Chapter 2 Global Health 101

sickness or any departure, subjective or objective, from a psychological or physiological state of well-being
Mortality- death

temporary or long-term reduction in a person's capacity to function

death

number of people suffering from a certain health condition over a specified time period

the rate at which new cases of a disease occur in a population

personal feature, social status, culture, environment, educational attainment, health behaviors, childhood development, access to care, govt plicy

find which disease people suffer from
determine how much the disease can cause death or disability
disease surveillance
MUST have consistent set of indicators

Life Expectancy At Birth, Maternal Mortality Ratio, Infant Mortality Ratio, Neonatal Mortality Rate, Under 5 Mortality Rate (Child Mortality Rate)

average number of years a newborn baby could expect to live if current mortality trends were to continue for the rest of the newborn's life

The number of women who die as a result of pregnancy and childbirth complication
PER 100, 000 live births in a given year

The number of death of infants under age 1
PER 1000 live births in that year

The umber of deaths to infants under 28 days of age in a given year
PER 1000 live births in that year

The probability that a newborn baby will die before reaching age 5
expressed as a number PER 1000 births

illnesses caused by a particular infectious agent that spread directly or indirectly from people to people, animals to people, or people to animals

illnesses not spread by an infectious agent

include road traffic injuries, falls, self-inflicted injuries, and violence, among other things

system to record births, death, causes
accurate system is key to qlty data on a population
low and middle income countries lack regis. sys
developing a sys would be progress to global health

HALE - Health Adjusted Life Expectancy
DALY - Disability-Adjusted Life Year

summarized expected no. of years to be lived in what might be termed the equivalent of good health, taking account of mortality and disability

Calculated by weighting the numbers of years of ill health according to severity, subtracted from the overall life expectancy

the sum of years of life lost due to premature death and years lived with disability

years lived with disability

a unit for measuring the amt of health lost because of a particular disease of injury

changes over time
varies by age, sex, ethniticy, socioeconomic status

Rural people less healthy than urban
ethnic minorities less healthy
women will suffer due to weak social conditions
poor people less healthy
uneducated people less healthy

higher income have greater non communicable disease
lower income have greater burden of communicable disease
Africa and South Asia are set apart by large burden of communicable disease

low and middle income country die of communicable disease
HIV/AIDS & TB leading cause of death in adults in low & middle income countries

an aspect or personal behavior or life-style, an environmental exposure, or an inborn or inherited charepidemiological evidence, is known to be associated with acteristic, that, on the basis of health-related conditions considered important to prevent

malnutrtion, high blood pressure, high cholesterol, smoking, and unsafe sex

in low and middle income countries and will put pressure on environment and create need for infrastructure

people will live longer with morbidities and disabilities
healthcare financing due to higher amt of people over 65 than those paying into health care

low fertility, declining population, aging population

relatively high fertility, growing populations

shift from high fertility/mortality to lower fertility/mortality
mortality declines due to better hygiene and nutrition
fertility declines
population growths slow and the older population numbers are growing

distinctive causes of death in each stage of the demographic transition

Shift from burden of disease dominated by communicable disease to burden of disease dominated by noncommunicable disease

Most low-income countries are in ongoing transition so they face large burdens of communicable and noncommunicable disease


First, high and fluctuating mortality, related to poor health conditions, epidemoics, and famine

The progessive declne in mortality as epidemics become less frequent

Finally, further declines in mortality, increases in life expectancy, and the predominance of noncommunicable diseases

improvements in health status are not the same across the globe
South Asia and Sub Sharan Africa lag
the break up of the soviet union did little for life expectancy
rapid income growth in East Asia has increased Life Expectancy in that country

economies of low income countries will need to grow so they can invest in their citizens health
other countries will need to invest in these countries - their water, sanitation, and education

development of vaccines, drugs, diagnostics
each countries health will depend on their availablity or choice to adopt these changes

Impact not entirely clear

Possible migration from places that become inhabitable

Possible change in populations of disease vectors

adverse weather

instability of the political climate has been proven to have impact on health issues
instability causes illness, disability and death as well as breakdown of infrastructure and services that leads to further health issues

Has impeded achieving the Millennium Development Goals

occurrences of disease and impact is difficult to predict

Pandemic flu could have a major impact in the future

Drug resistance outpacing our ability to produce safe and effective drugs could also have a substantial impact on the burden of disease

changes in 2004 - 2030
lower/middle income will shift away from communicable disease

causes associated with aging will become more important

mental health issues ill become important for all income groups

health increases as national income increase
some countries have achieved higher life expectancies than their incomes would predict
investmenst in nutrition, education, good hygeine, low cost services, and programs that have a high impact on vaccination programs

Attempt to construct a single indicator to compare how far countries are from the state of good health

This index would take into account of morbidity, mortality, and disability; calculate by age, gender, and region; allow comparison across region

This index would measure what is referred to as the burden of disease

People are living longer in much of the world

Globally, women live 5 years longer than men

In the last 4 decades, there have been significant declines in communicable, maternal, neonatal, and nutritional causes of death

Mortality rates have decreased, particularly for children under 5

Rate of mortality decrease differs by country

Years of life lost due to premature death are increasing for diabetes, some cancers, drug use disorders, conflict, and terrorism

Burden of disease is predominantly non-communicable

Low-income countries have a unique pattern of deaths and DALYs, dominated by Group 1 cases


Most of the country income groups of DALYs attributable to lower back and neck pain, sense organ disease, skin diseases, and depressive disorders

Although ischemic heart disease and stroke are leading causes of death for females, global health literature focuses on reproductive health

Rural populations are less healthy than urban populations

Disadvantaged ethnic minorities are less health than majority population

Females suffer from a number of conditions related to their relatively disadvantaged social positions

Poor people are less healthy than wealthier people

Uneducated people will less be health than those better-educated

Majority of growth will occur in low-and middle-income countries especially SSA

High-income countries are below replacement fertility

Elderly support ratio between the number of people aged 15 to 64 years, compared to the number of people over 65

Aging population and shift in the elderly support ratio has profound implications for:
The burden of disease
Health expenditures
How health care will be financed

The majority of global population lives in urban areas

Urbanization puts pressure on urban infrastructure, such as water and sanitation, schools, and health services

Gaps in infrastructure can have substantial negative consequence for health

Highest-income countries have low fertility, declining populations, and aging populations

Lowest-income countries have high-fertility, although it is slowly declining

Shift in pattern of high fertility and high mortality to low fertility and low mortality, with populations growth in between

Decline in mortality with improved hygiene and nutrition, followed by decline in fertility

Factors that lead to improvement in health are complex, they include: nutrition, education, political stability, and scientific improvements

Will be influenced by changing factors, some of which will relate to the DOH

Other drivers include: economic development, scientific and technological change, climate change, political stability, emerging and re-emerging infectious diseases

Investing effectively and efficiently in areas that address key factors and determinants of health

Investing effectively and efficiently in relatively low-cost but high-impact health services

Take community-based approach primary health care

largely behavioral

range from nutritional issues, lack of safe water and sanitation, indoor and ambient air pollution, to tobacco smoking

Population growth

Population aging

Urbanization

pattern of high morality and high fertility to low mortality and low fertility

Health usually increases as national income increases

Some countries have achieved higher life expectancy than their incomes would predict

This is possible with investments in the "best buys" such as nutrition, education,good hygiene, and low-cost services that have a high impact such as vaccination programs and TB control