question
Global health
answer
eliminating disparities, achieving better health outcomes for vulnerable populations, health as a quality of liberty (its a freedom, everyone should have it), and equity
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Equity
answer
understands that people begin in different circumstances, has the goal of giving equal outcomes (may provide more to someone who begins with less)
question
Are non-infectious (non-communicable) disease more common in high or low income countries
answer
high income countries (like heart disease)
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Are poor infant/maternal health outcomes higher in high or low income countries?
answer
low income countries
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Are infectious diseases more common in high or low income countries?
answer
low income countries
question
Which country spends the most on healthcare?
answer
The US, but clearly spending doesn't always translate to improved health
question
Health (WHO definition)
answer
a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
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Public health definitions grounded in many principles (thought to be narrow in scope)
answer
Use of evidence to inform decisions, focus on population (not individual), promotion of social justice/equity, work towards preventing poor health rather than curing illness AFTER it manifests)
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International health
answer
health work abroad in lower income countries, often concerned with infectious disease/maternal/child health, considers complex global/local forces
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Global health similarities to international health/public health
answer
Works at the population level, focuses on preventative (not curative) measures, emphasis on systems/structures in shaping health patterns, tries to address health disparities in under-deserved/lower income communities, focus on health equity/health as a public good
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Global health differences from international health/public health
answer
Not restricted to issues that span international borders (focuses on issues of global scope), can focus on domestic and international, broader view on health issues (like diabetes, not just infectious disease and maternal/child), stresses importance of collaboration, ideas from diverse disciplines/cultures, partnerships with equal knowledge transfer between high and low income countries
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Emerging field of collaboration (what are they trying to do/how?)
answer
Work led by researches from low/middle income countries, training and global health centers forming in lower-income nations
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Common issues on global health interventions
answer
Fixation on novel/dramatic risks rather than boring/expected threats, lack of public support for continued funding of ongoing interventions, donor countries hubristic with aid (don't listen to countries they are helping)
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Morbidity
answer
a state of poor health (proportion of illness in a population)
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Mortality
answer
frequency of occurrence of death among a defined population during a specified time interval
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Disability-Adjusted Life Year (DALY)
answer
years of life lost because of premature mortality (YLLs) + years of healthy life lost due to disability (YLDs)
question
How are LMICs classified?
answer
World bank: gross national income of a country, average income of a citizen of a country
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Why would investing in community care providers be beneficial?
answer
Community members tend to be trusted and have a better sense of local resources/needs
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When was the WHO founded
answer
1948, following WWII
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What are some important points of the WHO constitution?
answer
Health as a fundamental right, necessary for peace within countries, government has responsibility to maintain health of its people
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How many members are there of the WHO currently?
answer
196
question
How is the WHO funded?
answer
Country membership dues (less than 1/4 of funding), voluntary contributions from members and partners (funding is EXTREMELY limited)
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Critiques of WHO
answer
Competing ideologies within organization (verticalists vs horizontalists), organization as too bureaucratic/leads to inefficiency and lack of transparency as well as politicization, without flexible funding, lose control of priorities
question
Alma Ata conference (what is it?)
answer
1978 international conference on primary care FOR ALL, WHO, UNICEF and 134 signatory nations
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Alma Ata principles:
answer
increased investment in primary healthcare, individuals and communities involved in planning/implementation, governments responsible to ensure adequate healthcare, goal of achieving acceptable level of health for all people globally by 2000
question
Alma-Ata outcomes
answer
Funding never reached to follow through on goals, some success stories in countries building up their healthcare systems to meet their specific needs
question
Millenium Development Goals (what is it/when was it signed)
answer
Signed in 2000, combating MANY things: 4 goals on physical health, 4 on determinants of health (no great framework for assessing progress towards meeting these goals)
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Sustainable Development Goals (what are they/when was it adopted)
answer
17 SDGs adopted by all UN member states in 2015, 169 specified targets, 2030 agenda (very broad including poverty, health-improvement strategies, reducing inequality, tackling climate change)
question
Primary healthcare principles
answer
Holistic view of health/wellbeing, comprehensive care (meeting your needs in ONE place), delivered close to community members, driven by community needs
question
What are challenges to providing accessible primary healthcare?
