question
What is the difference between public health and medicine?
answer
Public health:
-Population focus
-Greatest good for the greatest number- public service
-Emphasis on preventing disease and promoting health of communities
-Interventions target environment, behavioral lifestyles, and medical care- broad spectrum
Medicine:
-Individual focus
-Needs of individual more important than needs of group- personal service
-Emphasis on diagnosing and treating diseases
-Interventions are medical-emphasis on medical care
-Population focus
-Greatest good for the greatest number- public service
-Emphasis on preventing disease and promoting health of communities
-Interventions target environment, behavioral lifestyles, and medical care- broad spectrum
Medicine:
-Individual focus
-Needs of individual more important than needs of group- personal service
-Emphasis on diagnosing and treating diseases
-Interventions are medical-emphasis on medical care
question
Define health (WHO, 1948), public health, global health
answer
WHO health definition: "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."
Public health: The science and practice of protecting and improving the health of a community, as by preventative medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards. (The American Heritage Dictionary)
Global health: "The application of the principles of public health to health problems and challenges that transcend national boundaries and to the complex array of global and local forces that affect them"
Public health: The science and practice of protecting and improving the health of a community, as by preventative medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards. (The American Heritage Dictionary)
Global health: "The application of the principles of public health to health problems and challenges that transcend national boundaries and to the complex array of global and local forces that affect them"
question
What are different ways that people view health?
answer
Clinical - The absence of disease, illness, or symptoms
Functional - Ability to perform as expected in social/work roles
Adaptive - Ability to adapt to environment and stressors, maintain stability
Functional - Ability to perform as expected in social/work roles
Adaptive - Ability to adapt to environment and stressors, maintain stability
question
Why should we study global health?
answer
-Understand the progress made and remaining global health problems
-Many health problems require global solutions and international cooperation
-Global health is broader than the perspective of any individual country
-Global health recognizes that countries must work together to solve health concerns
-Some issues affect the whole world
-Many health problems require global solutions and international cooperation
-Global health is broader than the perspective of any individual country
-Global health recognizes that countries must work together to solve health concerns
-Some issues affect the whole world
question
How many Sustainable Development Goals (SDGs) are? What are some of the types of problems covered in the SDGs?
answer
17 SDGs goals: 169 targets and 230 indicators
Aim by 2030 to end poverty, protect the planet, and promote prosperity and peace.
Aim by 2030 to end poverty, protect the planet, and promote prosperity and peace.
question
Give examples of determinants of health
answer
-Physical environment
-Employment & working conditions
-Access to health services
-Individual characteristics
-Health behaviors
-Healthy [prenatal &] child development
-Social [& economic] environment (Chapter 3)
-Governance, policies, & interventions
-Employment & working conditions
-Access to health services
-Individual characteristics
-Health behaviors
-Healthy [prenatal &] child development
-Social [& economic] environment (Chapter 3)
-Governance, policies, & interventions
question
life expectancy at birth
answer
The average number of years a newborn baby could expect to live if current mortality trends persist for the rest of the newborn's life.
question
Maternal mortality rate
answer
the number of women who die as a result of pregnancy and childbirth complications per 100,000 live births in a given year
question
Infant mortality rate
answer
the number of infant deaths per 1000 live births during the year
question
Neonatal mortality rate
answer
the number of child deaths (0-28 days) per 1000 live births in a year
question
Under-5 mortality rate
answer
Probability that a newborn baby will die before reaching age 5; expressed as a number per 1000 live births
question
Prevalence
answer
number of ALL people with a disease
Number of all people with a disease/
Average population or total in group
(during a time period)
Number of all people with a disease/
Average population or total in group
(during a time period)
question
Incidence
answer
number of NEW cases
Number of new cases/
Total population at risk (minus "old" cases)
X multiplier (e.g. 100) during a period of time
Number of new cases/
Total population at risk (minus "old" cases)
X multiplier (e.g. 100) during a period of time
question
What are DALYs and what "losses in health" are considered in DALYs versus mortality rates?
answer
-DALY: health lost due to particular illnesses & disabilities in a particular year in a particular population compared with the healthiest possible population
-DALYS consider health lost to an illness rather than mortality
-Higher DALY = a society with more premature death, illness, and disability
-Lower DALY is better
-Years of life lost to premature death+ years lived with disability= disability-adjusted life years
-DALYS consider health lost to an illness rather than mortality
-Higher DALY = a society with more premature death, illness, and disability
-Lower DALY is better
-Years of life lost to premature death+ years lived with disability= disability-adjusted life years
question
Demographic transition
answer
The shift from a pattern of high fertility and high mortality to low fertility and low mortality.
