An Overview Of Global Health Flashcards
1
Q
Learning Objectives
A
- Planetary health
- One health
- Health and development
- International organizations concerned with health
- The MDGs and SDGs
- The World Health Organization
- Universal Health Coverage
- Health Inequalities
- Primary care
- The current status of global health
- Leading causes of death
2
Q
What is global health about today?
A
- Health is more prominent and influential as a global issue
- Globalized world provides complex backdrop to health improvement
- Factors affecting health across all aspects of political, economic, and social development
- Global health at the crossroads of agendas concerning security, economic development and social justice
- Cluster of trade, food, water, environment, finance and energy challenges relevant to health
3
Q
Define planetary health
A
“The health of human civilization and the state of the natural systems on which it depends”
4
Q
Describe one key health issue
A
- Antibiotic-resistant germs can spread through food, healthcare and the environment e.g. food and water
- This makes is harder to treat certain infections in animals and people.
- Vector-borne diseases are increasing with warmer temperatures and expanded mosquito and tick habitats.
- Diseases in food animals can threaten supplies, livelihoods, and economies.
- Contamination of water used for drinking and recreation can make people and animals sick.
5
Q
Why is it important to build a culture of health and well-being?
A
- Building a culture of health to improve population health, well-being and equity means:
- Making health a political marker of a successful society
- Making health a shared value; fostering cross-sectoral collaboration to improve well-being;
- Enhancing bottom-up, participatory approaches; creating healthier and more equitable communities;
- Such a “culture of health” would be mutually reinforcing with a culture of sustainable behaviours (e.g., environmental, economic and health benefits of walking and cycling).
- This also needs to be integrated by and linked to structural environments that enables the choice of healthy behaviours and protect and promote health e.g., safe walking and cycling routes, green spaces, clean air, safe workplaces.
6
Q
What is meant by development?
A
- Development is not purely an economic phenomenon but rather a multi-dimensional process involving reorganization and reorientation of entire economic and social system
- Development is process of improving the quality of all human lives with three equally important aspects. These are:
- Raising peoples’ living levels, i.e. incomes and consumption, levels of food, medical services, education through relevant growth processes
- Creating conditions conducive to the growth of peoples’ self-esteem through the establishment of social, political and economic systems and institutions which promote human dignity and respect
- Increasing peoples’ freedom to choose by enlarging the range of their choice variables, e.g. varieties of goods and services
7
Q
List the institutional elements relevant to development
A
- Governance
- Public representation and elections
- The rule of law
- Independence of judiciary
- Governmental regulatory capacity
- Taxation
- Economy
- Customs
- Monetary policy
- Banking
- Protection of private property and contractual rights
- Employment creation
- Investment in social infrastructure
- Health
- Education
- Social protection
8
Q
What is the Millennium Development Goals (MDGs)?
A
- United Nations Millennium Declaration (September 2000)
- Eradicate extreme poverty and hunger
- Achieve universal primary education
- Promote gender equality and empower women
- Reduce child mortality
- Improve maternal health.
- Combat HIV/AIDS, malaria, and other diseases.
- Ensure environmental sustainability.
- Develop a global partnership for development.
9
Q
What has been achieved from the MDGs so far?
A
- Poverty as measured by the number of people living on less than $1.25 per day has declined by more than half
- Under 5 mortality decreased at an annualized rate of 2% from 1990 to 2000, and 3.5% from 2000 to 2013
- Maternal mortality decreased slowly at an annualized rate of 0.3% from 1990 to 2003, and from 2.7% from 2003 to 2013.
- Global mortality from HIV/AIDS and malaria increased from 1990 to 2005, but then declined substantially
- Development assistance for health increased from $11.6 billion in 2000 to $33.1 billion in 2012.
10
Q
How many SDG goals are there?
A
- There are 17 goals altogether
- SDG #3 is one of the most important ones
- It’s to Promote healthy lives and well-beings for all at all ages
11
Q
Provide the World Health Organisation’s definition of “Health”
A
Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity
12
Q
What is the World Health Organisations triple billion target?
