorities
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Alma-Ata Declaration - "Health for All" *
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1978 international conference on primary healthcare, focus on primary healthcare for all people.
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Alma-Ata Principles (6)
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• Increased investment in primary healthcare.
• Health inequities as "grossly unacceptable".
• Individuals and communities should be involved in planning and implementing their healthcare.
• Governments are responsible for ensuring adequate healthcare, in coordination with other sectors.
• Goal of achieving "acceptable level of health" for all people globally by 2000 (Health For All); requires freeing up resources for health (e.g., disarmament).
• Recognition that health is tied with social and economic factors
• Health inequities as "grossly unacceptable".
• Individuals and communities should be involved in planning and implementing their healthcare.
• Governments are responsible for ensuring adequate healthcare, in coordination with other sectors.
• Goal of achieving "acceptable level of health" for all people globally by 2000 (Health For All); requires freeing up resources for health (e.g., disarmament).
• Recognition that health is tied with social and economic factors
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Alma-Ata international relevance (4)
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shapes global health agendas, helps set priorities and goals, provides frameworks for designing objectives and goals, helps to organize and mobilize resources and personnel to act
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Beyond Alma-Ata: Millennium Development Goals
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8 MDGs, committed world leaders to combat "poverty, hunger, disease, illiteracy, environmental degradation, discrimination against women"
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Sustainable Development Goals
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17 SDGs, adopted by UN member states in 2015, recognize that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth - all while tackling climate change
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Primary healthcare principles
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holistic view of health and wellbeing; comprehensive care, remove access barriers, decentralization of health services, driven by community needs, community participation and empowerment, prioritizes health promotion and illness prevention over treatment. also intersectional!
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Barriers to accessible primary healthcare
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User fees have become more common in many areas (charging individuals for services instead of financial support from governments offsetting costs).
➢Some argued this raises healthcare resources and increases community ownership.
➢However, often associated with reduced use of key health services.
• Also often see focus on categorical (disease-specific) funding, in place of a more holistic approach.
➢Some argued this raises healthcare resources and increases community ownership.
➢However, often associated with reduced use of key health services.
• Also often see focus on categorical (disease-specific) funding, in place of a more holistic approach.
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What is a human right? (from UNICEF)
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Human rights are standards that recognize and protect the dignity of all human beings. Human rights govern how individual human beings live in society and with each other, as well as their relationship with the State and the obligations that the State have towards them.
Human rights law obliges govts. to do some things, and prevents them from doing others. Individuals also have responsibilities; in using their human rights, they must respect the rights of others. No govt., group or individual person has the right to do anything that violates another's rights.
Human rights law obliges govts. to do some things, and prevents them from doing others. Individuals also have responsibilities; in using their human rights, they must respect the rights of others. No govt., group or individual person has the right to do anything that violates another's rights.
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Alma-Ata Critiques
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too aspirational (no clear targets to achieve goal by 2000)
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Universal Declaration of Human Rights
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proclaimed by UN General Assembly in 1948, considers all human rights as indivisible (all intertwined, one cannot be fully realized without the others)
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International Covenant on Economic, Social, and Cultural Rights
(expanded in 1966)
(expanded in 1966)
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Presents comprehensive view of the States' obligations to "respect, protect, and fulfill" the right to health, including:
➢Right to be free to control one's body and free from non- consensual medical testing and treatment.
➢Right to entitlements, including system for disease prevention, access to essential medical services, access to health information and education.
➢Right to be free to control one's body and free from non- consensual medical testing and treatment.
➢Right to entitlements, including system for disease prevention, access to essential medical services, access to health information and education.
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Underlying determinants of health
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• Factors required to maintain health: clean drinking water, nutritious food, adequate housing, well maintained sanitation systems, access to healthcare, education and training opportunities for care providers, and access to needed high-quality treatments.
• These health goods, infrastructure, and services must be available to all people (of all backgrounds and locations).
• These health goods, infrastructure, and services must be available to all people (of all backgrounds and locations).
