Global Health 223 – Mid Term #1

1. scope - problems resulting from globalization, solutions that require global cooperation
2. location (geographic) - problems that occur across the world, but are discussed in reference to specific places:
- local, community, regional, national, international, worldwide

as defined by WHO as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
1. physical - absence of disease and positive well-being
2. mental - absence of disease and positive well-being
3. social - ensuring basic human needs are met, people coexist peacefully in communities

1. spirituality
2. disease management
3. old age + disease
4. access to care and primary health providers
5. pharmaceutical development and regulations
6. disabled people

1. Medical model - Individual behaviors and patterns, individual relationships with health providers
Social Model - Improving circumstances and context for health, that can include occupational exposures, environmental exposures, social justice, impoverished people groups,
2. Ensure access healthy environments, as well as health care providers, services, and treatments

All people:
1. Individual clinical care & population level prevention
2. Special attention to vulnerable and marginalized groups
All diseases:
1. Acute epidemic outbreaks & noncommunicable diseases
2. Structural causes of bad health & health inequalities

1. "The health of everyone everywhere is the health of anyone anywhere" Richard Solnick (diseases across borders)
2. Injustice is the world order are connected w/ deep inequalities in health & health care systems
3. The gravity of human rights violations
4. Many issues are much to large & interconnected to solve on one's own

1. Tropical Medicine 18th -19th century
- centered white, wealthy Europeans traveling to the tropics, grounded in colonial empires
2. International Health 1940s - 90s
- philanthropic efforts from paternalistic HIC --> LIC
3. Global Health 1990s - Future
- more partnership & collaborative studies
- planetary health
- connectivity and wholeness/ sustainability

1. Climate Crisis
2. Health in Conflict Zones
3. Reducing Health Inequities
4. Medicines: Expanding access, reducing resistance
5. Stopping Infectious Diseases
6. Epidemic preparedness
7. Food and product safety
8. Investment in health care workforce
9. Adolescent Health
10. New technologies
11. Improving public trust of health care workers
12. Threat of Anti-microbial resistance
13. Health care sanitation -- PPF

Global Trends:
1. Rising Life Expectancy
2. Childhood Mortality
3. Shifting Burdens of Disease toward noncommunicable diseases (NCDs)
Key Health Indicators:
1. Life Expectancy
2. Health average Life Expectancy (HALE)
3. Disability-Adjusted Life Years (DALYs)

HALE = LE (Life Expectancy) - YLD (Years Lived with Disability)
ex. 68-(17yrs*0.4) = 61.2

DALY = YLD (Years Lived w/ Disability) + YLL (Years of Life Lost)

Biological determinants - Age, sex, genetics, behavioral patterns, & risk factors, biology of disease
Social determinants - Economic status, education, employment, geography, race/ethnicity, age, gender

ex. India accounts for 1/5th of global maternal deaths

1. An extension of governance to the world as a whole
- Formal Elements - UN Conventions, treaties, decision-making processes, rules & standards (eg UN Convention on the Rights of the Child)
- Informal Elements - Voluntary Codes of Conduct (eg. multinational corporate codes), Ways of shaping collective responses to issues of global significance (global responses to questions of financial stability, environmental sustainability, peace and security, human rights, public health )

1. No agreed upon governing structure at the global level
2. No hierarchical political authority with jurisdiction over nation states
- "Traditional instruments for mobilizing collective action at the national level: taxation, routine law enforcement, democratic decision making procedures: ALL ABSENT)
- No supranational govt. w/ sovereignty

Major Players:
1. WHO - World Health Organization (universal org w/ 1 nation = 1 vote policy)
2. World Bank
General Examples:
1. Philanthropic Orgs - Bill & Melinda Gates Foundation
2. NGOs - Doctors w/out Borders, Oxfam
3. Private Industry - pharmaceutical industry, corporate initiatives in global health
4. Professional Associations - medical associations, public health associations
5. Academic Institutions - London School of Tropic al Medicine and Hygiene

A central decision making body of the WHo
1. Delegations from all 194 WHO member states attend
2. There is focus on a specific health agenda prepared by the executive Board

World Health Organization. A group that deals with health care issues on a global basis.
1. 1 nation = 1 vote (decisions made are not democratic)

