Chapter 2: Global Health

1.) what are the factors that influence health Status the most

2.)what are the indicators we use to measure health status?

3.) What are the key trends in health status that have occurred historically

interconnected factors that determine individuals health status (ex. access healthcare is only one factor that determines if we are healthy it is not the only one.-genetics, age, living conditions, healthcare behaviors, etc.)

include personal/inborn factors (genetic makeup, sex, ethnicity, age), socioeconomic status (economic, social, work status) culture (how does one use health services/feel about it, how women are treated), environment (indoor and outdoor, educational attainment (knowledge of good health practices and more money/social networks and this is related to better health), health behaviors, childhood development, access to care (ensures that you will be healthy if something was to go wrong), and government policy (such as universal healthcare and ensure safe water supply for entire population), way in which families nourish and care for the young (real biological potential, staying school, linked to developing noncommunicable diseases.)

increasing attention is being paid to the social determinants of health

1.) understanding what diseases people suffer from
2.) determining the extent to which diseases causes death or disability
3.) carry out disease surveillance (what is affecting people, what the extent to which it is affected people, where are they affecting people at (country), what might be done to address the disease?)

(must use a consistent set of indicators in order to make a comparison across same or different countries)

1.) Infant Mortality Rate
2.) Life Expectancy at Birth
3.) Maternal Mortality Rate
4.) Neonatal Mortality Rate
5.) Under 5 Mortality Rate (child mortality rate)

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

(the higher life expectancy at birth, means the better health status of a country).

the number of deaths of infants under the age of 1 per 1,000 live births in a given year.

the number of deaths of infants under 28 days in a given year per 1,000 live births in that year.

the probability that a a newborn baby will die before the age of 5, expressed as a number per 1,000 live births

the number of women who die as a result of of pregnancy and childbirth complications per 100,000 live births in a given year

Is higher for high income countries than low income countries (defined by World Bank)

Is higher for lower income countries than higher income countries

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

death

death rate: number of deaths per 1,000 population in a given year

temporary or long-term reduction on a persons capacity to function

the number of people suffering from a certain health condition over a specific period of time.


(the pool of people with a disease at a particular time)

the proportion of the population that is diseased at a single point in time.

(flow of new cases of people each year with that disease each year into that pool.-changes because people die or are cured.)

the rate at which new cases of a disease that occurs in a population

illnesses caused by. a particular infectious agent (pathogen) that spreads directly or indirectly from people to people, animals to people, or people to animals; also called infectious diseases.

(ex. influenza, HIV, malaria, measles, Zika, Ebola)

illnesses not spread by an infectious agent (pathogen)

(hypertension, coronary heart disease, diabetes)

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

United States and New Guinea

record births, deaths, and causes of death

An accurate system is key to having accurate data on a population

Many low-middle-income (developing) countries lack vital registration system (have basic systems cannot fulfill their statistical or legal requirements.)

highly unfair (higher income people enjoy a better access)- inequitable (seen on graph)

Their are also cultural barriers to timely vital registration.
- many countries wait until a child is of a certain age before they registering their birth. (and if they die before this age their birth is never registered.)
- lack of access to vital registration (so the existence of some children are never recorded).
-immigration can affect VRS
-difficulties with reporting accurate deaths (HIV but caused someone to get pneumonia and die). (especially in adults)
-limited number of well trained physicians
- social stigma of reporting certain diseases (ex. HIV)
-some countries will over record people for funding purposes
-rural diseases

----We need to assess and improve the VRS for countries in order to help them understand the main causes of death among their population/ and progress on solving them. (surveys and projection models have been developed.)

in lower income countries they already have a problem with communicable diseases but gap between economies causes them to also have a burden of noncommunicable diseases

A single indicator that focuses on how far different countries are from a state of good health.

Takes into account morbidity, mortality, and disability by age, gender and region. (across countries across regions within a country: measuring the health status).

the expected number years to be lived in what might be termed the equivalent of good health.

A health-expectancy measure

To calculate HALE: the years of ill health are weighted according to severity and subtracted from overall life expectancy.