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Provided good and services must meet certain requirements*
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AAAG:
- Available: sufficient quantity and easily reached when needed
- Accessible: affordable, safe to acquire, all people can use them, available in an accessible format
- Acceptable: respects cultural norms, gender equity, and medical ethics
- Good quality: medically approved and safe
- Available: sufficient quantity and easily reached when needed
- Accessible: affordable, safe to acquire, all people can use them, available in an accessible format
- Acceptable: respects cultural norms, gender equity, and medical ethics
- Good quality: medically approved and safe
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Misconceptions about health as a right
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Right to health is NOT the same as the right to be healthy (good health is influenced by several factors)
Right to health is NOT only a programmatic goal to be attained in the long term
A country's difficult situation does NOT absolve it from having to take action to realize the right to health
Right to health is NOT only a programmatic goal to be attained in the long term
A country's difficult situation does NOT absolve it from having to take action to realize the right to health
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Human rights framework requires focus on inequities
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rights-based approach must consequently improve ability to attain health, starting with those facing the most barriers
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Neglected diseases are a right-to-health issue with many faces
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largely ignored by medical community; almost exclusively affect poor and marginalized populations in a low-income country, in rural areas and setting where poverty is widespread. must guarantee underlying determinants of the right to health. discrimination is cause and consequence of neglected disease. Essential drugs often unavailable or inadequate. Health interventions and research development have long been underfunded
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Neglected disease determinants
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neglected because receive relatively little medical and health attention or funding, tend to affect people living in low-resource regions.
• Often associated with lack of access to underlying health determinants, including clean water, effective sanitation, nutritious/safe food, adequate healthcare, etc.
• These factors also contribute to changes in immune function, including inflammation.
• Often associated with lack of access to underlying health determinants, including clean water, effective sanitation, nutritious/safe food, adequate healthcare, etc.
• These factors also contribute to changes in immune function, including inflammation.
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What is inflammation?
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Acute immune response to injury and infection, first line of protection.
• If inflammation is excessive or long-lasting/chronic, it may instead contribute to health problems (e.g., severe COVID-19, autoimmune diseases, asthma, heart disease, inflammatory bowel disease
• If inflammation is excessive or long-lasting/chronic, it may instead contribute to health problems (e.g., severe COVID-19, autoimmune diseases, asthma, heart disease, inflammatory bowel disease
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These inflammation patterns play out in low-resource areas within high-income countries.
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Despite high-amount spent on health in the US, many people don't have reliable access to care and other basic services required to maintain health. Patterns may compromise the right to health and contribute to lifelong inequities.
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Case Study with African-American children from rural Mississippi
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- Part of the REACH study
- explore parasitic infection rates and intestinal inflammation levels
- explore parasitic infection rates and intestinal inflammation levels
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What is medical anthro?
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• A subfield of anthropology that investigates how cultural, historical, socioeconomic, and political factors shape ideas about health, illness, and disease.
• Considers how these forces shape health disparities, healthcare practices and barriers to care, perceptions of risk and vulnerability, etc.
• Considers how these forces shape health disparities, healthcare practices and barriers to care, perceptions of risk and vulnerability, etc.
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What does medical anthro contribute to understandings of health?
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• Health and disease are cultural concepts, as well as biological ones!
• Cultural factors shape disease risk and health patterns.
• Cultural factors impact how a disease is defined, how it is treated (e.g., what is considered appropriate care and who has access), while also shaping the social consequences of infection (e.g., stigma).
• Cultural factors shape disease risk and health patterns.
• Cultural factors impact how a disease is defined, how it is treated (e.g., what is considered appropriate care and who has access), while also shaping the social consequences of infection (e.g., stigma).
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Cultural relativism
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Idea that cultural aspects must be considered in their own terms, without making value judgements based on norms drawn from other cultures
Caveat: Health patterns vary across culture for a variety of local, historical, and global reasons
➢There is generally no reason to assume that poor health is inevitable within a certain cultural setting or that it's not possible to improve health outcomes without negatively impacting cultural practices.
➢Access to resources often cross-culturally associated with poor health outcomes.
Caveat: Health patterns vary across culture for a variety of local, historical, and global reasons
➢There is generally no reason to assume that poor health is inevitable within a certain cultural setting or that it's not possible to improve health outcomes without negatively impacting cultural practices.
➢Access to resources often cross-culturally associated with poor health outcomes.
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Perceptions of health are context dependent
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• Cultural perceptions of physical signs of good health/disease vary (e.g., variation is whether substantial adipose tissue reflects good or poor health).
• Individuals within a society may also have different definitions of health (e.g., an elite athlete vs someone with a more sedentary lifestyle).
• Certain physical conditions may be beneficial in some contexts but potentially pose a risk in others (e.g., high RBC counts at altitude vs sea level).
• Understandings of health determinants may vary (e.g., poor health caused by a pathogen, by witchcraft, by certain behaviors or foods, etc.), leading to differences in preferred treatments.