question
Epidemiologic transition
answer
The shift from health issues stemming from communicable diseases and famine to noncommunicable diseases.
question
What are examples of leading causes of death shared in low/middle- and high-income countries? What are examples of areas where these differ?
answer
-Low income: High blood pressure, household air pollution, low birthweight/short gestation, child growth failure, unsafe sex, unsafe sanitation, smoking
-High income: high blood pressure, smoking, high BMI, high cholesterol, high fasting plasma glucose, alcohol use, heart disease, stroke
-Low income causes of death are related to lack of resources, education, and healthcare, while high income causes of death are related to overconsumption and excess.
-Low income countries suffer from more communicable diseases than high income countries, which suffer most from non-communicable disease
-High income: high blood pressure, smoking, high BMI, high cholesterol, high fasting plasma glucose, alcohol use, heart disease, stroke
-Low income causes of death are related to lack of resources, education, and healthcare, while high income causes of death are related to overconsumption and excess.
-Low income countries suffer from more communicable diseases than high income countries, which suffer most from non-communicable disease
question
What regions of the world have the shortest life expectancy?
answer
South asia, sub-saharan Africa, middle east & north Africa
question
What are the 3 broad groups of causes of death used by WHO?
answer
Group I: communicable, maternal, perinatal, nutritional
Group II: non-communicable, usually chronic, diseases
Group III: injuries
Group II: non-communicable, usually chronic, diseases
Group III: injuries
question
What made smallpox eradication successful?
answer
-No animal vector
-Easily diagnosable
-Vaccine available - no refrigeration needed
-Available technology-Bifurcated needle allowed easy application, small amount of vaccine
-Lifetime immunity
-Easily diagnosable
-Vaccine available - no refrigeration needed
-Available technology-Bifurcated needle allowed easy application, small amount of vaccine
-Lifetime immunity
question
How is poverty defined globally, and what regions of the world have the largest percent of people living in poverty?
answer
Poverty: people living on less than $1.90 a day
question
How do education, income and health affect each other?
answer
-Intergenerational links: parents' health and education affect their children
-Malnutrition and disease affect children's cognitive development and school performance
-Education contributes to disease prevention and management
-Maternal education associated with better child outcomes
-Good health increases lifetime earnings
-Healthy workers are more productive than unhealthy workers
-Wealth promotes health:Better nutrition, Better housing, Access to a healthier environment, Access to health care, Access to education
-Malnutrition and disease affect children's cognitive development and school performance
-Education contributes to disease prevention and management
-Maternal education associated with better child outcomes
-Good health increases lifetime earnings
-Healthy workers are more productive than unhealthy workers
-Wealth promotes health:Better nutrition, Better housing, Access to a healthier environment, Access to health care, Access to education
question
What do equity and health disparities mean?
answer
-Equity: fairness in distributing a resource, such as conditions for a healthy life
-Health disparities: differences among populations in measures of health and healthcare
-Inequities: unfair differences in resources that increase disease burden (Ethnic or gender discrimination, geographic—rural or remote, poverty)
-Health disparities: differences among populations in measures of health and healthcare
-Inequities: unfair differences in resources that increase disease burden (Ethnic or gender discrimination, geographic—rural or remote, poverty)
question
What are measures of the income level of a country and what do they measure? How do they relate to health?
answer
-GDP: Total amount of goods and services produced within a country by its own and foreign corporations during a specified period of time. Includes consumer spending, investment, government spending, exports
-GINI: Index of income inequality. Half the average of the absolute differences between all pairs of incomes within a distribution, normalized on mean income. Interpretation:
0.0 (perfect equality of income in country)
1.0 (perfect inequality of income in country)
CIA and World Bank use 0 to 100
-GINI: Index of income inequality. Half the average of the absolute differences between all pairs of incomes within a distribution, normalized on mean income. Interpretation:
0.0 (perfect equality of income in country)
1.0 (perfect inequality of income in country)
CIA and World Bank use 0 to 100
question
What groups are most likely to face inequities in access to care?
answer
-Poor people (cost of services too high)
-Less educated (underutilize health care)
-Women (education)
-Minorities, Indigenous (lack of health insurance, poorer quality, disregard cultural aspects)
-Rural: lack of transport to urban areas
-Sexual minorities; Disability groups
-Less educated (underutilize health care)
-Women (education)
-Minorities, Indigenous (lack of health insurance, poorer quality, disregard cultural aspects)
-Rural: lack of transport to urban areas
-Sexual minorities; Disability groups
question
What part of the national income do high- and low-income countries spend on health?