A
- Universal Health Coverage
- Health and Well-being
- Health Emergencies
13
Q
Define Universal Health Coverage (UHC)
A
(UHC) is defined by the World Health Organization (WHO) as ensuring that all people have access to promotive, preventive, curative, and rehabilitative health services of quality, when and where they need them, without financial hardship.
14
Q
Define Well being
A
The state of being comfortable, healthy, or happy
15
Q
Provide examples of elements of well-being
A
- Environmental quality
- Social connections
- Personal security
- Civic engagements and governance
- Jobs and earnings
- Income and wealth
- Health status
- Housing
- Subjective well-being
- Work-life balance
- Education and skills
16
Q
Provide examples of elements of happiness
A
- Social support
- Life expectancy
- Freedom to make life choices
- Generosity
- GDP per capita
- Perceptions of corruption
17
Q
What is the world health organisation?
A
- Specialized Agency of the UNITED NATIONS
- World Health Assembly (194 members). Meets once a year (May)
- Executive Board (32 members). Meets twice a year (January and May)
- Secretariat (7000 staff) Head: Director-General
18
Q
List the core functions of the WHO
A
- Providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
- Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;
- Setting norms and standards and promoting and monitoring their implementation;
- Articulating ethical and evidence-based policy options;
- Providing technical support, catalysing change, and building sustainable institutional capacity; and
- Monitoring the health situation and assessing health trends.
19
Q
What are the changing expectations of health systems pressures for reform?
A
- Demography-the increasing proportion of the old and the very old
- Co-morbidities amongst the old
- Technological advances-diagnostic, therapeutic, pharmaceutical
- Raising population expectations for quality care
- Litigation pressures
- The increasing involvement of public institutions and financing
- Pressures for quality, efficiency and cost-control
20
Q
List the different mechanisms for the public funding of care
A
- “Single payer” tax-based general revenues-provide care directly through state-owned and run facilities e.g. the UK, Canada
- Possibility of earmarked (hypothecated) health tax
- Social insurance financing e.g. Germany, France,
- Individually based insurance e.g. United States (see Affordable Care Act)
- Support health care consumers directly through “vouchers”
21
Q
What is the problem when it comes to inequities?
A
- Inequities are killing people on a “grand scale” reports WHO’s Commission 57
- A child born in a Glasgow Scotland suburb can expect a life 15 years shorter than another living only 5 miles away.
- A girl in Lesotho is likely to live 26 years less than another in Japan.
- Maternal mortality ratio (maternal deaths per 100,000 live births) in Sweden is 4, in Afghanistan 638.
- Biology does not explain any of this. Instead, the differences between - and within - countries result from the social environment where people are born, live, grow, work and age.
- Inequities driven by differences in the distribution of “power, money and resources”.
22
Q
What are the upstream approaches to health promotion?