• Individuals within a society may also have different definitions of health (e.g., an elite athlete vs someone with a more sedentary lifestyle).
• Certain physical conditions may be beneficial in some contexts but potentially pose a risk in others (e.g., high RBC counts at altitude vs sea level).
• Understandings of health determinants may vary (e.g., poor health caused by a pathogen, by witchcraft, by certain behaviors or foods, etc.), leading to differences in preferred treatments.
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What is "disease"?
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• Biological changes that impair function, largely shaped by biomedicine constructs.
• Thought to be fairly objective, although may at times be context dependent.
• Common disease types include injury, infection, malnutrition, genetic, chronic, psychological.
Various disease-causing pathogens.
• Thought to be fairly objective, although may at times be context dependent.
• Common disease types include injury, infection, malnutrition, genetic, chronic, psychological.
Various disease-causing pathogens.
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What is "illness"?
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• Generally used to refer to subjective experience of discomfort/suffering (shaped by the individual's culture).
• Healthcare providers typically share this culturally constructed understanding of illness and use this to inform disease diagnoses.
• Successful treatment generally relies on a close match between individual's illness presentation and provider's disease diagnoses criteria... mismatches can lead to frustration and continued discomfort.
• Illness considered more holistic concept of poor health than disease (physiological symptoms vs lived experiences and social/physical/psychological aspects).
• Healthcare providers typically share this culturally constructed understanding of illness and use this to inform disease diagnoses.
• Successful treatment generally relies on a close match between individual's illness presentation and provider's disease diagnoses criteria... mismatches can lead to frustration and continued discomfort.
• Illness considered more holistic concept of poor health than disease (physiological symptoms vs lived experiences and social/physical/psychological aspects).
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What is "sickness"?
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• Has a sociological meaning (e.g., "sick role", socially recognized set of behaviors).
• Adopting a sick role may require legitimation (e.g., documentation from a care provider, a failed COVID screening, etc.).
• Sick role may also lead to experiences of stigma (e.g., due to fear of disease).
• Adopting a sick role may require legitimation (e.g., documentation from a care provider, a failed COVID screening, etc.).
• Sick role may also lead to experiences of stigma (e.g., due to fear of disease).
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Drs. Scheper-Hughes and Locke in 1987:*
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3 bodies that determine health:
• Individual body: Individual level (both physical and mental aspects, although material body often privileged in biomedicine).
• Social body: Social factors may impact individual health (e.g., social divisions, conflict, warfare, inequities may all lead to increased risk of poor health).
• Body politic: How social and political forces affect individual bodies within society, with implications for opportunities and health outcomes.
• Individual body: Individual level (both physical and mental aspects, although material body often privileged in biomedicine).
• Social body: Social factors may impact individual health (e.g., social divisions, conflict, warfare, inequities may all lead to increased risk of poor health).
• Body politic: How social and political forces affect individual bodies within society, with implications for opportunities and health outcomes.
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Medicalization
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• The process of defining and treating human conditions (often largely shaped by social factors) as medical pathologies in need of intervention.
• Grants authority to healthcare provider, as conditions become subject to medical study, diagnosis, and treatment.
• Grants authority to healthcare provider, as conditions become subject to medical study, diagnosis, and treatment.
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Example of medicalization: (birth)
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• Medical interventions have helped reduce risks, but are they too common?
• Why are U.S. maternal deaths higher than other high-income nations? High C-section rates partly to blame?
*Missouri 2019 C-section rate = 30.1%
• Why are U.S. maternal deaths higher than other high-income nations? High C-section rates partly to blame?
*Missouri 2019 C-section rate = 30.1%
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"Proximate" vs "Ultimate" disease causes*
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• Proximate: Immediate cause of poor health and disease symptoms. (viruses, hormones, cell growth, organ function)
• Ultimate: Root factors contributing to risk of poor health in the first (politics, environment, economy, evolution)
place.
Can pick a disease, for example HIV/AIDS, and ask two questions:
• HOW: How does HIV/AIDS infect a host? How exactly does it affect immune function? (Proximate)
• WHY: Why are humans susceptible to HIV/AIDS? What are the evolutionary, historical, socioeconomic factors that increase HIV/AIDS risk? (Ultimate)
• Ultimate: Root factors contributing to risk of poor health in the first (politics, environment, economy, evolution)
place.
