Lecture 2

The interconnected factors that determine an individuals health status. These determinants include personal and inborn features, socioeconomic status, culture, environment, educational attainment, health behaviors, childhood development, access to care, and government policy.

d) All of the above

Different ways to assess population health. Health measures include data on the population, vital statistics, health statistics, and statistics about health services

Collecting data on the population is one type of health measure. This includes the number of people in the population, as well as the age, sex, ethnic origin, and urbanization of the population

One kind of health measure that includes Live births and Deaths (including infant deaths) by sex, age, cause

One kind of health measure that includes morbidity by type, severity and outcome, data on reportable diseases, and tumor registries

A kind of health measure that includes number and type of facility, number and qualification of health professionals. It also includes services and utilization rates (how often this services are used) and cost and payment mechanisms

Vital registration systems record births, deaths, and causes of death. An accurate system is key to having quality data on a population. Many low- and middle income countries lack a vital registration system. There are often cultural barriers to timely vital registration.

• Low-income :$1,035 or less
• Lower middle-income :$1,036 to $4,085
• Upper middle-income :$4,086 to $12,615
• High-income : $12,616 or above
The WB Income Groups are based on gross national income per person

a) Finding which diseases people suffer from
b) Determining the extent to which the disease causes death or disability
c) Carrying out disease surveillance
But... To perform these functions, it is important to use a consistent set of indicators in order to make comparisons

Infant mortality rate
life expectancy at birth
maternal mortality ratio
neonatal mortality ratio
Under-5 mortality rate (child mortality rate)

I actually don't know this so this would be useful

The number of deaths of infants under age 1 per 1,000 live births in a given year

The average number of years a newborn any could expect to live if the current mortality trends were to continue for the rest of the newborn's life

The number of women who die as a result of pregnancy and childbirth complications per 100,000 live births in a given year

The number of deaths of infants under 28 days of age of age in given year per 1,000 live births in that year

The probability that a newborn baby will die before reaching the age 5, per 1,000 live births

Free primary & secondary education led to higher literacy rates. The very effective use of central programs in family planning, maternal & child health (ex. promoting breastfeeding), and universal immunization. The role of women in society (could inherit land)

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

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

Number of new cases of a disease per 100,000 people, over a defined period of time

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

Death

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

• The sum of years lost due to premature death (YLLs) and years lived with disability (YLDs). DALYs are also defined as years of healthy life lost
• A health-gap measure
• Indicates losses due to illness, disability and premature death in a population

Measure of quality adjusted life years gained by an intervention → $$$ /QALY

1. Setting healthcare priorities
2. Research priorities
3. Identifying disadvantaged groups
4. Evaluating interventions

• People in much of the world are living longer than before and dying at lower rates than earlier
• As people live longer, there is an increase in the years people live with disability
• The burden of disease is predominantly noncommunicable in all World Bank regions, except sub-Saharan Africa

• Rural people will be less healthy
• Disadvantaged ethnic minorities will be less
healthy
• Females will suffer from their weak social positions
• Poor people will be less healthy
• Uneducated people will be less healthy

an aspect or personal behavior or lifestyle, 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

• Current world population is 7.2 billion and growing
• Majority of population growth will occur in low- and middle-income countries
• This growth will put substantial pressure on the environment and infrastructure

ratio between the number of people that are 15-64 years of age, compared with the number that are 65 years of age or older

In the last decade, most of the world's population has lived their entire life in urban areas
• People are continuing to move from rural to urban areas, especially in low- and middle- income countries
• There is enormous population pressure on urban infrastructure, such as water and sanitation

• Highest income countries: low fertility, often declining populations, aging populations
• Lowestincomecountries:relativelyhighfertility, growing populations

• Shift from pattern of high fertility and high mortality to low fertility and low mortality
• Mortality declines with better hygiene and nutrition
• Population grows with gap between births and deaths
• Fertility declines
• Population growth slows and older share of population increases as births and deaths equalize

• Shift from burden of disease dominated by communicable disease to burden of disease dominated by noncommunicable disease
• Low-income countries are going through it now
• First, and historically: high and fluctuating mortality, related to very poor health conditions, epidemics, and famine
• Then, progressive declines in mortality as epidemics become less frequent
• Finally, further declines in mortality, increases in life expectancy, and the predominance of noncommunicable diseases
• The pace of this transition depends on factors related to the determinants of health

• Improvementsinraisinglifeexpectancyand improving health not uniform across countries
• LifeexpectancyinSouthAsiaandsub-Saharan Africa lags behind other regions
• Life expectancy in Europe and Central Asia changed little from 1990-2011, related to break- up of Soviet Union
• LifeexpectancyinEastAsiaincreased dramatically, partly due to rapid economic growth

• Economiesoflow-incomecountriesneedtogrow in order to invest in health
• Impactofeconomicdevelopmentwilldependon how equitable growth is across population groups and investments in areas that improve health such as water, sanitation, and education

• Developmentofvaccines,drugs,anddiagnostics
• Country's ability to adopt these changes will determine their effect on health

• Impact not entirely clear
• Possible migration from places that become
uninhabitable
• Adverseweather
• Possible change in populations of disease vectors

• Necessary for long-term gains in health
• Instability causes illness, disability, and death, as well as breakdown of infrastructure and services that leads to further health issues
• Instability has impeded achieving the Millennium Development Goals

• Occurrenceandimpactdifficulttopredict
• Pandemicflucouldhaveamajorimpactinthe
future
• Drug resistance outpacing our ability to produce safe and effective drugs could also have a substantial impact on the burden of disease

• Difficult to predict but can use models to project
• Substantialchangesprojectedto2030
• Low- and lower-middle-income countries will shift away from communicable disease
• Causes associated with aging will increase in importance
• Mental health issues will increase in importance for all income groups

• Health usually increases as national income increases
• Some countries have achieved higher life expectancies than their incomes would predict
• This is possible with investments in the "best buys" such as nutrition, education, good hygiene, and low-cost services that have a high impact such as vaccination programs and TB control