-High birth and death rates
-Death from infectious diseases and nutritional deficiencies
-Low birth and death rates
-Death from chronic and lifestyle disease
-Low birth rates and increasing death rates
-Increase in deaths from new and re-emerging infectious diseases
-Rapid spread due to globalization
-The industrial revolution and the emergence of epidemiology
-Bacterial infection of small intestines
-Transmitted through contaminated water
Yellow fever eradication strategy
-Draining water
-Screening or oiling water sources
-Quarantining people with YF in screened enclosures
-Fumigating
***Major victory for tropical medicine
***Strategy applied elsewhere
colonial medicine
-Colonial contexts empowered public health officials to act unilaterally
1. Idea of tropical medicine as its own field
2. Overcoming yellow fever reinforced the belief in US's scientific and technical expertise
3. Myth of US imperialism improving lives in colonies through scientific and technical expertise
-Strategies for hookworm control (quick fixes)
-De-emphasis on long-term solutions
-NOT addressing sanitation
-Staffed by US publich health officials who gained experience in colonies and military
-Motivations were economic for improving health
AMERICAN VERSION
-quick fix, quick win
-economically effective, cheap instead of treating the sanitation problem (too costly or time-effective)
-Social medicine
-Long-term fixes based on infrastructure and sanitation improvements
-Emphasis on long-term solutions
-Staffed by British and other European officials who gained experience in colonial medicine
EUROPEAN VERSON
-Mosquito-borne
-No vaccine
-Human and mosquito hosts
-DDT-reliant
-Toxicity
-Pesticides reduced cost
-Anti-malaria campaigns
-Great technical solution, but very toxic
-Vaccine with single dose
-Human-only host
-Flexibility in program
-Protect and promote health of all
-Advocated a health promotion approach to primary care
-HEALTH AS A HUMAN RIGHT
-WB, IMF, raised GNP around the world
-Produced economic growth (GNP) withough development (reduction of poverty
-Primary goal is to improve working conditions, living standards, and the fair and equitable treatment of workers in all countries
-Mirrored primary health care
-Categorical disease control
-UNICEF, the World Bank, and Rockefeller 1982 "Child Survival Revolution" providing vaccines and oral rehydration
-GOBI-FFF program (focused on babies and goals/strategies) and reduced child mortality
G: Growth Monitoring
O: Oral Rehydration
B: Breast Feeding
I: Immunization
F: Female education
F: Family planning
F: Food supplementation
-Political mobilization proved very challenging
-Oriented toward goal of global health equity
Avoided many problems of top-down, vertical programs
-Emphasized systems building
-Ex. Alma Ata
**LESS ATTRACTIVE TO DONORS**
Selective Primary Health Care
-Easy support from donor community
-Met NGO need for measurable, fast results
-Top-down, vertical program
-Not participatory or engaging sectors outside health ministries
-Ex. UNICEF, Rockefeller Compromise
***MORE ATTRACTIVE TO DONORS b/c of measurable easy, outcomes***
-Getting rid of tariffs and subsidies to encourage free international trade
-Devaluing currency to make exports less expensive and more competitive
-Reducing government spending on social services
-HIV/AIDS + MDRTB
-Public-private partnerships (ex. Bill and Melinda Gates)
-Global Travel
-"International" didn't mean so much anymore
-The number of years lost to ill health, disability, and death as a result of various conditions
-quantify how bad conditions could be
-One DALY represents the loss of one year of full health
-Ex. Cholera has a high DALY value (high # of deaths)
-Ex. Depression has a high DALY value (chronic)
-Important b/c it quantifies health as an economic variable and GDP. Importance of cost effectiveness
Ex. if a 10 year old develops diabetes he will have a higher DALY value than if a 65 year old develops diabetes
-Public awareness of global inequalities
-Increasing emphasis on sustainability and cultural sensitivity
-Major influences of private donors
-Public-private partnerships
-Increase vaccination rates
-Capacity building for vaccinations in LMICs
-Predictable financing for vaccination campaigns
-Stimulating research and development
-Hosted by Gates Foundation
-3 ministers of health of African countries, UNICEF, WHO, World Bank, Private foundation heads, Major NGO heads
-Technologies for global health improvement
**Keeps a lot of problems of global health investors alive**
GOALS MOST CLOSELY RELATED TO HEALTH:
4. Reduce Child Mortality