Can pick a disease, for example HIV/AIDS, and ask two questions:
• HOW: How does HIV/AIDS infect a host? How exactly does it affect immune function? (Proximate)
• WHY: Why are humans susceptible to HIV/AIDS? What are the evolutionary, historical, socioeconomic factors that increase HIV/AIDS risk? (Ultimate)
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Biological normalcy
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• To define poor health, must first define what a "normal" condition is.
• This is often done by examining statistical distribution of a trait in a population (e.g., height) and establishing based on these data what bodies "should" look like (e.g., identify individuals that are "abnormally" tall or short).
• However, these distributions vary across populations and individuals falling outside of "normal" ranges may not suffer poor health.
• This is often done by examining statistical distribution of a trait in a population (e.g., height) and establishing based on these data what bodies "should" look like (e.g., identify individuals that are "abnormally" tall or short).
• However, these distributions vary across populations and individuals falling outside of "normal" ranges may not suffer poor health.
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Concepts of biological normalcy affect disease conditions
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Lactose intolerance vs. persistence --> all about framing
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Evolutionary history of humans*
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Selection has shaped our biology in response to environments encountered throughout our evolutionary history.
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Evolution definitions:* (3) selection, stressor, adaptation
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Selection: Process by which one individual is more likely to reproduce successfully than another in the population due to the possession of an advantageous trait.
Stressor: An external stimulus that challenges the biological processes and health of an organism.
Adaptation: An advantageous trait that evolved for a specific reason & which increases reproductive success; difficult to define & prove.
Stressor: An external stimulus that challenges the biological processes and health of an organism.
Adaptation: An advantageous trait that evolved for a specific reason & which increases reproductive success; difficult to define & prove.
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What is culture?
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From Wiley and Allen, 2000: Culture is a set of shared meanings (i.e., it exists at the group level), embedded in social institutions, and an implicit shaper of individual beliefs and behavior.
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Different approaches to exploring how culture influence health?*
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1) Ethnomedical systems: Cultural similarities and variation in healing systems. All share theories of disease causation, diagnostic criteria, reliance on therapeutic measures, formalized healer-individual interactions, training systems for new healers. Scale of system may vary, from institutionalized, to more informal and local. Also difference in where disease agent situated (e.g., at a cellular level vs a non-physical spiritual ailment), informing treatment plans.
2) Political economy of health: Examines how structural factors and differences in power/wealth shape health (e.g., those with less power/fewer resources often face greater exposures to hazardous conditions while also having less access to healthcare = "structural violence").
2) Political economy of health: Examines how structural factors and differences in power/wealth shape health (e.g., those with less power/fewer resources often face greater exposures to hazardous conditions while also having less access to healthcare = "structural violence").
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Johan Galtung in 1969: *
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Coined structural violence. • Describes social structures—economic, political, legal, religious, and cultural—that stop individuals, groups, and societies from reaching their full potential.
• The arrangements are structural because they are embedded in the political and economic organization of our social world.
• They are violent because they cause injury to people (typically not those responsible for maintaining such disparities).
• They seem so ordinary in our ways of understanding the world, they appear almost invisible.
*ex. dying from TB in 1700s not structural violence, but now, it is
• The arrangements are structural because they are embedded in the political and economic organization of our social world.
• They are violent because they cause injury to people (typically not those responsible for maintaining such disparities).
• They seem so ordinary in our ways of understanding the world, they appear almost invisible.
*ex. dying from TB in 1700s not structural violence, but now, it is
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Interpretative approach:
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Requires anthropologist to fully situate illness within the cultural context (e.g., relevant behaviors in relation to worldview of individual, and how that worldview is shaped by historical, environmental, political, social, and economic factors). May result in "cultural syndromes", or conditions that may be recognized in one culture but not others. Considers how disease definitions, recognized symptoms, and treatments are influenced by cultural factors (i.e., "cultural construction of disease").
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applied medical anthropology
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Work that applies the knowledge produced through anthropological scholarship to the design and implementation of health interventions. For instance, may act as "cultural brokers" and help healers and individuals seeking care understand each other's perspectives, beliefs, and priorities
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Drs. Janes and Corbett in 2009, how medical anthropologists contribute to the global health field: (4)
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1) Produce studies of health inequities, while accounting for political and economic context.
2) Assess local impact of globally circulating science and technology.
3) Interrogate, analyze, and critique international health policies and programs.
4) Investigate how international health development affects social relations (with implications for health outcomes).
2) Assess local impact of globally circulating science and technology.
3) Interrogate, analyze, and critique international health policies and programs.