answer
User fees become more common (raises healthcare resources but associated with reduced use of key services), focus on categorical (disease-specific) funding in a place of a more holistic approach
question
Universal Declaration of Human Rights/relationship to right to health
answer
1948 statement by UN general assembly considers all human rights as indivisble, affirmed that health is a key part to of the right to an adequate standard of living
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Additions to right to health in 1966 from Universal Declaration of Human Rights
answer
Right to be free to control one's body, right to entitlements (system for disease prevention, access to essential medical services, access to health information and education)
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Underlying determinants of health
answer
Factors required to maintain health such as clean drinking water/nutritious food, adequate housing, sanitation systems, access to healthcare, education/training opportunities for care providers, access to high-quality treatments
question
Neglected disease
answer
affect poor/marginalized populations, relatively little attention/funding, associated with lack of access to underlying health determinants, contribute to changes in immune function
question
Neglected disease example: inflammation
answer
First line of protection against injury and infection
question
REACH study: intestinal inflammation rates in African American children from Rural Mississippi
answer
High FC levels and rates of clinically elevated intestinal inflammation --> household income associated negatively with FC levels. Showed that living conditions associated with low SES may be contributing to high levels of intestinal inflammation
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Medical anthropology
answer
subfield of anthropology that investigates how cultural, historical, socioeconomic, and political factors shape ideas about health, illness and disease (shows how CULTURAL factors shape disesase risk and health patterns)
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Cultural reletavisim
answer
idea that cultural aspects must be considered in their own terms without making value judgement based on norms
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What is disease?
answer
biological changes that impair function, shaped by biomedicine constructs, thought to be fairly objective but may be context-dependent (common diseases: injury, infection, malnutrition, genetic, chronic, psychological)
question
What is illness?
answer
Subjective experience of discomfort/suffering (shaped by culture), more holistic than disease (lived experiences)
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What is sickness?
answer
Sociological meaning (ex. sick role), may lead to experiences of stigma, may require legitimation
question
Three bodies that determine health
answer
Individual body (individual level, both physical and mental aspects), social body (social factors influencing individual health), body politic (how social/political forces affect individual bodies within society)
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Medicalizatoin
answer
the process of defining and treating human conditions as medical pathologies in need of intervention (ex. medicalizing birth, are high C-section rates partly to blame for US maternal deaths?)
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Proximate disease causes
answer
immediate causes of poor health and disease symptoms (virus, hormones)
question
Ultimate disease causes
answer
root factors contributing to the risk of poor health in the first place (politics, environment, economy, evolution)
question
Why is biological normalcy not a great way to measure poor health
answer
Individuals falling outside normal ranges may not suffer poor health
question
Evolutionary history of humans: selection, stressor, adaptation (all definitions answer)
answer
Selection: process where one individual becomes more likely to reproduce successfully
Stressor: external stimulus that challenges biological processes and health of an organism
Adaptation: advantageous trait that evolved for a specific reason and which increase reproductive success
Stressor: external stimulus that challenges biological processes and health of an organism
Adaptation: advantageous trait that evolved for a specific reason and which increase reproductive success
question
What is culture, how does it influence health?
answer
a set of shared meanings embedded in social institution, shaper of individual beliefs and behavior
many ways culture influences health: ethnomedical systems (similarities and variation in healing systems), political economy of health (structural factors and differences in power/wealth shape health), interpretive approach (situate illness within cultural context, disease definitions/symptoms/treatments influenced by cultural factors), applied medical anthropology (apply knowledge to design/implement health interventions)
many ways culture influences health: ethnomedical systems (similarities and variation in healing systems), political economy of health (structural factors and differences in power/wealth shape health), interpretive approach (situate illness within cultural context, disease definitions/symptoms/treatments influenced by cultural factors), applied medical anthropology (apply knowledge to design/implement health interventions)
question
Structural violence
answer
social structures that stop individuals/groups/societies from reaching their full potential, cause injury to people
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Medical anthropologist contribution to global health
answer
produce studies of health inequities, assess local impact of globally circulating science and technology, critique international health policies
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Infectious disease
answer
disease caused by microorganism, typically communicable/contagious (can be transmitted between persons or species)
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Chronic disease (non-infectious)
answer
