Global Health: Chapter 3

-intergenerational links: health and education of parents affects health and education of children
-malnutrition and disease affect cognitive development and school performance of children
-education contributes to disease prevention and management

-good health increases longevity and lifetime earnings
-healthy workers are more productive than unhealthy workers
-many people when ill cannot go to work, and when absent often do not earn

-costs of illness can cause individuals and families to lose or dispose of assets and can cause them to fall into poverty
-illness often leads to a decrease in earnings
-indirect costs, such as transportation
-long-lasting disabilities generally require considerable expenditure on health services

-"differences in health that are not only unnecessary and avoidable, but also unfair and unjust"
-equity concerns fairness and equality largely refers to outcomes

"differences in health status or in the distribution of health determinants between different population groups"

"a type of difference in health that is closely linked with social or economic disadvantage"

-health status
-access and coverage of health services
-protection from financial risks
-fairness of health financing
-the distribution of health benefits

-social and economic status
-ethnicity
-gender
-religion
-location
-occupation
-social capitol

less well-off people, with less social and political power, will generally have worse health, poorer services, and less fairness and protection in the financing of health services

-women
-indigenous people
-ethnic and religious minorities
-those living in rural areas
-those working in the informal sector
-less educated
-other marginalized groups, such as LGBT

-enormous variance in basic indicators
-differences reflect status of economic development, inequitable relationships between countries, and political choices
-life expectancy in OECD countries is 30% higher than in sub-Saharan Africa

-some countries have substantial variation in health indicators across population groups
-tend to be low- and middle-income countries or high-income countries with significant ethnic minorities

-urban dwellers tend to enjoy better health status, coverage, and access to services than rural dwellers
-rural people tend to have lower incomes, less education, less access to services, and weaker political voice

-large gap in access, coverage, fairness, and benefits between less well off and better off
-often examined by looking at income quintiles
-income is associated with better education, better housing, better access to water, sanitation, hygiene, and health services, and safety work environments

-"being born female is dangerous to your health"
-women face health concerns related to their diminished place in many societies
-Examples: female infanticide, less food for female children, lower enrollment in school, violence against women

-strong association between ethnicity and health status, access, and coverage
-linked to strong association between ethnicity and power, education, and income

-substantial out-of-pocket costs for poor
-the relative costs of those health services is much greater for the poor, which raises equity issues
-benefit of public subsidies often received by better off people

-keep equity, inequality, and disparities in mind at all times
-always consider the various dimensions of these issues
-be careful when using averages for indicators
-examine how each piece of key data relates to different population groups, especially the poor and marginalized

-most high-income countries spend 9-12% of GDP and have higher life experiences
-most low-income countries spend 3-6% of GDP and have lower life expectancies
-important outliers like Sri Lanka and Cuba spend relatively little, but achieve higher life expectancies

expenditure by any level of government or government agency

expenditure by sources other than the government such as a non-governmental organization or individuals

expenditure by individuals that is not covered or reimbursed by an insurance program

-cost-effectiveness analysis compares the cost of an intervention with the amount of health that can be purchased with that investment
-can help to set priorities among different ways of achieving a health goal
-can be used to compare costs and gains of different health interventions
-should not be the only factor in decisions

-good health promotes economic development at the societal level
-higher levels of economic development also promote better health, but many of these relate to improvements from education and technology
-Therefore, low- and middle-income countries must adopt policies that speed achievement of health goals, even with constrained incomes