1. Confederation vs. federation - regional groups have too much power & appointments aren't change inducing
- confederations are unified offices & federations are governing bodies
2. Sovereignty acceptance - gov. power to rule w/out interference, WHO has to accept that they don't have sovereignty over intra/international decisions made by nations
3. Financial Issues & Budgeting - 70% financed from donations = no core budget assurance,
- health ministers have less clout and thus less connection to financing ministers
4. Mission Creep
- Fundamentally they shifted to cover too much
1948 - "the attainment by all peoples the highest possible level of health"
2009 - expansion into highly politicized areas w/out additional financial/ managerial support/ability

works w/ shares (not 1 vote = 1 country)
1. ability to insert work that is important / pressing (they have pull)
2. coordination w/ finance ministers means a seat at the table
3. Insensitive to social causes
4. Create an enabling relationship w/ needy countries

They should restructure to find health & education which are currently at the bottom of the budget--- making practical decisions means acknowledging this need (efficient, effective, fair decision making)

Deciding on the policy questions of WHO
Appoint the Director-General (5 year terms)
Supervise financial policies
Review and approve the proposed program budget

A disease that spreads (transmitted/ contagious) directly or indirectly from one person to another
1. Person - Person
2. Person - Animal - Person
3. Person - Insect - Person
4. Person - Surface - Person

Although the disease is not considered highly transmissible, because contact w/ bodily fluid is necessary, it has a long latency period which means movement across boarders is possible.

1. Poverty -
- avg. family earnings less than 1$ day 2014
- chromic malnutrition, hunting & close contact w/ animal reservoirs
- lacking basic infrastructure (electricity, reliable roadways/networks)
- people traveling to neighboring towns & cities for work
2. Humanitarian Crisis -
- HC going on at the same time as health crises ex. Civil wars in Sierra Leone & Libera during Ebola outbreak 2014

No identification/ tracking available
after lab identification
w/out tracing people continue to move & spread the disease
lack of PPE for health care workers
healthcare workers suffer high mortality
health centers lack IV fluids
health centers become stigmatized as places to die & health care workers infected,
lack of lab services

Trained health care workers
Testing & Tracing Tools
Treatment & Vaccination
Care for Survivors
Good Community Engagement/ Relations
Donor Support w/ UN partner agencies
Preparation is the Best response

Relationships between Private firms and Public business that can be informal or formal ex. CDC partnership w/ Coca Cola (usually for a lacking of funding & credit)
PPP - public & private partnerships

1. road injuries, maternal and neonatal condition, and malnutrition
2. Communicable and Infectious diseases are close proxies
3. Noncommunicable diseases are often chronic, long duration diseases that are acquired by an individual and not transmitted over time (chronic/ acute is temporal while CD?NCD is about the mechanism of transmission )

Diseases that are not transmitted from 1 person to another
1. Top/ Most Severe - Cardiovascular diseases, cancers, diabetes, chronic lung disease
2. Although prior believed to be an issue of the affluent NCD burden is on LMIC as rising causes of death
ex. Heart Disease Case Study - countries w/ high rates of heart disease (India & US) have developed highly advanced critical care that can exacerbate disparities for the broader population w/out access to this kind of care

1. they produce and perpetuate poverty
--- strain economies w/ limited healthcare systems, undermine social & economic development, affect security & stability
2. Even though the majority of deaths in the world are a result of NCDs they are financially neglected in favor of more buzz worthy news (pandemic suffering, communicable disease ex. ebola)

1. 5x5 Framework (this framework is non-inclusive of the poorest billion/bottom billion -- it lacks expanse)
2; Capacity Load Model
3. Syndemic Suffering

Key NCDs:
1. Cardio vascular disease
2. Diabetes
3. Cancer
4. COPD
5. Mental Health
Key Risk Factors:
1. Smoking
2. Alcohol
3. Inactivity
4. Unhealthy diet
5. Air pollution

Two or more diseases that cluster together, exacerbate one another, and interact w/ social and economic inequalities

1. Sars-CoV-2 = novel virus, disproportionate mortality in people with NCDs
2. Precautions for Covid-19 (indoors, less exercise, isolation) exacerbate NCDs in the most vulnerableoWorst health at baseline, more stringent precaution so Fewer diagnoses, management for isolated and vulnerable.\oPeople with fewest resources have greatest risk of losses•Results from and contributes to persistent SES inequalities
3. Elderly with NCDs may not be able to shelter at home •Healthcare facilities diverted to Covid-19 rather than NCD management•Lack of NCD care àincreased risk of future complications from unmanaged NCDs•In addition, delayed diagnosis of NCDs