intro to global health <3 (weaponization of medicine!)

Equity is giving everyone what they need to be successful. Equality is treating everyone the same.

infectious disease specialist (global health patterns)

neonatal conditions, respiratory infections

heart disease and AD

afghanistan, nigeria, russia, ecuador, us, italy, singapore

resource access, war, social upheaval, cultural factors, disease outbreaks

effects of infections are not equally felt

increased recognization of inequities in the post-pandemic world

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

as a notion (current global health patterns), as an objective goal (the achievement of good health for all people), applied global health (research, scholarship)

narrow idea of global health (environmental health, promotion of social justice + equity, monitoring, outbreaks)

many public health systems together (also think about the fact that it's much harder to create a system with multiple countries — think different environments, genetics etc.)

work at population level + focus on preventative measures, primarily try to address health disparities in underserved, low resource populations, multidisciplinary approaches and engage many stakeholders

No geography limitation, domestic or international issues are the same, broad view on health issues (not only infectious disease and maternal/child health), stresses importance of collaboration btwn high income and low income countries

1. colonial/tropical medicine : keeping white people alive (still prevalent today! think Madhukar Pai)
2. international health : privileged people (high income) trying to help people in low income countries
3. current global health : researchers from rich countries lead programs in low-income areas
4,. emerging field of global health : work increasingly led by researchers from low and middle-income countries

now, more in high income countries.... merge the two... bring more opportunities to low-income areas (this is true collaboration... think back to global health goals)

fixation on novel threats versus "boring" and expected threats, continue funding for successful medicine (think vaccine),

problems tend to be inherently global — everything is interconnected

state of poor health das ballz

frequency of occurrence of death among a defined population during a specified time interval

years of life lost because of premature mortality + years of healthy life lost due to disability

third world -- go **** yourself. don't say that
instead,
say low and middle income countries + high income countries

nigeria, singapore, russia, ecuador, italy, afghanistan, us (relative to size of economy)

tanzania, iraq, algeria, us, russia, uruguay

recognize knowledge present in community, provide requested resources especially knowledge databases and training opportunities, will likely translate into improved health outcomes, since community members tend to be trusted and have a better sense of local resources and needs

founded 1948 (post WW2), works to establish priorities, goals, and frameworks for health program globally

adopted in 1946, entered into force in 1948
-not merely the absence of disease
-standard of health is a fundamental right regardless of x,y, and z

194 member states currently, divided into six regions, headquarters are in geneva, switzerland
-director = dr. tedros adhanom ghebreyesus

two main funding sources:
-less than 1/4: country membership dues (calculated relative to wealth & population of country)
-more than 3/4: voluntary contributions from members and their partners

1978: alma-ata international health conference
1979: smallpox eliminated
2000: millenium development goals developed
2009: development of H1N1 influenza vaccine (in response to last pandemic)
2015: sustainable development goals adopted

-competing ideologies (verticalists (biomedical technical interventions) VS horizontalists (organization should help regions develop their own health infrastructure)
-too bureaucratic
-slow covid response

-create new international agreement to ensure future global responses
-better fund pandemic preparedness and response
-design and implement more effective systems for multisectoral health surveillance
-strengthen the WHO so it is not constrained to respond to future crises

-1978 international conference on primary health care, held in Alma Ata
-focus on primary healthcare for all people

2000

-increased investment in primary healthcare
-health inequities as "grossly unacceptable"
-individuals and communities should be involved in planning and implementing their healthcare
-government responsible

-too aspirational (no clear targets)
-important "social" and "universally accessible" and "essential health care"

funding never reached level needed... just words,, them saying shit

world leaders combat bad shit in the world, set 2015 as a goal to achieve it

-Seventeen goals adopted by the U.N. in 2015 to reduce disparities between developed and developing countries by 2030.
-169 specified targets

-holistic view of health
-remove access barriers
-decentralization of health services
-driven up by common needs
-

standard that recognize + protect the dignity of ALL human beings
no one can violate them

applying human rights frameworks to health

written by individuals of different legal and cultural backgrounds, considers all human rights as indivisible
-article 25 --> health is key part of the right to "an adequate standard of living"

EXPANSION IN 1966
-respect, protect, and fulfill the right to health
-free to control of one's body and non consensual medical testing and treatment (HeLa)

clean drinking water, nutritious food, adequate housing, well maintained [hi michali in the future] sanitation systems, access to healthcare, education and training opportunities for healthcare providers

Accessible, available, acceptable, good quality

-right to health is NOT the same as right to be healthy

what differences does health as a human right make? (ted talk)