answer
-Most high-income countries:
spend 9-12% of national income on health and have high life expectancy
e.g., Germany & Iceland
-Most low-income countries:
spend 3-6% of national income on health and have low life expectancy
e.g., Ghana, Kenya, Mali
spend 9-12% of national income on health and have high life expectancy
e.g., Germany & Iceland
-Most low-income countries:
spend 3-6% of national income on health and have low life expectancy
e.g., Ghana, Kenya, Mali
question
What are public, private, and out-of-pocket expenditures for health?
answer
...
question
What is cost effectiveness and how can it be helpful in deciding how to spend money to promote health of a population?
answer
-Cost effectiveness: how much health do we buy for the cost
-Compare alternative treatments for a disease
ex:Cheap malaria drug or expensive, effective one (see Malaria: Killer #1 video)
-Compare different goals
ex: Coronary bypass surgery ($1,000)versus TB treatment($100)
-Set priorities
-Determine what is achievable with resources
-Compare alternative treatments for a disease
ex:Cheap malaria drug or expensive, effective one (see Malaria: Killer #1 video)
-Compare different goals
ex: Coronary bypass surgery ($1,000)versus TB treatment($100)
-Set priorities
-Determine what is achievable with resources
question
What are the top 4 cost-effective interventions to improve global health according to the 2008 Copenhagen Consensus?
answer
-Micronutrient interventions to fight hunger and improve education
-Malaria combination treatment
-Childhood immunization
-Deworming school kids
-Malaria combination treatment
-Childhood immunization
-Deworming school kids
question
What are solutions to eradicate the Guinea worm disease (dracunculiasis)?
answer
-Clean water source
-Use of water filters
-Avoid recontamination of water supply
-Health education
-Surveillance and reporting
-Use of water filters
-Avoid recontamination of water supply
-Health education
-Surveillance and reporting
question
What are the four types of technology (and examples of each) that can answer global health needs?
answer
-Biomedical technologies
ex: HAART for HIV
-Education & motivation
ex: Motivational interviewing
-Food & agricultural technologies
ex: Plumpy Nut
-Public health innovations
ex: Sanitation
ex: HAART for HIV
-Education & motivation
ex: Motivational interviewing
-Food & agricultural technologies
ex: Plumpy Nut
-Public health innovations
ex: Sanitation
question
What are three underlying factors that affect whether technologies solve global health needs?
answer
-Poverty & low education underlie much poor health in low-income countries
-Health may not be a priority to national & local leaders
-Poorly functioning health infrastructures
-Health may not be a priority to national & local leaders
-Poorly functioning health infrastructures
question
What are barriers to development of new technologies for global health?
answer
-Insufficient attention to low/middle income countries by major research institutions
-"For-profit" entities the major developers of new technologies
-Research for diagnostics, vaccines, drugs, and delivery devices are usually done for-profit and thus are not accessible to low and middle income groups
-Major profits derived from drugs sold in high income countries
-Only 10% of expenditures for research & development is related to diseases of developing countries
-"For-profit" entities the major developers of new technologies
-Research for diagnostics, vaccines, drugs, and delivery devices are usually done for-profit and thus are not accessible to low and middle income groups
-Major profits derived from drugs sold in high income countries
-Only 10% of expenditures for research & development is related to diseases of developing countries
question
What are the ideal characteristics of a new health product for global health? Be able to apply this to an example.
answer
-Affordable
-Easy to use & convenient (e.g., few doses)
-Safe (low risks)
-Non-invasive
-Requires little skill or training to use
-Quick results/interpretation
-Easy to transport, storage
-Heat stable
-Effective
-Easy to use & convenient (e.g., few doses)
-Safe (low risks)
-Non-invasive
-Requires little skill or training to use
-Quick results/interpretation
-Easy to transport, storage
-Heat stable
-Effective
question
Define culture and society; how are these different?
answer
-Culture: "behaviors and beliefs that are learned and shared"; "A set of rules or standards shared by members of a society, which when acted upon by the members, produce behavior that falls within a range of variation that members consider proper and acceptable."*
-Society: "A group of people who occupy a specific locality and share the same cultural traditions."
