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Who makes up the Global Health System?
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Global health is a landscape of actors who share the common mission of improving global health outcomes.
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Action
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takes place within context of evolving norms, laws & legally binding instruments, strategies, relationships, sectors, frameworks, social capital, soft power, and hard power
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Soft power
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Is the ability to attract, or convince rather than compel; non-coercive
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Hard power
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coercive, threats, use of military, economic or other strength
used to make actors make decisions they would otherwise not make
used to make actors make decisions they would otherwise not make
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Primary Prevention
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top priority
Prevention of diseases
Prevention of diseases
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Secondary Prevention
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Detection and intervention of diseases
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Tertiary Prevention
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Management of established diseases
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Horizontal
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More general healthcare wise system intervention
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Vertical
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targets very specialized intervention
thinks horizontal will take to long
ex. GAVI, GPEI
thinks horizontal will take to long
ex. GAVI, GPEI
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Diagonal
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Combines horizontal and vertical, improves health system through targeting one specific disease.
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Types of Impact on Health
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Direct or Indirect
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Health Policy
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"Decisions, plans, and actions that are undertaken to achieve specific health care goals within a society" "Defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term.
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Landscape of Actors
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Multilateral (UN Agencies, Multilateral Development Banks), Bilateral (PEPFAR), Nongovernmental (NGOs), International Partnerships, Philanthropic, Research, Education, Policy, Private Sector, National (Systems, Programs, Bilateral Development Agencies)
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Multilateral actor examples
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WHO, World Bank, UNICEF, UNFPA, UNAIDS, other UN agencies
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NGOs examples
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(International) Red Cross, CARE International, Partners In Health
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Philanthropic organization examples
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The Bill & Melinda Gates Foundation, Rockefeller Foundation
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International partnership examples
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GAVI, GFATM
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Private sector examples
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Big pharma, food industry
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Eradicate
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to get rid of it across the whole world
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Eliminate
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to get rid of in a defined region
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H8
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WHO, WB, Gavi the The Vaccine Alliance, UNICEF, UNFPA, UNAIDS, The Global Fund to Fight Aids Tuberculosis and Malaria, The Bill and Melinda Gates Foundation
8 Influential GH Actors who meet twice a year for talks and planning for global health focus, strategy, and scale-up. Most are also influenced by their funders
8 Influential GH Actors who meet twice a year for talks and planning for global health focus, strategy, and scale-up. Most are also influenced by their funders
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4G
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Gavi, Global Fund, World Bank Group, GFF
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Goals of Health Systems
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Improved Health Levels and Equity
Responsiveness
Social & Financial Risk Protection
Responsiveness
Social & Financial Risk Protection
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6 Building Blocks of Health Systems
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Service Delivery
Health Workforce
Information
Medical Products, Vaccines, Technology
Financing system
Leadership, Governance
Health Workforce
Information
Medical Products, Vaccines, Technology
Financing system
Leadership, Governance
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Bedrock of global actors
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National Health Systems
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Government financing
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government collected revenues or taxes
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Multilateral
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Work together to support many countries
Ex. UN Agencies, World Bank
Ex. UN Agencies, World Bank
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Bilateral
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One to one relationship
Ex. PEPFAR supports a single country
Ex. PEPFAR supports a single country
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What are the ways in which health is financed?
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General Government financing, employment taxes, private out-of-pocket spending, private health insurance arrangements, official development assistance (ODA)
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Employment taxes
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sometimes referred to as social security or social health insurance.
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OOP spending
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paid at the point of contact with health facilities or providers
catastrophic spending for poor families
catastrophic spending for poor families
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DAH
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Development Assistance for Health
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HSS
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Health System Strengthening
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SWaps
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Sector Wide Approaches
Concerted action from many different stakeholders including recipient governments, technical agencies, and multilateral donors in order to increase development (WHO).
Increased health sector coordination, stronger national leadership and ownership, and strengthened countrywide management and delivery systems (WHO).
Concerted action from many different stakeholders including recipient governments, technical agencies, and multilateral donors in order to increase development (WHO).
Increased health sector coordination, stronger national leadership and ownership, and strengthened countrywide management and delivery systems (WHO).
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How much of total health spending in low
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income nations comes from aid? -
27% of health spending is in the form of official development assistance (ODA)
27% of health spending is in the form of official development assistance (ODA)
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How much of total health spending in middle
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income nations comes from aid?-
3% of health spending in lower middle income countries is in the form of ODA
3% of health spending in lower middle income countries is in the form of ODA
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Universal Health Coverage Cube
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Who is covered? Top priority
Which services are covered?