-REACH
-parasite infection rates/intestinal inflammation levels
-all black population + low-socioeconomic status
-stool samples collected
-Feta calprotectin (FC)
-Found high FC levels in the population (may be negatively associated with household income)
-long lasting inflammation may lead to chronic health issues later in life

acute immune response to injury + infection, first line of protection

examples: helicobacter pylori
-spreads person-through-person

subfield of anthropology, how different factors shape ideas of health, illness, and disease

health and disease are cultural concepts, Culture affects health & disease by shaping the patterns,

the practice of judging a culture by its own standards; caveat, health patterns vary across cultures bc of geography & historical etc. differences

derived from old english word -- hale -- meaning whole
"state of complete social, psychological, and physical well-being."

-cultural perceptions of physical health/disease vary (what is considered "healthy" in one place may not be in another)
-certain shit might be helpful in some areas versus not in others (high blood cells in altitude versus sea level)

-biological changes that impair function
-biomedicine concept/objective

the subjective experience

sociological meaning, may require legitimation (ex: COVID test)

-proposed the three "bodies" that determine health
-individual --> physical + mental aspects
-social --> social factors may impact individual health (ex: inequities)
-body politic --> how social + political forces affect individual bodies within society

process of defining and treating human conditions, grants authority to healthcare providers
(ex: medicalizing births/C sections)

-immediate versus root cause of poor health and disease; -how (proximate) versus why (ultimate)
(ex: aids)

checking normal statistics for health; affect disease definitions

selection --> one is more likely to successfully reproduce bc of trait
stressor --> external stimulus that challenges human health
adaptation --> advantageous trait that evolved for a specific reason

define what exactly culture is:
"set of shared meanings, embedded in social institutions and an implicit shaper of individual beliefs and behavior"

different approaches in medical anthropology:
political economy of health --> power + wealth shape health
ethnomedical systems --> alternative medical systems based on practices of local sociocultural groups

termed the idea of structural violence:
violence (injury to people) embedded in political and economic organization (structural issue) which influences the practice of medicine (TB example old vs new)

outlined how medical anthropologists contribute to the global health field:

1. produce studies of health inequities
2. asses local impact
3. critique international health policies
4. investigate how international health development affects social relations

A disease that is caused by a pathogen and that can be spread from one individual to another.

A disease that cannot spread from one individual to another (ex: cancer); usually long duration

-"upon people study"
-the how and why all things disease
-relies heavily on statistics
-populations rather than individual

-historically tracked past populations around the world (mortality rates)
-john snow --> importance of tracing disease origins, sat clicking stats on shit disease from water (guy from video)
-william farr --> helped develop health and vital statistics records
-Ignaz Semmelweis --> hospital best practices for hygiene

see how old shit failed to make present shit better

-methods used to identify vulnerable groups by age, sex, race..etc (think statistics!)
-more collaborations

rate at which new cases occur over a given time (incidence --> prevalence --> deaths/cures)
leaking sand bag

total number or proportion of cases in a specific time period (incidence --> prevalence --> deaths/cures)
leaking sand bag

how a virus with a reproduction number spreads (whatever the number is, is how many people each person affects)

diseases that occurs infrequently and irregularly

aggregation of cases in certain area within a specific time period (may not be more than expected)

occurrence of more cases than expected in certain area within a specific time period

new cases spread rapidly through a population

extreme epidemic, over vast amount of geographic space

new cases occur at a relatively low but constant rate over time

proportion of people with a disease who die from it

a host population in which the pathogen lives and multiplies

spread between animals and people

used as a measure of overall quality of life within a population

set priorities for future work + assess progress and evaluate effectiveness

(1) identify disease cases, (2) calculate disease rates, (3) compare rates

not ethical
-little formalized research
-doesn't prioritize safety and privacy

voluntary informed consent, expected benefits must outweigh risks, researchers must avoid injuring subject

drafted in 1964 by the world medical association in helsinki finland
subject over society
"every subject should get the best known treatment."

