Global health exam 1 part 4

impact of a health problem or disease as measured by financial cost, social cost, mortality, morbidity, or other indicators. It is often quantified in terms of disability-adjusted life years (DALYs) which quantify the number of years lost due to disease

•Attempt to construct a single indicator to compare how far countries are from the state of good health
•This index would take into account of morbidity, mortality, and disability; calculate by age, gender, and region; allow comparison across regions
•This index would measure what is referred to as the burden of disease

•Disability-adjusted life year (DALY) - the sum of years lost due to premature death and years lived with disability (YLDs)
•Calculated by subtracting the age at which one dies and one's life expectancy at that age

•Health-adjusted life expectancy (HALE) - number of years a person of a given age can expect to live in good health, taking account of mortality and disability
•Calculated by weighting the number of years of ill health according to severity, subtracted from the overall life expectancy

DALY = Death/Disability Years

•People are living longer in much of the world
•Globally, women live 5 years longer than men
•In the last 4 decades, there have been significant declines in communicable, maternal, neonatal, and nutritional causes of death
•Mortality rates have decreased, particularly for children under-5

•Rate of mortality decrease differs by country
•Years of life lost due to premature death are increasing for diabetes, some cancers, drug use disorders, conflict, and terrorism
•Burden of disease is predominantly noncommunicabe
•With increased life expectancy and declining death rates, there is an increase in the number of years people live with disability

Although ischemic heart disease and stroke are leading causes of death for females, global health literature focuses on reproductive health

•Rural populations are less healthy than urban populations
•Disadvantaged ethnic minorities are less healthy than majority population
•Females suffer from a number of conditions related to their relatively disadvantaged social positions
•Poor people are less healthy than wealthier people
•Uneducated people will be less health than those better-educated

•Population growth
•Population aging
•Urbanization
•Demographic divide
•Demographic transition

•Global population estimate was 7.6 billion in 2018
•Estimated global population in 2050 is 9.9 billion
•Majority of growth will occur in low- and middle-income countries, especially SSA
•High-income countries are below replacement fertility

•Elderly support ratio - ratio between the number of people aged 15 to 64 years, compared to the number of people over 65
•Aging population and shift in the elderly support ratio has profound implications for:
- the burden of disease
-health expenditures
-how health care will be financed

•The majority of the global population lives in urban areas
•Urbanization puts pressure on urban infrastructure, such as water and sanitation, schools, and health services
•Gaps in infrastructure can have substantial negative consequences for health

•Highest-income countries have low fertility, declining populations, and aging populations
•Lowest-income countries have high-fertility, although it is slowly declining

•Shift in pattern of high fertility and high mortality to low fertility and low mortality, with population growth in between
•Decline in mortality with improved hygiene and nutrition, followed by decline in fertility

•The Epidemiologic Transition
•First, high and fluctuating mortality, related to poor health conditions, epidemics, and famine
•Then, progressive decline in mortality as epidemics become less frequent
•Finally, further declines in mortality, increases in life expectancy, and the predominance of noncommunicable diseases

•Factors that lead to improvements in health are complex, they include: nutrition, education, political stability, and scientific improvements

•Burden of disease will be influenced by changing factors, some of which will relate to the determinants of health
•Other drivers will include:
-Economic development
-Scientific and technological change
-Climate change
-Political stability
-Emerging and re-emerging infectious diseases

•Investing effectively and efficiently in areas that address key risk factors and determinants of health
•Investing effectively and efficiently in relatively low-cost but high-impact health services
•Take community-based approach to primary health care

•DALYs - amount of healthy life years lost due to premature death and to years lived with disability
•Leading cause of death and DALYs worldwide for both sexes and all age groups is ischemic heart disease
•Burden of disease is predominantly noncommunicable in all regions except SSA

•Epidemiological transition - movement from pattern of communicable to noncommunicable disease
•Risk factors for deaths and DALYs in high-income countries are largely behavioral
•Risk factors for deaths and DALYs in low-income countries range from nutritional issues, lack of safe water and sanitation, indoor and ambient air pollution, to tobacco smoking

•Understanding demographic trends is helpful to addressing key global health issues
•Three key demographic trends:
-Population growth
-Population aging
-Urbanization
•Demographic transition - pattern of high mortality and high fertility to low mortality and low fertility