4) Investigate how international health development affects social relations (with implications for health outcomes).
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infectious disease
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• Disease caused by a microorganism, such as a bacterium, virus, fungus, worm/helminth, or protozoan as they grow and replicate in human host (causing damage).
• Typically also communicable (or contagious), meaning it can be transmitted between persons or species.
• Infection may or may not lead to clinically recognizable symptoms or impaired function.
• Transmission pathways:
➢Infectious agent may be transmitted person-
to-person through direct contact.
➢Or indirectly via contaminated surfaces, contaminated liquids or foods, airborne inhalation, or through vectors (e.g., ticks or mosquitoes).
• Typically also communicable (or contagious), meaning it can be transmitted between persons or species.
• Infection may or may not lead to clinically recognizable symptoms or impaired function.
• Transmission pathways:
➢Infectious agent may be transmitted person-
to-person through direct contact.
➢Or indirectly via contaminated surfaces, contaminated liquids or foods, airborne inhalation, or through vectors (e.g., ticks or mosquitoes).
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non-infectious or chronic disease
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• Not caused by an acute infectious process & not directly passed from one person to another, examples include:
➢Heart disease & stroke ➢Hypertension
➢Type 2 diabetes ➢Arthritis
➢Cancer
➢Allergies or asthma
• Diseases of long duration and generally slow progression.
• Environmental conditions and lifestyle factors often play an important role in non-infectious diseases.
➢Heart disease & stroke ➢Hypertension
➢Type 2 diabetes ➢Arthritis
➢Cancer
➢Allergies or asthma
• Diseases of long duration and generally slow progression.
• Environmental conditions and lifestyle factors often play an important role in non-infectious diseases.
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What is epidemiology?
answer
"upon people study"
how and why of disease: - Define and identify cases, transmission pathways, risk factors, most affected pops, etc.
- Helps understand how many people have a condition, if those numbers are changing, and possible socioeconomic impacts.
• Often interdisciplinary in nature.
• Relies heavily on statistics.
• Population rather than the individual is the unit of study.
how and why of disease: - Define and identify cases, transmission pathways, risk factors, most affected pops, etc.
- Helps understand how many people have a condition, if those numbers are changing, and possible socioeconomic impacts.
• Often interdisciplinary in nature.
• Relies heavily on statistics.
• Population rather than the individual is the unit of study.
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Applications of epidemiology: *
answer
- define and document novel pathogens, help systematically understand disease spread, symptoms, and prognosis
- identify key determinants (causes of disease), that can be targeted to design more effective interventions
- identify segments of the population that especially require protection
- identify key determinants (causes of disease), that can be targeted to design more effective interventions
- identify segments of the population that especially require protection
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Origins of contemporary epidemiological methods:
answer
- Historical documents indicate past populations around the world tracked key epidemiologic metrics (e.g. mortality rates)
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John Snow (worked in 1800s)*
answer
Helped demonstrate the importance of systematic data collection to trace disease origins (cholera dude)
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William Farr*
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Helped develop health and vital statistics records
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Ignaz Semmelweis*
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Helped establish hospital best practices for hygiene
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Effects of plague*
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Facilitated the formation of surveillance programs
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Effects of cholera epidemic*
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Demonstrated importance of population level data
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1918 influenza*
answer
spurred formation of academic epidemiology programs
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Incidence definition*
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rate at which new cases occur over a given time
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Prevalence definition *
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Total number of cases in a specific time period
The proportion of individuals in a population with a disease at any one time
The proportion of individuals in a population with a disease at any one time
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R0: disease reproduction number
answer
COVID: 1.5-3.5
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Sporadic disease: *
answer
A disease that occurs infrequently and irregularly.
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Cluster: *
answer
aggregation of cases in certain area within a specific time period (may not be more than expected)
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Outbreak: *
answer
occurrence of more cases than expected in certain area within a specific time period
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Epidemic: *
answer
New cases spread rapidly through a population
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Pandemic: *
answer
extreme epidemic, over vast amount of geographic space
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Endemic: *
answer
New cases occur at a relatively low but constant rate over time
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Morbidity: *
answer
A diseased state
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Mortality (death) rate*
answer
Frequency of occurrence of death among a defined population during a specified time interval
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Case fatality rate*
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The proportion of people with a disease who die from it (useful for seeing most at-risk groups)
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Disease reservoir*
answer
A host population in which the pathogen lives and multiplies
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Life expectancy at birth is often used:
answer
as a proxy measure of overall quality of life (e..g general patterns of health and resource access) within a population
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Another key metric: infant and child mortality
answer
• Disease and death (mortality) rates for different age groups also provide insights into causes
of poor heath.