not caused by an acute infectious process, not directly passed from one person to another (diabetes, heart disease, cancer)
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What is epidemiology/how can it be applied
answer
The how and why of disease, relies on statistics, studies population
Can be applied to define/document novel pathogens, understand disease spread, can identify key determinants of disease/segments of population that require more protectoin
Can be applied to define/document novel pathogens, understand disease spread, can identify key determinants of disease/segments of population that require more protectoin
question
Incidence
answer
rate at which new cases occur over a given time
question
Prevalence
answer
total number of cases in a specific time period (proportion of individuals in a population with a disease at any one time)
question
R0: disease reproduction number
answer
how fast a transmission is happening/how quickly it is infection people (less than 1: controlled, 1: maintaining a consistent rate, above 1: exponential growth)
question
Sporadic
answer
disease that occurs infrequently and irregularly
question
Cluster
answer
aggregation of cases in certain area with a specific time period
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Outbreak
answer
occurrence of more cases than expected in a certain area within a certain time period
question
Epidemic
answer
new cases spread rapidly through a population
question
Pandemic
answer
extreme epidemic, over vast amount of geographic space
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Endemic
answer
new cases occur at relatively low but constant rate over time
question
Case fatality rate
answer
the proportion of people with a disease who die from it (often associated with severity of infection)
question
Disease reservoir
answer
a host population in which the pathogen lives and multiplies
question
Zoonoses/zoonotic disease
answer
disease and pathogens that can spread between people and animals
question
Ways to assess changes in health and disease over time
answer
life expectancy at brith, infant and child mortality, general mortality patterns
question
How to conduct an epidemiological study (tracking a disease)
answer
1) identify disease cases 2) calculate disease rates, 3) compare rates (between population and over time)
question
Cross sectional study
answer
individual level variables, individual data on their lifestyle and general health, can do statistics tests to see relations (not following over time, can't make conclusions about causality)
question
Case control study
answer
identifying individuals who have the disease vs individuals who don't (asking them to think back about exposures so you can try to trace the differences of the two groups), difficult to determine causality (recall bias, not following over time)
question
Cohort study
answer
recruit group of people at the start of the study they all don't have the disease, follow them overtime and collect data as you determine what factors might lead to a disease manifesting over time
question
Ecological study
answer
at least one of the variables ins measured at the group level, compare people in city X and city Y (because there is no individual data, you can't definitively say that a person in city X was exposed because of conditions in city X)
question
Randomized control study
answer
take people and design an intervention, give one group treatment, one group no treatment, see outcomes
question
Research ethics
answer
researcher responsibilities when working with human subjects
question
Nuremberg Code
answer
Nuremberg trials held in Germany to hold Nazi doctors accountable for human experiences, code developed (10 standards that must be observed when carrying out experiments on human subjects)
Key points:
- Voluntary informed consent
- Expected benefit must outweigh risk
- Researchers must avoid injuring subject
Key points:
- Voluntary informed consent
- Expected benefit must outweigh risk
- Researchers must avoid injuring subject
question
Declaration of Helsinki
answer
Added two main elements to Nuremberg Code (1964): interest of subjects placed above society, every subject should get best known treatment
question
Belmont report (3 principles)
answer
Respect for persons (individual has right to self determination), beneficence (research is designed to maximize benefit and minimize harm), justice (equal distribution of risks across all members of society)
question
What is community based participatory research (CBPR)?
answer
actively involves community members and stakeholders at all phases of research, community members considered researchers, ensures production of useful/relevant information
question
Colonization
answer
control by one population/power over an area or people (exploitation of people and resources, fueling empire growth, associated with forced assimilation including health practices)
question
Health implication of colonization
answer
Novel pathogens: no biological immunity to disease, no cultural/behavioral responses in place
question
Bioterrorism
answer
active promotion of infection by colonizers
question
What sparked the birth of colonial/tropical medicine?
answer
Blame was placed on environments when European colonizers got diseases (yellow fever, malaria) --> led to colonial medicine to control disease that imperiled colonial endeavor (not a concern for indigenous communities) -- couched in terms of a BURDEN
question
What are the tropics in tropical disease/what are examples?
answer
Tropics are an INVENTED term by imperial powers to reflect the environments that presented unique health challenges, examples include malaria, schistosomiasis, trachoma, yellow fever (consistently eliminated in high income countries but persist in LMICs)
question
How did health measures become part of colonization?
answer
Disease control efforts resulted in efforts to control movement/behavior/diets of colonized people, included missionary efforts to convert indigenous people by leveraging healthcare
question
Upstream cause of disease
answer
backing away from a focus on individual (downstream) disease risk factors and looking at social circumstances (GOOD! looking at SDHs)
question
What is the legacy of colonial medicine?
