IR 339 Midterm

Populations
- Public health professionals work to understand population health - surveillance and research, distribution, understand causal relationships between exposures and outcomes.
- Prevention and health promotion
Cyclical process - monitor community health, investigate, inform, mobilize, develop policies, enforce laws, provide care, evaluate, research.
- Environment and human behavior interventions
- Social sciences
- Observation studies w/ control and cohort studies

Overly state centric
Referred to problems of colonies/developing countries
Focus on tropical diseases

Transition from International Health to Global health after series of WW1, WW2, Cold War, post 9/11
Need to pay attention to non-state actors
Recognition of health problems in developed countries
Novel and chronic disease

The study of the cause of disease or death

The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems

Focuses on the "who, what, when, and where" of an event
What = health issue of concern
Who = person/people
Demographics
Modifiable and unmodifiable risk factors
Where = place
Geographic extent and variation
When = time
Used when little is known about the disease
Relies on pre-existing data
Illustrates association/patterns

Focuses on the "why and how" of an event
Used once aspects of disease are known
Relies on new data
Evaluations causality of associations/patterns

Individuals
Diagnosis and Treatment
Clinical Interventions
Well-established profession
Clinical sciences
Experimental studies w/ control groups

Populations = burden of disease (ie., malnutrition in Global South vs. obesity in Global North)
Action = immunizations, ORT, bed nets (vertical approach)
Cooperation = climate change, infectious disease control
Equity = neglected tropical diseases, health systems (horizontal approach)
Security = bioterrorism, HIV/AIDS

Targets social and economic policies affecting health

Targets risk factors leading to injury/disease (safety belt laws or vaccinations)

Prevents injury/disease once exposure to risk factors occurs but still in early, "preclinical" stage

Rehabilitating persons with injury/disease to reduce complications (vocational rehab to retrain workers after injury)

Epidemiologic transition = a reduction in global death rates
Fertility transition = a reduction in global birth rates
Demographic transition = increasing global population
Nutrition transition = shift from a stage where undernutrition is prevalent to an end stage where obesity is the major health issue

Freedom from Fear
Freedom from Want
Freedom from Indignity

the existence of strong and resilient public health systems that can prevent, detect, and respond to infectious disease threats, wherever they occur in the world.

A risk factor for global health security
Cross-border infectious disease spread

The WHO
Horizontal, community-based approach
Addressing the root causes/issues with health
Alma-Ata Conference of 1978
Themes:
Appropriate health technology
Ending medical elitism
Health as a tool of development
Challenges:
Needs more defined, realistic goals
Rise of neoliberalism killed this

Rockefeller Foundation and UNICEF
Vertical, top-down approach
Cost-effective
Fast delivery
Quick results
GOBI-FFF
Challenges:
Disease-specific (also could be an advantage)
Does not address underlying issues
Donor-driven (although easier for funding, not community based)

Vertical:
Disease specific
Top-down approach (donor driven)
Easier for funding
Ex: Selective Primary Healthcare (GOBI and GOBI-FFF)
Horizontal:
More comprehensively addressing underlying issues
More abstract
Ex: Primary Healthcare

The approach:
Growth monitoring
Oral Rehydration Therapy
Breastfeeding
Immunizations
FFF Compromise:
Female literacy
Food supplementation
Family planning

Measure of overall disease burden, expressed as the cumulative number of years lost due to ill-health, disability, or early death

Encompasses the various deprivations experienced by poor people in their daily lives
poor health
lack of education
inadequate living standards
disempowerment
poor quality of work
threat of violence
living in areas that are environmentally hazardous

The interconnectedness of social categorizations (race, sex, class, etc.) and how it relates to degree of privilege (creates interdependent and overlapping systems of disadvantage and discrimination)

P - Place
R - Race/ethnicity
O - Occupation
G - Gender
R - Religion
E - Education
S - Social Capital
S - Socioeconomic positions
Plus:
Age
Disability
Sexual Orientation
Vulnerable Groups

Structural Determinants:
- Socioeconomic position
- Education
- Gender
- Ethnicity
- Social class
- Unequal distribution of material and monetary resources
Socioeconomic and Political Context
- Governance
- Policies
- Values
- Exposure, vulnerability, and outcome
Intermediary Determinants:
- Material circumstances
- Psychological factors
- Behaviors/biological factors
- Social cohesion and capital

Social determinants create health inequities
How can we change these determinants?
Not easy
Identifying -> taking action
All sectors and levels

Refers to proportion or rate of persons to develop a condition at or during a particular time period

Refers to proportion of persons who have a condition at or during a particular time period

Water:
- Access to adequate daily supply of water
Function of:
- Quality
- Reliability
- Quantity
- Proximity
- Cost
Hygiene:
Practice of maintaining cleanliness in order to prevent disease
Sanitation:
- Safe disposal of human excreta
- Open defecation free = all members are using -designated toilet facilities and no one is defecating outside
- People who do not have access to improved water and sanitation -> increased risk for infectious diseases spread through fecal matter contact

MDGs: 8 goals, 21 targets, 60 indicators
Criticisms of MDGs:
Too narrow / ambitious
Do not address the root causes of poverty
Many achievements not related to UN endeavors
"Built In" Success
Failures = regionally & certain goals
Created by group of elite UN diplomats

SDGs: 17 goals, 169 targets, 230 indicators
"3 Es" of sustainability:
equity, economy, environment
"5 Ps" of sustainable development:
people, prosperity, planet + peace, partnership

"Zero" goals
Universal goals
More comprehensive
Inclusive goal setting
Distinguishing hunger and poverty
Peace building
Data Revolution
Quality education
Gender integrated throughout
Sustainability explosion