A
- Structural policy responses to social and economic determinants
- Tackling health destructive environments e.g. obesogenic environments
- Promoting health literacy
- Providing health information and education
- Health promotion and empowerment
- Making healthy choices easy choices
- “Nudge” type policies
- Regulation and legislation
23
Q
Describe the structural approaches to health improvements (PART 1)
A
- Structural interventions refer to public health interventions that promote changes in the structural drivers of people’s lived experience
- Increasing health equity requires changes in the distribution of “power, money and resources” (Marmot)
- E.g., political, social, economic and economic factors e.g., autonomy; employment, income; housing; environmental circumstance; stigma, and discrimination around gender, race, ethnicity, sexuality
- Intersectionality-these factors operate together in complex ways to reduce health status
24
Q
Describe the structural approaches to health improvements (PART 2)
A
- Increasingly structural determinants are integrated with social determinants of health as “social and structural determinants of health (SDOH)”
- Thinking driven by recent life expectancy falls in USA and UK
- Shift from traditional public health practices to broader approaches that engage the larger socioeconomic thinking in which health exists
- Disease and conditions are part of, and exist within, a larger set of social and physical factors
25
Q
Describe the structural approaches to health improvements (PART 3)
A
- SDOH acts as bridge between reducing health disparities and achieving health equity
- Tackling SDOH requires multi- and cross-sector approaches
- Focus both on:
- Environmental factors targeting a particular health issue
- Enhancing access to resources and power for vulnerable populations without voice and influence
- Needs excellent evidence and a strong ethical framework
26
Q
Describe the structural approaches to health improvements (PART 4)
A
- Needs political commitment, and ideally the active agreement of the individuals and communities affected
- Consider the autonomy of the people and communities affected, otherwise may be criticized as patronising and “nanny statist”
- Avoid “victim blaming”
27
Q
What are the challenges to public health action? (PART 1)
A
- Lack of political commitment to public health
- Predominance of medical model in policy thinking
- Political and managerial preoccupation with health care services, as well as strong vested interests
- Poor multisectoral thinking, and particularly involvement of local government
- Unwillingness to move policy “upstream” to health promotion and disease prevention
28
Q
What are the challenges to public health action? (PART 2)
A
- Worry that too little evidence underpins public health policies and actions
- “Decisionless decision making” and “symbolic posturing”
- Too little attention to politics and practicalities of change
- Unsympathetic political, social, cultural and religious values
- “Big government and libertarian concerns”
29
Q
What are the new public health perspectives after Covid 19?
A
- Enhanced investment in public health
- Embrace systems approaches, to deal with complexity, uncertainty and ambiguity
- Strength public health infrastructure
- Transform the public health workforce with skills and competencies to advance change
- New public health approaches
- Planetary health e.g., climate change
- One-Health Human, animal and environmental health considered together
- Culture of health and well-being, with healthy behaviours the norm
30
Q
Define Primary care
A
“The term primary (medical) care ….stands for those medical services to which people have direct access and in contrast with secondary care services normally reached by referral (meaning second or tertiary level specialist services”
31
Q
What are the ideal roles of Community Health Centres?
A
- The prevention and treatment of common diseases, injuries, basic emergency services;
- Referrals to and coordination with other levels of care that include
- Hospital and specialist care,
- Primary mental health care,
- Palliative care,
- Health promotion,
- Healthy child development,
- Primary maternity care and
- Rehabilitation services;
32
Q
What are the ideal roles of Community Health Centres?
A
- On-call services around the clock;
- Availability of essential drugs;
- Laboratory services;
- Disease screening for communicable and non-communicable diseases;
- Tele-health services via real-time telecommunication, tele-consultation, information dissemination, and video conferencing support amongst physicians and different healthcare professionals.
- Supervise the Community Health Posts
33
Q
What is the oft-seen situation in LIC’s?
A
- Health status is unacceptably low across in many countries, in particular in Sub-Saharan Africa but pockets of ill-health and extreme poverty in all regions
- Socio-economic status of great importance to health experience
- Effective prevention, cure or treatment and relevant technologies are well known for most of the burden of disease
- Necessary focus of primary health care, and promotion and prevention
- At the centre of this crisis is the failure of health systems
34
Q
What are the key issues in Limited income countries?
A
- Finance: chronic under-investment
- Human resources: the acute crisis in Africa
- Information deficiencies
- Shortages of vital commodities and supplies
- Poor health governance
- Equity issues: access to quality care not only to the elites
- The aid architecture debate in health: horizontal and/or vertical
35
Q
Why are NCDs a development issue?
A
- Effect on poverty and human development
- Catastrophic expenditures for treatment, high out-of-pocket expenditure and loss of employment
- Impact on productivity
- Effect on health budgets, social care costs, and national economies
- Care and treatment required
- NCDs estimated to cost developing countries between 0.02% and 6.77% of GDP
- Each 10% rise in NCDs associated with 0.5% lower rate of annual economic growth
36
Q
List some list some behavioural determinants of NCDs
A
- Risk factors
- Smoking
- Excess alcohol
- Diet (high in fat, salt, sugar; low in fibre, fruit &veg)
- Physical inactivity