- When are people getting sick and
dying & what are they dying from? - Infant mortality vs. prime-age
mortality vs. old-age mortality
• Highlight issues that require particular attention from health researchers and providers, as well as persistent health inequities.
of poor heath.
- When are people getting sick and
dying & what are they dying from? - Infant mortality vs. prime-age
mortality vs. old-age mortality
• Highlight issues that require particular attention from health researchers and providers, as well as persistent health inequities.
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Understanding disease patterns can help global health professionals:
answer
- Set priorities for future work and interventions
- Assess progress towards disease elimination or other targets
- Evaluate the effectiveness of ongoing interventions
- Provide feedback to improve performance going forward
- Advocate for resources and investments where they are most needed
- Measure impact of donor aid and consider how to enhance outcomes
- Provide info to granting agencies (so agencies can evaluate their investments and strategies)
- Assess progress towards disease elimination or other targets
- Evaluate the effectiveness of ongoing interventions
- Provide feedback to improve performance going forward
- Advocate for resources and investments where they are most needed
- Measure impact of donor aid and consider how to enhance outcomes
- Provide info to granting agencies (so agencies can evaluate their investments and strategies)
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How to conduct epidemiological study? 3 steps:
answer
1) Identify disease cases (need to define extent of disease, so cluster --> outbreak --> epidemic --> pandemic), develop case definition by sharing info with other researchers, consider likely modes of transmission)
2) Calculate disease rates (compare frequency of disease between locations with unequal pops, helps w/ health planning)
3) Compare rates (use stats to track disease rates between pops and over time)
2) Calculate disease rates (compare frequency of disease between locations with unequal pops, helps w/ health planning)
3) Compare rates (use stats to track disease rates between pops and over time)
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5 types of epidemiological studies:*
answer
CCCER: Cross-sectional, case-control, cohort, ecological, randomized control
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Nuremberg Code (1948) key points:*
answer
voluntary informed consent, expected benefit must outweigh risk, researchers must avoid injuring subject
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Declaration of Helsinki (1964)
answer
drafted by World Medical Association building upon Nuremberg Code; added, 1) interests of the subject should always be placed above the interests of society and 2) every subject should get the best known treatment, expanding consent
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Belmont Report (1978) (RBJ)
answer
Created by the National Commission, 3 fundamental principles: 1) Respect for persons (self-determination, vulnerable individuals entitled to extra protection) 2) Beneficence 3) Justice (equal distribution of risks)
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Benefits of CBPR/importance on GH*
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more ethical and equitable research, increased community participation. ensures that methods used and resulting interventions are relevant to the community where you are working
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Where to start with SciComm?
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identify audience. consider what main takeaways are. connect with audience on personal level.
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Thomas McKeown*
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Scottish physician and demographer (active in mid 1900s)
studied death records in UK from 1800s through 1960s and found that life expectancy increased before certain medical breakthroughs
proposed that population health not only influenced by healthcare, but by changes in living conditions (sanitation, nutritious food, clean water)
studied death records in UK from 1800s through 1960s and found that life expectancy increased before certain medical breakthroughs
proposed that population health not only influenced by healthcare, but by changes in living conditions (sanitation, nutritious food, clean water)
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SDH Upstream, Midstream, Downstream
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upstream: improving laws and social policies that shape community conditions, social and institutional inequalities
midstream: address individual social needs, living conditions
downstream: addressing health outcomes, health outcomes, symptoms
midstream: address individual social needs, living conditions
downstream: addressing health outcomes, health outcomes, symptoms
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proximate vs ultimate disease causes*
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proximate: immediate causes of poor health and disease symptoms
ultimate: root factors contributing to risk of poor health in the first place
ultimate: root factors contributing to risk of poor health in the first place
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Examples of SDH in readings and conclusion*
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lead ingestion linked with substandard housing, reduced cognitive function and growth deficits. living in food desert...-----> cumulatively, poor health resulting from these factors might not become apparent for years
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Epigenetics, telomeres
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rate of telomere shortening impacted by lived experiences, premature agagin.
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SDH is a key source of health disparities within and between populations. examples:
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Discrimination or exclusion based on gender, race, ethnicity, religion, SES, mental health, sexual orientation, geographic location, etc.