5. Improve Maternal Health
6. Combat HIV/AIDS, Malaria, and other diseases
-Ready-to-use Therapeutic Foods (RUTFs)
-packaged food that is nutritiously dense for children experiencing malnutrition
-Not a long term solution but still helps
-Falls under "Reduce Child Mortality" Goal
-Health worker training
-Antenatal care
-Family planning
-All technical interventions
-Not addressing underlying conditions
-POC are marginalized and racial health disparities in the the U.S
-Falls under "Improve Maternal Health"
-HIV, TB, Malaria
-Vaccines, medications, mostly technical solutions
-Falls under "Combat HIV/AIDs, Malaria, and Other Diseases"
-a group of infectious diseases that cause substantial illness for more than one billion people globally
-Affecting the world's poorest people
-impair physical and cognitive development, contribute to mother and child illness and death, make it difficult to farm or earn a living, and limit productivity in the workplace
***No financial incentive to develop and roll out treatments for NTDs, funders are not well versed in these diseases and care about their political image***
-a disease that is not transmitted from one host to another
-Can't catch from other people
-60% of global deaths
-Ex. Cancer, mental health, diabetes
-Harder to "put a bandaid on", no quick technical approach
-The "long tail" of non-communicable diseases
-Thinking about global health
-Utilizing interventions
-Global health practitioners
-Driven, idealistic, motivated to save lives
"Medicine is a social science, and politics is nothing else but medicine on a large scale"
-politics will always be in medicine
-Father of sociology
-interpreted the meaning of social action
-Argued social actions must be placed in historical and cultural context
-The non-clinical factors that impact a person's health
-The conditions in which people are born, grow, live, work, and age
-5 factors:
-Economic Stability
-Neighborhood and Built Environment
-Health and Health Care
-Social and Community Context
-Education
-STRUCTURAL VIOLENCE
-Partners in Health
-Illness narratives
-Social suffering
-social forces that harm certain groups of people, producing, and perpetuating inequality in health and well-being
-upstream determinants that put people at risk of risks
-Ex. Limiting access to healthcare, Displacing populations and exposing them to risks, The stress of living with fear and uncertainty
-connects how cultural norms are examined and understood in relation to their political impact on global health campaigns
Ex. The failure of PHC in Nepal (little cultural understanding of Nepal lead to it not succeeding)
-Considers political, social, cultural, and economic contexts in which illness and disease arise
-attempts to understand the conditions that shape population health within wider political and economic contexts
-Examines the causes of causes (stress, early life, work, unemployment, social exclusion, social support, addition, food, transport)
-At the individual level, health is seen as the absence of disease
-A curative model that privileges technical fixes
-Views health and illness as a consequence of individual and household actions/beliefs
-Holds that regulating or changing personal actions or attitudes (i.e., education, counseling, incentives) will stop problematic behaviors in improve health)
Examined 30,000 British Civil Service members , found:
-link between hierarchical status, and cardiovascular disease; found that the less senior the employment hierarchy, the shorter the life expectancy
-Inquired about the major causes of stress-related illness; found that they were linked to high job demands and low control (related to the causes of causes under the political economy of health approach)
Descriptive epidemiology
Person, place, and how its changing over time
Time: when was the population affected?
Place: where was the population affected?
Person: who was affected?
-Number of NEW causes per population
-Tells you how quickly something is increasing or decreasing during a period of time
Number of TOTAL causes per population
-Tells you how widespread something is at a single point in time
-Not telling what's happening over time (no incidence)
-Where a disease is concentrated at a single point in time
***SNAPSHOT OF A DISEASE IN TIME***
-Shows cases are going down from 2006 to 2012
-Transmission is slowing down
***CHANGE/TIME***
-Highest # of new cases in Sub-Saharan Africa
***CHANGE/TIME***
-Shows TB for various countries
-Shows us Eastern Europe and Africa have highest HIV
-Duel epidemic
***CHANGE/TIME***
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