18. International Health and Intervention Strategies 12/4

Question 1

GLOBAL HEALTH

Answer 1

Common health problems across borders
Health disparities
Between countries
 Within countries
 Global responsibility

Question 2

COMMON PROBLEMS ACROSS BORDERS (1)

Answer 2

Pandemics; e.g. HIV/AIDS, SARS, H5N1, cholera
Environmental issues; e.g., Songhua/Amur River, Nov 2005
Surveillance and control; e.g., H5N1, H1N1
Immunization programs (polio eradication)
Regulations; e.g., inter-country control of toxic/infectious materials, air pollutants (e.g., crop burning)

Question 3

COMMON PROBLEMS ACROSS BORDERS (2)

Answer 3

Migration; e.g. international migrant groups
Refugees
War
Global warming
Natural disasters (e.g., tsunamis, earthquakes)
Food safety

Question 4

HEALTH DISPARITIES

Answer 4

Within countries
Gender
Ethnic minorities
Economic
Educational
Health and health care access
Between countries
Developing countries; e.g., Bangladesh, Laos
Transitional countries; e.g., China, Brazil
Developed countries; e.g., USA, Europe, Australia

Question 5

THE LEADING CAUSE OF POOR HEALTH GLOBALLY IS

Answer 5

POVERTY

Question 6

Water Sources and Usage

Answer 6

Nearly 97% of the planet’s water is salt water in seas
and oceans
Close to 2% of Earth’s water is frozen in polar ice
sheets and glaciers
Only a fraction of 1% is available for drinking,
irrigation, and industrial use
Agriculture accounts for 70% of all water use

Question 7

Lack of Clean Water and Safe Waste Disposal

Answer 7

The average American uses a hundred gallons of water at home every day
In developing countries, nearly one billion people worldwide have no access to clean water
2.5 billion people (40% of world’s population) have no safe way to dispose of human waste

Question 8

Dirty Water and Lack of Hygiene

Answer 8

Dirty water and lack of a toilet and proper hygiene kill 3.3 million people around the world annually, most of them children under age five

Question 9

Reasons for Lack of Clean Water

Answer 9

Climate (drought, deforestation, climate
changes) and dropping water tables worldwide
(unsustainable rate of water use)
Poverty (inability to build wells or to afford
piped water or water purification tablets if
available)
Rural dwellers- remote, sparsely populated,
drought-stricken villages of the world are least
likely to be reached for water provision,
education, etc.
Pollution

Question 10

Waterborne Illnesses and Parasites

Answer 10

According to the World Health Organization, the incidence of diarrheal diseases (2,533 million cases) topped all other diseases in the Southeast Asian (SEARO) and Western Pacific (WPRO) regions in 2004, accounting for 72.8 million disability-adjusted life years (DALYS) - 4.8% of all DALYS worldwide due to both infectious and non-infectious diseases

Question 11

Diarrheal Diseases (1)

Answer 11

According to the World Health Organization in 2005, 1.8 million people died of diarrheal diseases, nearly 70% of whom were young children
Worldwide, diarrheal diseases are the third leading cause of mortality and morbidity (exceeded only by lower respiratory infections and cardiovascular diseases)

Question 12

Diarrheal Diseases (2)

Answer 12

Oral-fecal route of infection (contaminated water and food)
Leads to rapid dehydration and inability to absorb nutrients from food; survivors may have impaired growth and development, malnutrition, long-term GI disorders, reduced immunity

Question 13

Steps to Reduce Waterborne Diseases

Answer 13

Safe disposal of human waste (latrines)
 Hand washing
 Education about sanitation
 Piped treated water
 Food safety

Question 14

Politics of Water

Answer 14

The United Nation’s General Assembly voted to make water a basic human right. But 41 countries, including the United States, opted out, saying they were waiting for more data!

Question 15

THE EPIDEMIOLOGIC TRANSITION

Answer 15

The worst of both worlds
Infectious diseases persist
Diseases of affluence (e.g. cardiovascular) increase

Question 16

SETTING PRIORITIES IN DEVELOPING COUNTRIES

Answer 16

e.g., HIV vs. malaria

numbers, severity, impact

Question 17

Public Health Intervention Strategies

Answer 17

Biologic; e.g., vaccines
Behavioral – individual, community
Political – lobbying
Structural – laws and regulations

Question 18

Biological Strategies

Answer 18

Immunizations
Prophylaxis
Improved nutrition
Mother and child health programs
Microbicides
Improved sanitation
Improved water quality (including oceans, etc.)

Question 19

Behavioral Strategies

Answer 19

Promote good health habits; e.g., exercise, diet
School health programs
Promote immunization programs and other interventions
TV, radio and media public health messages
Promote safe sexual behavior
Incentives

Question 20

Political Strategies

Answer 20

Lobby legislators
Promote healthy, safe communities
Promote and enforce appropriate health laws and regulations
Promote universal access to health care, especially preventive care
Improve standard of living (e.g., housing)
Reduce poverty and inequalities

Question 21

Structural Strategies (1)

Answer 21

Monitoring and surveillance of diseases and health hazards
Safe drinking water
Safe waste disposal
Regulations to protect workers
Regulate driving (e.g., speed limits, auto and road safety)
Legislation and regulations for safety; e.g., occupational, vehicular, roads, etc.