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Social gradient in health
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individuals at the top with most power and resources tend to live longer and healthier lives.
this is based on relative deprivation, NOT only absolute deprivation (i.e. poverty). someone may have enough to make ends meet, but when comparing to someone else, may feel disadvantaged and this stressor can still lead to negative health effects
^^occurs in all countries
this is based on relative deprivation, NOT only absolute deprivation (i.e. poverty). someone may have enough to make ends meet, but when comparing to someone else, may feel disadvantaged and this stressor can still lead to negative health effects
^^occurs in all countries
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homeostasis:*
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ability to maintain and restore a stable internal physiological environment within tolerable limits (like maintain constant body temp.) Stressors interfere with homeostasis
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Stress response:*
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suite of physiological and behavioral responses that restore homeostasis and maintain stability
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Fight-or-Flight Response (coined by Walter Cannon)
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Automatic physiological responses to a real or perceived threat. seen across mammals
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General Adaptation Syndrome (proposed by Hans Selye)*
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stages of body response to stressor:
1) Alarm reaction (moves beyond initial fight or flight)
2) Resistance (signs of alarm reaction disappear, but still on guard. id imagine cortisol is being pumped tf out rn)
3) Exhaustion. long-term consequences of stress in system breakdown due to wear-and-tear
1) Alarm reaction (moves beyond initial fight or flight)
2) Resistance (signs of alarm reaction disappear, but still on guard. id imagine cortisol is being pumped tf out rn)
3) Exhaustion. long-term consequences of stress in system breakdown due to wear-and-tear
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Two-part defense mechanism to acute stress: *
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1) Rapid response - sympathetic-adrenal-medullary (SAM) axis
- Epinephrine (aka adrenaline) realized
- Physiological effects: mobilizes energy, increases blood pressure and heart rate, increases respiration, supports vigilance and arousal
2) Delayed response - Hypothalamic-Pituitary-Adrenal (HPA) Axis
- Activated within minutes
- Release of CORTISOL (key human stress hormone), impacts biological processes and exhibits a strong diurnal rhythm
- Physiological effects:
enhances action of adrenaline, increases blood glucose, suppresses non-essential functions
- Epinephrine (aka adrenaline) realized
- Physiological effects: mobilizes energy, increases blood pressure and heart rate, increases respiration, supports vigilance and arousal
2) Delayed response - Hypothalamic-Pituitary-Adrenal (HPA) Axis
- Activated within minutes
- Release of CORTISOL (key human stress hormone), impacts biological processes and exhibits a strong diurnal rhythm
- Physiological effects:
enhances action of adrenaline, increases blood glucose, suppresses non-essential functions
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Acute stress vs chronic stress*
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long-term, repeated activation of the stress response can lead to damage and negative health consequences, such as: cardiovascular disease, type 2 diabetes, immunosuppression and poor immune regulation, altered reproductive function, major depression, sleep disruption, delayed wound healing, memory problems, cognitive problems, and aging of the brain
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humans and some other primates experience psychological stressors related to anticipated social challenges (i.e. psychosocial stress). perceived social stressors. Key factors contributing to psychosocial stress:
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- unpredictable conditions, perceived lack of control, perceived lack of full social engagement and participation, minimal info on duration and intensity of stressors, lack of social support
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Whitehall study* (1967, conducted by Prof. Sir Michael Marmot)
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- followed health of thousands of British govt. officials (all had stable jobs and univesal healtjcare)
- Strengths: large sample, clear indicator of social position (occupation), controlled for care access and "risk" behaviors, longitudinal study design
- Strengths: large sample, clear indicator of social position (occupation), controlled for care access and "risk" behaviors, longitudinal study design
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Main findings of Whitehall*
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lower employment grades consistenyl exhibited higher mortality and morbidty risks.
biological differences, psychosocial differences (less satisfaction and control associated with work in lower grade, fewer hobbies, less social support)
biological differences, psychosocial differences (less satisfaction and control associated with work in lower grade, fewer hobbies, less social support)
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Direct physiological effects through continual activation of stress response leads to exhaustion and contributes to allostatic load and indirect effects through health-related behaviors (diet, substance use, sleep)
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Don't blame the victim and attribute poor health outcomes linked with social inequities to individual behavior
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health outcomes are ___ inevitable *
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NOT!