answer
Many colonies rely on foreign aid/medical services, continued unequal partnerships between high/low income nations
question
What is neoliberalism, what are the pillars/proposed benefits (of these pillars)
answer
resurfaced in 1970s, lack of government intervention, free market leads to better allocation and utilization of resources, increased economic growth, individual choice, everyone has same choices, decentralization leads to better response times (pillars: liberalization, privatization, individualism, decentralization)
question
Downsides of neoliberalism
answer
less protection of rights, increase in poverty and inequality, high costs of services = inaccessible to many, does decentralization actually work (can smaller governments support programs?), communal good of society often ignored in favor of perceived good/freedom of the individual
question
Austerity, benefits
answer
a set of economic policies implemented by governments to control and reduce national debt (may involve government spending cuts to health related services), thought to reduce debt/increase confidence in economy, create more room for private sector to operate
question
Downsides of austerity
answer
unpopular for government to raise taxes so instead they cut government provided services (healthcare/education), this will not impact all citizens equally (individuals making less money rely more on these services that are being cut)
question
How does neoliberalism view healthcare?
answer
Health as an individual choice, public healthcare funding as inefficient, reframing care as a good for sale
question
Healthcare regulation: what is it/what does it have to do with neoliberalism
answer
Regulation by government to enforce compliance with standards/ensure patient safety (neoliberalism is against that!!), may regulate the price of some drug, etc.
question
What are social determinants of health (and examples)?
answer
circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness (income, education, workplace environment, race/ethnicity)
question
Broad vs narrow applications of SDH framework
answer
Broad = more upstream (wealth, income, education -- less directly influence health related behaviors/environments)
Narrow = more midstream (walkability, recreational areas, healthy food access), still SOCIAL determinants of health but not as broadly focused
Can see how the midstream factors are influenced by the upstream factors
Narrow = more midstream (walkability, recreational areas, healthy food access), still SOCIAL determinants of health but not as broadly focused
Can see how the midstream factors are influenced by the upstream factors
question
How does SDH connect to health outcomes/what percent
answer
SDH account for 30-55% of health outcomes (more than healthcare use/lifestyle patterns)
question
Epigenetics (potential mechanism for SDH)
answer
how environments shape genes and their products, modifications to DNA that do not change the structure but influence how it is expressed (toxicants/nutrition/stress/sleep/trauma/disease/migration), may be transmitted across generations
question
Telomere length (related to SDH/what are telomeres)
answer
Caps on end of chromosomes, every time a cell replicates they get shorter, when telomeres are too short, cells can no longer replicate --> rate of telomere shortening impacted by lived experiences, may lead to premature aging
question
Allostatic load (related to SDH)
answer
measure of cumulative damage/wear and tear on the body in response to chronic stressful experiences (looks at neuroendocrine activity/immune function/cardiovascular and metabolic health) --> serves as a measure to explain socioeconomic status differences in mortality
question
Social gradient in health
answer
stepwise, gradient fashion in which health outcomes improve as socioeconomic position improves (individuals at the top/with most power/resources tend to live longer and healthier lives), based on relative deprivation (feeling if you are disadvantaged can still lead to negative health effects), occurs in low/middle/high income countries
question
Social inequality and health in the US (percentages of income distribution/life expectancy)
answer
US income distribution: 43% of wealth controlled by 1% of population, relatively low socioeconomic mobility
Relatively low life expectancy at birth compared to other OECD nations (78.5 in US), people in poverty have greater disease risk and shorter life expectancy
Relatively low life expectancy at birth compared to other OECD nations (78.5 in US), people in poverty have greater disease risk and shorter life expectancy
question
Homeostasis
answer
ability to maintain and restore a stable internal physiological environment with tolerable limits (stressors INTERFERE with homeostasis/disrupt normal functioning)
question
Stress response
answer
suite of physiological and behavioral responses that restore homeostasis and maintain stability
question
Flight or flight response
answer
automatic physiological responses to a real or perceived threat (increased PB, heart rate, mental alertness)
question
General adaptation syndrome
answer
Stage 1: alarm reaction stage 2: resistance, stage 3: exhaustion
question
Defense mechanism to acute stress: two part (what are they?)