Question 22

Structural Strategies (2)

Answer 22

Laws to ban smoking, require helmets, etc.
Regulate air and water quality (ocean, lakes, waterways)
Enforcement of health and safety laws
Establish safe communities and parks
Establish universal medical access
Taxation (e.g., cigarettes, alcohol)
Regulation of drugs and food (FDA)

Question 23

Using Anxiety as a Public Health Tool

Answer 23

Level of Anxiety

Too little-no action
Sufficient -appropriate action
Too much -fatalism and no action

Question 24

Isolation and Quarantine

Answer 24

Isolation of cases (e.g., SARS, Ebola)
Quarantine of exposed individuals (e.g., yellow fever, SARS, H1N1)
Culling (murder) of diseased flocks, herds (e.g., H5N1)

Question 25

Eradication

Answer 25

``` Eradicated: Smallpox Dracunculus (close) Targeted: Polio? Measles? ```

Question 26

Improved Standard of Living (1)

Answer 26

Less crowding decreases respiratory spread (e.g., TB) Better quality of food (fresh, healthy, and uncontaminated) decreases gastrointestinal and chronic diseases Year-round access to vegetables and fruit (eliminates vitamin deficiency diseases such as beri beri)

Question 27

Improved Standard of Living (2)

Answer 27

Refrigeration allows fewer preserved foods (salted or chemically modified), which may reduce some cancers Improved nutrition Promotion of education Reduced poverty Better methods of primary, secondary, and tertiary prevention (structural, behavioral, and medical)

Question 28

Objectives of Vaccination

Answer 28

Prevent infection Prevent disease Prevent transmission

Question 29

Requirements for a Vaccine

Answer 29

Must be safe Should be easy to administer (e.g., nasal spray, oral) Must elicit a protective immune response Must stimulate both humoral and cellular immunity Must protect against all variants of the agent Must provide long-lasting immunity Must be practical to produce, transport and administer (e.g., lyophilized)

Question 30

Vaccines - Sociopolitical Considerations

Answer 30

Cost of development – federal government and/or private industry? Responsibility for liability – federal government, industry, or insurance companies? Priorities for funding and distribution of vaccine Appropriateness and acceptability of vaccine for target population(s)

Question 31

Primary Issues for Vaccine Evaluation

Answer 31

Evaluation/testing procedures (animal models?) Level of efficacy against infection Level of efficacy against transmissibility Level of efficacy against clinical disease Acceptability

Question 32

Innovative Strategies

Answer 32

Smallpox eradication(search and contain)

Question 33

Popular Opinion Leader Model(targeting of natural leaders in a social group)

Answer 33

Examples Gay bars Markets in Fuzhou, China Dormitories in St. Petersburg, Russia

Question 34

Community Intervention

Answer 34

Getting the community to recognize the problem Getting the community to accept responsibility and implement change Changing community norms (e.g., smoking, condoms) Co-opt business marketing strategies

Question 35

Legislative Change

Answer 35

Requires political will To be effective, also requires enforcement (e.g., smoking prohibition, seat belt laws, maximum highway speeds, safety regulations, pollution laws) Requires constant vigilance (e.g., attempts to repeal of motorcycle helmet laws, weaken pollution laws, and environmental protection etc)

Question 36

Need for Evaluation of Intervention Strategies

Answer 36

Some logical interventions are unsuccessful Continuation of ineffective interventions prevents implementation of other potentially successful interventions, and wastes money and personnel Elements of evaluation

Question 37

Elements of Evaluation (1)

Answer 37

Are the appropriate risk groups and areas identified and targeted (e.g. HIV/AIDS vaccine)? Is the intervention strategy culturally and economically appropriate and acceptable to the target group and the community? (e.g., township health workers in China and changes in blood collection strategy)

Question 38

Elements of Evaluation (2)

Answer 38

How is the effectiveness of the intervention strategy measured (process variables (e.g., number of vaccine recipients) vs. outcome (e.g., reduction in incidence of disease)? Is the existing public health system and community structure a part of the evaluation scheme? Is the strategy cost-effective? Can the intervention be scaled up?

Question 39

TAKE-HOME MESSAGES

Answer 39

Sleep 7-8 hours per night Eat breakfast Brush your teeth Take the bus, save the environment Cultivate a social network, promote your community Exercise regularly, use the stairs, not the elevator Drive safely Don’t do it – BUT if you must, wear a condom Be kind to your professor!

Question 40

COmmon problems across borders pandemics

Answer 40

HIV/AIDS, SARS, H5N1, Chloera

Question 41

Water sources and usage

Answer 41

nearly 97% of the planet's water is salt water in seas and oceans. Close to 2% of earth's water is frozen in polar ice sheets and glaciers. Only a fraction of 1% is available for drinking, irrigation, adn industrial use. Agriculture accounts for 70% of all water use

Question 42

Lack of clean water and safe waste disposal

Answer 42

The average american uses a hundred gallons of water at home every day In developing coutnries, nearly one billion people worldwide have no access to clean water 2.5 billion people (40% of world's population) have no safe way to dispose of human waste

Question 43

Pandemics

Answer 43

HIV/AIDS, SARS, H5N1, cholera, polio in Syria

Question 44

Environmental issues;

Answer 44

Songhua/Amur River, Nov 2005 china split mercury into the river and that river goes into Russia. All the factories had to close water supplies because it was contaminated.

Question 45

Surveillance and control

Answer 45

H5N1, H1N1

Question 46

Regulations;

Answer 46

e.g., inter-country control of toxic/infectious materials, air pollutants (e.g., crop burning)