Global Health Issues Midterm

Understand the progress that has already been made. Understand the challenges that still remain.Diseases are not limited by national boundaries.Significant health disparities among groups. Link between health and development

"Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

"...an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants, and solutions, involves many disciplines within and beyond the health sciences, and promotes interdisciplinary collaboration; and is a synthesis of population based prevention with individual-level clinical care."

we must understand the factors that influence health status most,
the indicators used to measure health status, the key trends that have occurred historically

The interconnected factors that determine an individual's health status

sickness or any departure, subjective or objective, from a psychological or physiological state of well-being

death

temporary or long-term reduction in a person's capacity to function

number of people suffering from a certain health condition over a specified time period

the rate at which new cases of a disease occur in a population

illnesses caused by a particular infectious agent that spread directly or indirectly from people to people, animals to people, or people to animals

illnesses not spread by an infectious agent
Injury- include road traffic injuries, falls, self-inflicted injuries, and violence, among other things

record births, deaths, and causes of death

summarizes expected number of years to be lived in what might be termed the equivalent of good health

a unit for measuring the amount of health lost because of a particular disease or injury

"Health gap measure," indicating losses due to illness, disability and premature death in a population. Gives a better estimate of the health of a population than death rate. Accounts for health conditions like mental illness that rarely cause death

High income= noncommunicable diseases, Low income= communicable diseases

Children in low- and middle-income countries often die of communicable disease
HIV/AIDS and TB are among the leading causes of death among adults in low- and middle-income countries

an aspect or personal behavior or life-style, an environmental exposure, or an inborn or inherited characteristic, that, on the basis of epidemiological evidence, is known to be associated with health-related conditions considered important to prevent

Majority of population growth will occur in low- and middle-income countries
Put pressure on the environment
Create need for more infrastructure and services

Population of the world is aging
Implications for burden of disease because people will be living longer with morbidities and disabilities
Healthcare financing will be affected by change in ratio of working people to those over 65 years

Majority of the world's population lives in urban areas for the first time
Enormous pressure on urban infrastructure like water and sanitation

Highest income countries: low fertility, declining populations, aging populations
Lowest income countries: relatively high fertility, growing populations

Shift from pattern of high fertility and high mortality to low fertility and low mortality
Mortality declines due to better hygiene and nutrition
Population grows with younger share of population increasing
Fertility declines
Population growth slows and older share of population increases

Shift from burden of disease dominated by communicable disease to burden of disease dominated by noncommunicable disease
Most low-income countries are in ongoing transition so they face large burdens of communicable and noncommunicable disease

Specialized economies"- economies that depend on 1-3 key exports.
Inadequate and corrupt distribution systems.
Inadequate nutrition

Financial global core viewed as wealthy industrialized nations.
Developing areas as periphery.
Variations in life expectancy
Colonial legacies

Specialized economies
Weak internal political structure
Low standard of living
High potential for class conflict and political instability
Repressive rulers or governing bodies

Slave trade: mid 1400's to late 1800's
Resource exploitation
Creation of "shell" governments
Misappropriation of resources

Many regimes caught in a crossfire
"surrogate" wars- expanded violent conflicts and encouraged dependence on foreign $ and weapons

Fragile tropical soils
No effective soil conservation programs
Erosion and flooding
Insects a major health threat
Drought followed by famine
Heat stress on some crops
Parasites abundant

Periphery leaders stay in power with strong-arm tactics
Attempts to keep power for life
Western models of democracy deemed inappropriate
Delaying progress in water supplies, electricity, and toilet facilities extends length of power
Potential for violent reactions

Health and education of parents affects health and education of children
Malnutrition and disease affect cognitive development
Education contributes to disease prevention

Good health increases longevity, lifetime earnings
Healthy workers are more productive than unhealthy workers

Costs of health care are high
Illness often leads to a decrease in earnings
Poor people when sick temporarily falls below the poverty line
Poor countries- out of pocket expense for healthcare is maximum

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
In India under 5 Child Mortality rate varies across different States.
In USA the life expectancy for a white American male is higher than for a black American male.

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
Stunted growth of a child more prevalent among rural dwellers as compared to Urban population.
Urban women use contraceptive methods more as compared to rural population.

Large gap in access, coverage, fairness, and benefits between less well off and better off
Richer population will have less of underweight children and will very likely immunize their child as compared to poor population in a same region.

"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 in low-income countries
Benefit of public subsidies often received by better off people

expenditure by any level of government or government agency

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

Latter half of last century, GATT was initiated to facilitate freer trade
Major factor in lowering tariffs internationally
More competition for goods
Also more interdependence among governments
Search for more fair agreements

Signed by Mexico, Canada and the US in 1993
Reduction of tariff and trade barriers
More investment and capital mobility across borders
One goal was reduction of poverty in Mexico
Opposition
Poverty reduction process slow
Increased pollution due to Mexican laws
Environmental issues along US-Mexican border

Meant to assist developing countries via technical assistance and training
Difficult task due to range of underdevelopment
Variable levels of resources and how they are used

Development's influence on health
Diseases can actually increase with some forms of development
Environmental degradation has many health consequences
Emergence/reemergence of virulent diseases
Increases in the incidence/prevalence of endemic diseases
Need to learn balance between positive aspects of development and negative consequences

Funds many programs aimed at improving health around the world, I.e. malaria, AIDS, environmental programs, etc.
Health promotion in some regions
Claims to set global health standards
HIV/AIDS "programme"
Technology and heath information systems
PAHO a part of WHO

Meant to protect children and their rights
Lots of emphasis in primary health care
Employs physicians and pediatricians in many regions of the world
Includes education, safe water and sanitation
Research and evaluation functions
Includes improvement of children and their mothers
Evaluation of social policy

The unauthorized and uncompensated taking of biological resources

Use of microbes to destroy populations
Anthrax
Smallpox
Difficult to detect, easy to make, inexpensive, does not destroy infrastructure
More damaging than explosives or chemicals
Anti-crop weapons

Quest for natural resources, i.e. water
Search for cheap labor (moves industry and pollution to other countries)
Waste generation and disposal
Waste transfer to poorer neighborhoods and regions
Changing nature of landfills
Nuclear waste policies
Variable regulations for businesses and many local governments

Balance between population and resources
What are the regions of balance?
Regions of heavy dependence on commercial/plantation agriculture
Demands for minerals and care for mined areas
Global Pollution
Unsustainable development happens when a nation's natural capital is depleted faster than new capital is created
71% of the world's output is consumed by 15% of the world population (primarily in US, Japan, and Europe)

Committed to poverty reduction and improved living conditions
Washington-based with 180 nation-members
International development via loans
Financing development projects
Environmental protection commitment, but finances lower-cost projects
Finances health and social services projects