- The sum of years lost due to premature death (YLLs) and years lived with disability (YLDs). DALYs are also defined as years of healthy life lost
- A health-gap measure
- Indicates losses due to illness, disability and premature death in a population

ex. a 20 year old male dies and the greatest (female or male) life expectancy is 86. So you would do 86-20=66. Therefore, he would 66 Years of Life Lost (YLL).

Years Lived with Disability (YLDs) is calculated by weighing these years by a disability index, if a disability was given a weight of 0.5 and they had the disease for 30 years (and they lived to the highest life expectancy) then you would do. 30 * 0.5= 15 of life lived with the disablity.

If the two people lived in the same society then to get the total DALYs for that society would be the total of the years of life lost due to premature death of the first person and the years lived with a disability for the second. In this case the total DALYs lost due to premature death and years lived would be 66+15=81.

If we only measured deaths we would miss an important disability that surrounds that population.

Important to gain understanding of:

1.) Leading causes of illness, disability and death in the world.

2.) Variations in these causes by age, sex, ethnicity, and socioeconomic status

3.) Changes over time and how these might change in the future.

People in much of the world are living longer than before and dying at lower rates than earlier
(therefore the death rates have lowered).

As people live longer their is an increase in the years people live with a disability

The burden of disease is predominantly noncommunicable diseases in all World Bank regions, except sub-Saharan Africa

Over the last few decades, the burden of disease has shifted increasingly towards noncommunicable diseases in all World Bank regions

This shift has been fueled among other things by a reduction in communicable disease and the aging populations

the lowest income counties have a greater burden of communicable disease: in low-middle income countries 58% is noncommunicable deaths, 31% for communicable causes

stroke and ischemic heart disease continue to be number one causes of death in all income groups

higher income countries tend t have a greater burden of noncommunicable diseases

Africa and South Asia are st apart by their large burdens of communicable diseases

HIV aids came on the list, ischemic heart disease and stroke stayed the same, lung cancer increased and diabetes in now on here!

overall, globally we have shifted from communicable diseases to noncommunicable diseases

mainly causes of death in low-middle income countries are preventable

--Rural people will be less healthy than the urban populations. (age, food desert, access to healthcare, sanitation problems-ex, Amish-no western medicine/lack of sanitation).
--Disadvantaged ethnic minorities will be less healthy tan majority populations.
--Females will suffer from their weak social positions with a number of conditions
--Poor people will be less healthy; than better off people
--Uneducated people will be less healthy; than educated people.


Overall, lower socioeconomic status people will have higher rates of communicable diseases as well as malnutrition and death related to maternal causes. (preventable deaths)

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

a factors that raises the risk of a person developing a certain health outcomes

Population Growth, Population Aging. Urbanization, The demographic divide and, demographic transition


they affect people's health

average number of children a women is supposed to have during her reproductive life cycle

The current world population is 7.2 billion people by 2050 is expected to be 9.2 billion

Majority of population growth is expected to be in low-and-middle income countries; this shows that the fertility rate is falling slowly in many countries that high fertility rate, whereas the high income countries already have a slow fertility rate

this population growth of low income countries will put substantial pressure on the environment (its risk for health) and infrastructure (such as water supply and sanitation (will have to be provided to an increasing number of people in the countries that have to largest service gaps and that can least expand such services).

this can causes low income countries to have substantial detrimental effects on their health. An increasing population will make it more difficult for low-income countries to provide education and health services, which will have additional consequences for the health of their people in the future.

the population of the world is aging (this especially true for high income countries ho have low fertility rates), but this is happening in other countries as well

Elderly support ratio- the ratio between the number of people that are 15-64 years of age, compared with the number that are 65 years of age or older
---This differs depending on country a person lives in: Japan has very low fertility rates; so high aging population; whereas Nigeria has a high fertility rate so they don't have as large of a aging population

Affects burden of disease because people will be living longer with morbidities and disabilities (due to noncommunicable diseases).

Affects healthcare financing because of costs of caring for older people (this will raise healthcare costs and; the number working adults compared to the larger number of older adults is non proportionate; difficult to pay.)