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Drs. Zaneta Thayer and Amy Non (two baddie women in STEM)*
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maternal and early life chornic stress associated with epigenetic patterns. one study looked at individuals who lived in orphanages early in life, experienced psychosocial stress during critical periods of development
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Market integration:*
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the degree to which people consume from and produce for the global market economy
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Push determinants to join market economy: (kinda being forced, against will)
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internal population pressure (e..g depletion of natural resources), encroachment by outsiders
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Pull determinants: (kinda to make your own life better)
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increased food consumption, reduced food availability throughout the year, allure of foreign goods
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MI may improve health outcomes by increasing access to:
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nutritious food, healthcare, filtered water, sanitation systems, houses with paved floors, education/employment opportunities, etc.
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MI may cause harm to health:
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crowd disease spread in densely populated areas, increased waste accumulation, increased consumption of processed foods, reduced physical activity levels, increased access to alcohol and tobacco, cultural losses
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Environmental harm from MI:
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oil and gold mining might result in environmental deterioration and reduced biodiversity, lead to use of local resources in unsustainable ways such as cash cropping and raising cattle might cause deforestation. health impacts such as exposure to pollution or toxins, creating of standing water and breeding sites for disease vectors
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infectious disease risk of MI
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increased travel between communities, creation of vector breeding sites, increased risk of zoonotic disease
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MI and Stress: lifestyle incongruity
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driven by inconsistencies between economic status and lifestyle practices (aspirations > resources).
lead to poor health outcomes, such as high BP, reduced immune function, etc.
lead to poor health outcomes, such as high BP, reduced immune function, etc.
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MI is difficult to study because
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within a population, unlikely all communities and individuals will be affected equally
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Shuar (Amazonian Ecuador) Health and Life History Project: Three research objectives:
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- determine the effects of economic and cultural changes on health outcomes
- investigate trade-offs between competing biological demands (e.g. immune function, physical activity, growth, and reproduction) and to use this information to better understand health across the life course
- provide meaningful health info to assist in local health efforts and to improve the well-being of the Shuar (work WITH community leaders)
- investigate trade-offs between competing biological demands (e.g. immune function, physical activity, growth, and reproduction) and to use this information to better understand health across the life course
- provide meaningful health info to assist in local health efforts and to improve the well-being of the Shuar (work WITH community leaders)
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General health measures with the Shuar:
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1) Anthropometrics - height, weight, body fat, etc.
2) Blood collection - finger prick (lipid panel, fasting glucose, hemoglobin levels)
3) Blood pressure
2) Blood collection - finger prick (lipid panel, fasting glucose, hemoglobin levels)
3) Blood pressure
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Differences apparent between regions in Shuar: *sex and household
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individuals living closer to town had higher blood pressure and cholesterol levels
Sex differences: females had worse lipid profiles than males, especially closer to town (maybe bc activity and diet with MI)
Household differences: more MI households tend to eat more market foods, may lead to some poor health outcomes
Sex differences: females had worse lipid profiles than males, especially closer to town (maybe bc activity and diet with MI)
Household differences: more MI households tend to eat more market foods, may lead to some poor health outcomes
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MI-linked variation in parasitic infections hypotheses:
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1) parasite infection risk and intensity highest among participants living in less MI households and 2) parasite infection risk and intensity will be highest among participants reporting aspects of household construction linked with parasite transmission (floor material, water source, bathroom type)
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MI-linked variation in parasite infection sample:
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620 participants in 152 households across 10 communities
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parasite definition and examples
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organism biologically dependent on another species, typically at expense of the host: malaria parasite, ectoparasitic tick, Giargia
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measured Style of life SOL
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housing SOL
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measuring parasitic load:
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helminth eggs/species presence, infection prevalence, species-specific EPG
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results:
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hypothesis 1 supported (except whipworm), mixed on hyp. 2
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Stunting: ( think of padre lol)
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Assessed by height for age index.
- Indicator of past nutrition.
- Not necessarily associated with higher risk of disease or death.
- Indicator of past nutrition.
- Not necessarily associated with higher risk of disease or death.
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Wasting:
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Assessed by weight for height index
- Present nutritional status and near past food intake.
- Associated with higher risk of disease and death.
- Present nutritional status and near past food intake.
- Associated with higher risk of disease and death.
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importance of adipose:
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store energy for later use like immune responses, thermal insulation, secretes key hormones that influence food instake and metabolism
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BMI: *
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weight/height generally correlated with body fat
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Diabetes: two types
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I: juvenile onset, rarest (cells are damaged)
II: lifestyle factors
II: lifestyle factors
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nutritional dual-burden:
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coexistence of undernutrition and overnutrition
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