answer
Rapid response (epinephrine, physiological effects such as energy mobilization, increased BP and HR)
Delayed response (within minutes, release of cortisol, impacts biological processes, suppresses non-essential functions)
Delayed response (within minutes, release of cortisol, impacts biological processes, suppresses non-essential functions)
question
Acute vs chronic stress (which leads to more long term negative health consequences?)
answer
Acute: sudden and severe
Chronic: frequent and repeated, leads to negative health consequences
- Continuing to mobilize energy/suppress other functions is dangerous (type 2 diabetes. immunosuppression, hypertension due to high BP)
Chronic: frequent and repeated, leads to negative health consequences
- Continuing to mobilize energy/suppress other functions is dangerous (type 2 diabetes. immunosuppression, hypertension due to high BP)
question
Psychosocial stress
answer
stressors related to anticipated social challenges that affect our wellbeing (contributed to by unpredictable conditions, perceived lack of control or social engagement, minimal information on duration/intensity of stressors, lack of social support)
question
Whitehall study
answer
followed health of British government officials, found those in lower employment grades exhibited higher mortality/morbidity risks, worse self reported health status, only PARTLY explained by physical factors (smoking/obesity/etc)
question
What did the whitehall study show about psychosocial differences
answer
lower grade employees reported less satisfaction and control associated with work, had fewer hobbies, reported less social support (physiological effects through activation of stress response, indirect effects through health related behaviors such as diet/substance use/sleep)
question
Market integration
answer
the degree to which people consume from and produce for the global market economy (participation in market economy/associated health outcomes)
question
Push/pull factors to join MI
answer
push: depletion of natural resources, decreased land and resources due to encroachment from outsiders
pull: increased food consumption, reduced food variability, allure of foreign goods
pull: increased food consumption, reduced food variability, allure of foreign goods
question
MI health benefits
answer
increases access to many important thing (such as healthcare, clean water)
question
MI negative health impacts
answer
Crowd disease spread in densely populated areas, waste accumulation, consumption of processed foods, cultural losses
infectious disease: can create disease vectors, increase pathogen transmission, increase risk of zoonotic disease spread
chronic disease: stunted childhood growth, elevated chronic disease, increased psychosocial stress levels (LIFESTYLE INCONGRUITY)
infectious disease: can create disease vectors, increase pathogen transmission, increase risk of zoonotic disease spread
chronic disease: stunted childhood growth, elevated chronic disease, increased psychosocial stress levels (LIFESTYLE INCONGRUITY)
question
Environmental impacts of MI
answer
reduced biodiversity, use of local resources in unsustainable ways, these changes have health impacts!!
question
Shuar health and life history project
answer
using anthropometrics (measurements/proportions of body) and blood collection to determine effects of economic and cultural changes on health outcomes in the Shuar of Amazonian Ecuador
question
Shuar chronic health patterns
answer
relatively good metabolic health: differences between regions (individuals closer to town had higher BP and cholesterol), sex differences (females had worse lipid profiles than males especially closer to town) household differences (more MI households tend to eat more market foods which may lead to some poor health outcomes)
question
MI linked variation in parasite infections
answer
found that parasite infection was highest among participants living in lower MI households: more MI households displayed lower odds of infection and lower parasite loads (mixed support on household construction type)
question
Macro vs micro nutrients
answer
Macro: need larger amounts (water/carbs/protein/lipids/fats)
Micro: only need small amounts (vitmans/minerals)
Micro: only need small amounts (vitmans/minerals)
question
Calorie
answer
amount of heat required to raise the temperature of one gram of water by one degree celsius (amount of energy that food provides us)
question
Determinants of growth for humans
answer
Stunting: assessed by height for age
Wasting: assessed by weight for height
Wasting: assessed by weight for height
question
Adipose tissue distribution and health
answer
higher levels of adiposity (body fat) DO NOT necessarily lead to poor health, it is one factor, meidcal providers generally more concerned with visceral (around the organs) adipose tissue, measured by weight, body fat percentage, BMI
question
Epidemiological transition
answer
changes in disease burden, seen with changes in infrastructure and medicine (decrease in infectious disease increase in chronic conditions in many parts of the world)
question
Nutritional dual burden
answer
the coexistence of undernutrition (stunting) and over-nutrition (overweight and obesity) in the same population/group, family/household, or even person
question
Dual disease burden
answer
co-occurrence of infectious disease and chronic/non-communicable conditions, both impact low-resource communities (the two can interact to cumulatively impact health)
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