What proportion of the cost is covered?
Which services are covered?
What proportion of the cost is covered?
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Things to keep in mind for a project or intervention?
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1) Who asked for this?
2) Who stands to benefit from this?
3) How can community collaborators not only have a seat at the table, but be the leading voice? (Essential for equity of leadership and long-term change)
2) Who stands to benefit from this?
3) How can community collaborators not only have a seat at the table, but be the leading voice? (Essential for equity of leadership and long-term change)
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4 step research process
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1. Research 2. Design 3. Implement 4. Evaluate
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How do you calculate DALYs?
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YLL + YLD
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Proximal risk factors
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Direct impact on health, ex. smoking
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Distal risk factor
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Indirect impact on health, ex. tobacco taxation
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Global risk factors
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dietary risks, high blood pressure, smoking, indoor/outdoor air pollution, alcohol, high bmi, high blood sugar, childhood underweight, physical inactivity
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Policy triangle
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content, context, and process
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Biopsychosocial Model of Health
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An approach to studying health and human function that posits the importance of biological, psychological, and social (or environmental) processes.
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Different types of Networks
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Societal, Community, Interpersonal, Individual
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Different types of Barriers
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Sociocultural, Financial, Structural
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Demographic transitions
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Shift from High Birth/High Mortality to Low Birth/Low mortality
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Urban shift
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Shift from Rural to Urban
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Nutritional shift
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Shift from cereals, fiber, vegetables to animal foods, high fat, sugar
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Epidemiologist
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Shift from infectious to chronic diseases (hence LMIC dual disease burden)
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4 Types of Global Transitions
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Demographic, Urban shift, Nutritional shift, Epedimiology shift
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Structural violence
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Violence that results from the way that political and economic forces structure risk for various forms of suffering within a population
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Health-Wealth Gradient
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Ones health is strongly related to ones place in the social hierarchy
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Status Syndrome
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The disparity in health status and rates of premature mortality between the impoverished and the affluent
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Environmental determinants play a role in over ____ disorders from ___ groups.
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80, 3
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indoor air pollution most impacts
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women and children
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cause of indoor air pollution
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Use of solid fuel for cooking in poorly ventilated homes
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Cause of outdoor air pollution
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Use of fossil fuels, deforestation, bovine methane production, resulting in 100s of toxins
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Cause of unsafe water, sanitation, hygeine
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water, soil contaminated with chemicals, lack of latrines, poor hygiene, open defacation
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Undernutrition
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The condition in which not enough calories, or macronutrients/micronutrients, are ingested to maintain health
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Overnutrition
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Too much food energy or excess nutrients to the degree of causing disease or increasing risk of disease; a form of malnutrition
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Global Health Definition
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an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide
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Components of Health
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Physical, Social, Mental
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Components of equity
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Disparities, Inequities, Injustices
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What are the groups used to measure the global burden of disease?
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Group 1:Communicable, Maternal and Child Health, Nutritional Health. Group 2 : NCD, Neuropsychiatric, Cancer. Group 3- Injuries, intentional and unintentional
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Incidence
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The number or rate of new cases of a particular condition during a specific time.
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Prevalence
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The number or proportion of cases of a particular disease or condition present in a population at a given time.
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How does water leave from the bathtub?
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Death or Recovery
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DALYs
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disability adjusted life years
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DALY formula
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DALY = YLL + YLD
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Primary prevention
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Efforts to prevent an injury or illness from ever occurring.
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secondary prevention
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Efforts to detect disease in early stages so as to provide a more effective treatment—for example, screening.
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Tertiary prevention
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actions taken to contain damage once a disease or disability has progressed beyond its early stages, improve quality of life.
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Is a DALY cost effective?
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If it is less than or equal to 3 x a countries GDP per capita
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Global North
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A term used to refer to the world's wealthy, industrialized countries located primarily in the Northern Hemisphere
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Global South
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A term used to designate the less-developed countries located primarily in the Southern Hemisphere
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The G7
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Group of seven leading industrial countries: Canada, France, Germany, Italy, Japan, United Kingdom, United States
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LMIC
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low and middle income countries
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HIC
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high income countires
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SDI
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SocioDemographic Index, scale of 0 to 1
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BRICS
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Brazil, Russia, India, China, South Africa (major emerging economies)
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WHO health regions
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AMRO, AFRO, EMRO, SEARO, WPRO, EURO
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Where do most of the world's poor live?
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70% live in MIC
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Low income classification
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GNI per capita: 1,085 or less
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high income countries clasification
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GNI per capita: 13,206 or higher
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