--In the last decade, most of the world's population has lived their entire life in urban areas
-- People are continuing to move from rural to urban areas, especially in low- and middle-income countries
---There is enormous population pressure on urban infrastructure, such as water and sanitation, which are already in short supply in some countries (this can have substantial consequences on health).

Highest income countries: low fertility, often declining populations, aging populations

Lowest income countries: relatively high fertility, growing populations, less of an aging population

also enormous health differences

this is a shift from a pattern of high fertility and high mortality to low fertility and low mortality, with population growth occurring in between.

In the 19th century mortality rates declined as t decline because of better nutrition and hygiene and the burden of infectious diseases became less

later fertility declined as births and deaths became more equal, population growth slows.

As birth and deaths stay more equal than the share of population was of older age increased.

---Shift from burden of disease dominated by communicable disease to burden of disease dominated by noncommunicable disease (specially as low-middle income countries go through his transition)
---Low-income countries are going through it now
---First, and historically: high and fluctuating mortality, related to very poor health conditions, epidemics, and famine

(closely related to demographic transition).


----then, progressive declines in mortality as epidemics become less frequent, (improved nutrition, hygiene, education and socioeconomic factor's, advances in public health/medicine-vaccines and antibiotics) so life expectancy increases

--the peace of transition depends on factors related to the determinants of health

most high income countries went through epidemiological transition slow, and low-middle income countries are going though it now (low -middle income countries are in the transition now so they continue to face problems with both communicable and noncommunicable diseases and injuries at the same time; so financial burden on these countries to have resources to deal with all of these health conditions)

- Improvements in raising life expectancy and improving health not uniform across countries
- Life expectancy in South Asia and sub-Saharan Africa lags behind other regions (mainly due to HIV/Aids epidemic and political combat
- Life expectancy in Europe and Central Asia changed little from 1990-2011, related to break-up of Soviet Union
- Life expectancy in East Asia increased dramatically, partly due to rapid economic growth

economic development, scientific and technological change, climate change, political stability, emerging and re-emerging infectious diseases, food insecurity

Economies of low-income countries need to grow in order to invest in improving their countries health

Impact of economic development will depend on how equitable growth is across population groups and investments in areas that improve health such as water, sanitation, and education

the extent to the appropriateness in their investments is also critical

Development of vaccines, drugs, antiretrovial therapy and diagnostics (such as for TB) or development of vaccine son malaria and HIV would drastically improve the worlds health

Country's ability to adopt these changes will determine their effect on health (when they are made)

impact not entirely clear; but its impact on rising sea levels and weather could have direct and indirect health impacts on us
indirect: affect crop growth and people have to migrate
direct: leads to adverse weather changes that harm people's health

possible vectors leave places because no longer habitable to them but also may go other places because the weather in habitable to them

(Possible migration from places that become uninhabitable, Adverse weather, Possible change in populations of disease vectors)

Necessary for long-term gains in health

Instability causes illness, disability, and death, as well as breakdown of infrastructure (water, electricity and sanitation) and services that leads to further health issues and indirect impacts

Instability has impeded achieving the Millennium Development Goals

Occurrence and impact difficult to predict; when new diseases will emerge or if old diseases will reemerge; also not possible to know how well countries do at recognizing this

But we do know that; Pandemic flu could have a major impact in the future disease patterns

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

Difficult to predict but can use models to project

Substantial changes projected to 2030

Low- and lower-middle-income countries will shift away from communicable disease (HIV/AIDS is the only communicable disease supposed to be in low income countries list of DALYs or leading causes of death and no communicable diseases in middle to high income countries)

Causes associated with aging will increase in importance (hearing loss will increase and arthritis, dementia, and refractive disorders)

Mental health issues will increase in importance for all income groups )stoke, heart disease will continue to remain high for all groups , diabetes will grow in all income groups

Health usually increases as national income increases

Some countries have achieved higher life expediencies 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

economic progress with help reduce fertility rates, reduce mortality from communicable diseases and help to produce a healthier population. (however, the rate of progress as of now will take a very long time for this to happen in low income countries, therefore the challenge is to short circuit this process with the little money these countries have)