-created by the national commission (1978)
-respect for persons
-beneficence
-justice

need consent for matrix

-often working with vulnerable populations that need protection

-community based participatory research
-actively involved community members
-ensures research produces info of interest
-think of Dr.Luz Claudia video w heels

importance in global health:
-make sure methods/intervention relevant to community
-think of Dr.Luz Claudia video w heels

global health is rooted in the consequences of European colonization

One population power over/take over another area to be used for their benefit; forced cultural shifts

-widespread slavery/indentured servitude
-forced movement of people
-

think christopher columbus but when same shit happened to him, he thought it was because of environment

saving white people in native land from disease that natives "gave" to the white people but not saving the natives from shit white people brought (think christopher columbus!)

invented term by imperial powers to reflect novel environments

classic example: study of malaria transmission by patrick manson

neo-colonialism --> present day colonialism & unequal parternships btwn high and low income countries

-industrial revolution in Europe led to decreased standards of living
-led to calls for national health reform

still focusing on financial gains over health for the sake of improving individual lives

set of economic policies implemented by gov. to control and reduce national debt (neoliberalism !)

-neo=new
-liberal=free from gov. intervention

-Father of communism
-allows economy to flourish and grow w out gov intervention

removing gov. market oversight

transferring a system from state to private control

individuals are assumed to act in their best interest and choose the options best suited to their needs

removing power from central state gov to local

people are more capable to figure out shit for themselves
"it's just noise." -vedant <3

set of economic policies implemented by gov. to control and reduce national debt (neoliberalism !)

-gets rid of debt
-less gov. spending

-difficult to raise taxes
-will not impact citizens equally
-cut down services

-healthcare funding is ineficient
-health is often viewed as an individual choice

-Bamako Initiative
-user fees used to pay for health resources
-healthcare usage decreases (unaffordable for people)

Structural Adjustment Policies — international institutions imposed them to ensure national debt repayment and economic restructuring

-circumstances in which people are born, grow up, live, work and age and the system put in place to deal with illness
-looks "upstream" (disease cause) rather than "downstream" (effects/causes)
-examples include income, education, workplace, environmental conditions

-studied death records in the UK & found that life expectancy increased before certain medical breakthroughs (ex: antibiotics)
-proposed population health influenced not just by healthcare, but by changes in living conditions

doesn't put a bandaid over a gunshot wound...
-considers root causes (much harder to do) of poor health (upstream issues) rather than resulting negative effects (downstream)

can be applied broadly or narrowly & account for 30-55% of health outcomes (more than healthcare use)
-shapes individual access to healthcare and other resources while also influencing living conditions and behavioral patterns

-lead ingestion link with substandard housing (low income) may result in reduced cognitive function & growth deficits
-pollution and allergens in low-resource communities exacerbate asthma
-living in "food desert" (not enough fresh produce)
-limited opportunities to safely exercise may increase risk for poor metabolic or cardiovascular health outcomes

1. Health history is very important
2. Health history includes more than just info about acute physical illness and managing symptoms. As a nurse interacts with patients, they must consider the whole person and their whole life
3. Focusing on prevention can save money, time, patient suffering, and can lengthen life

-"above" genetics
-newer subfield of genetic research
-epigenetic modifications affect gene expression (it's not only genes you inherit, but how your cells express them

-SDH can shape individual biology/health
-epigenetics is DNA methylation, histone modification, non-coding RNA

diet, stress, sleep, trauma, disease LIVING CONDITIONS!!

-caps on end of chromosomes (organized packages of DNA)
-when cell replicates, telomeres get shorter (when too short, they can no longer replicate effectively (senescence)
-telomere shortening impacted by lived experiences --> premature aging

-measure of cumulative damage on body in response to chronic stressful experiences and living conditions
-"wear and tear"

-longitudinal study of older adults with 7 year follow up mortality data
-used biological dysregulation to explain socioeconomic status differences in mortality
-allostatic load served as a measures of cumulative biological dysregulation across multiple systems

-complex, multifaceted, intersecting causal mechanisms that can be difficult to test
-can be difficult to obtain across multiple sectors
-time lags

improve living conditions, decrease inequitable distribution of resources (taxes), train healthcare workforce in SDH, raise public awareness, focus efforts on vulnerable communities

data collected at one point in time

data collected repeatedly over time

-less regulation = less protection of rights
-high cost of services make many options inaccessible

-social determinants of health as a key source of health disparities within and between populations
-discrimination or exclusion based on gender, race, ethnicity, religion...

the perception that one is worse off relative to those with whom one compares oneself

an objective measure of poverty, defined by the inability to meet minimal standards for food, shelter, clothing, or health care

A tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level

restore homeostasis

physiological response to perceived threat

1. Alarm
2. Resistance
3. Exhaustion

1. rapid response (epinephrine - release of adrenaline)
2. delayed response (release of cortisol)

long term repeated activation of acute stress

civil servants study, measured range of health conditions from large sample size (strength).
-lower employment grade --> high mortality and morbidity risks
-stress response as a biological pathway
-social inequalities are key health determinants