-Society: "A group of people who occupy a specific locality and share the same cultural traditions."
question
How do collectivist and individualistic cultures differ?
answer
Collectivist:
Individualistic:
Individualistic:
question
Ethnocentricism
answer
evaluate another culture from one's own cultural perspective: in the UK they drive on the wrong side of the road (instead of: they drive on the opposite side of the road)
question
cultural relativism
answer
evaluate another culture by that culture's standards, even if aspects are harmful
question
cultural humility
answer
awareness that knowing another's culture is a long, evolving process
question
Why is it important to study the relationship between culture and health?
answer
The relationship between culture and health influences:
-Perceptions of health & illness
-Health behaviors
-Health beliefs
-Utilization of health services
-Health practices & medical treatment
-[also influences health worker effectiveness]
-Perceptions of health & illness
-Health behaviors
-Health beliefs
-Utilization of health services
-Health practices & medical treatment
-[also influences health worker effectiveness]
question
How do the concepts of illness and disease differ?
answer
Illness: Reactions to disease or discomfort [or threat]
-How he/she describe symptoms of an illness
-May have a culturally recognized name for the description of symptoms (i.e., empacho)
-Varies across cultures
Perceptions of disease (Western view)
Disease: malfunction of biological and psychophysiological processes in the body
Beliefs about what causes illnesses [and in some cases disease too]:
-Being frightened
-Body out of balance (i.e., hot and cold)
-Supernatural
-Emotional stress
-Punishment
-How he/she describe symptoms of an illness
-May have a culturally recognized name for the description of symptoms (i.e., empacho)
-Varies across cultures
Perceptions of disease (Western view)
Disease: malfunction of biological and psychophysiological processes in the body
Beliefs about what causes illnesses [and in some cases disease too]:
-Being frightened
-Body out of balance (i.e., hot and cold)
-Supernatural
-Emotional stress
-Punishment
question
What are the 3 broad categories of health care providers in global health?
answer
-indigenous (Midwives, Shamans, Curers, Spiritualists, Witches, Sorcerers, Priests, Diviners, Herbalists, Bonesetters)
-western biomedical (Pharmacists, Nurse-midwives, Nurses, Nurse practitioners, Physicians, Dentists)
-other medical systems (Chinese medical system practitioners, Chemists/herbalists, Acupuncturists, Ayurvedic practitioners)
-western biomedical (Pharmacists, Nurse-midwives, Nurses, Nurse practitioners, Physicians, Dentists)
-other medical systems (Chinese medical system practitioners, Chemists/herbalists, Acupuncturists, Ayurvedic practitioners)
question
Ecological perspective
answer
"mega focus", multiple levels of change
question
Health belief model
answer
focus on "fears"
question
States of change model
answer
Focus on "Readiness"
1. Precontemplation (ignoring the problem)
2. Contemplation ("thinking about" change)
3.Decision/determination (decision point)
4. Action (needs support for efforts)
5. Maintenance (part of daily living)
1. Precontemplation (ignoring the problem)
2. Contemplation ("thinking about" change)
3.Decision/determination (decision point)
4. Action (needs support for efforts)
5. Maintenance (part of daily living)
question
Diffusion of Innovations: a process
answer
-Communication promotes social change
-Success depends on:
-use of "opinion leaders" & a product that's easy, fits with culture, etc.
-Differences in "users": innovators & early adopters to laggards
-Success depends on:
-use of "opinion leaders" & a product that's easy, fits with culture, etc.
-Differences in "users": innovators & early adopters to laggards
question
Read the case studies in Chapter 7 of the textbook. What were cultural barriers to exclusive breastfeeding in Burundi and polio vaccination in India? How did culture affect the spread of Ebola?
answer
-Important barriers to EBF in Burundi:
1. lack of nourishment education/knowledge of EBF
2. beliefs that god would disprove of EBF
3. lack of social acceptance of EBF
-Barriers to polio vaccine in India:
1. high population density
2. poor sanitation
3. high poverty levels
4. resistance to immunization by minority groups
5. political resistance
6. misinformation
7. lack of social mobilization
-Culture affecting spread of Ebola
1. burial practices: postmortem washing/viewing of the body spreads Ebola
2. caregiving practices
3. social stigma: misinformation, shunning
4. gender roles: men more likely to hunt and come into contact with ebola; women more likely to perform caregiving rituals
1. lack of nourishment education/knowledge of EBF
2. beliefs that god would disprove of EBF
3. lack of social acceptance of EBF
-Barriers to polio vaccine in India:
1. high population density
2. poor sanitation
3. high poverty levels
4. resistance to immunization by minority groups
5. political resistance
6. misinformation
7. lack of social mobilization
-Culture affecting spread of Ebola
1. burial practices: postmortem washing/viewing of the body spreads Ebola
2. caregiving practices
3. social stigma: misinformation, shunning
4. gender roles: men more likely to hunt and come into contact with ebola; women more likely to perform caregiving rituals
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