Exam 1 Flashcards
What is the Global North
Northern, more affluent countries
What is the Global South
Southern countries with more marginalized economies (different way to say developing or 3rd world country)
What is meant by Global North paternalism
Most studies, scientific papers, and books are created by the Global North (enables them to feel superior or pass judgement)
What is health according to WHO
A state of complete physical, mental, and social well-being and not merely the absense of disease or infirmity
What 3 things does public health focus on
Prevention of disease, populations not individuals, and multiple determinants of health
What does global health focus on
Transational issues, determinants, and solutions, interdisciplinary collaborations, and population-based prevention and individual clinical care
Is global health different from public health
Not neccisarily
Why is global public health a geography course
It thinks critically about place, space, scale, how people interact with all their environments, and where, when, how, and why diseases are prevalant
What is a biosocial apprach to health
Intertwining reality of biological and social factors in health, how they interact with each other and influence health and disease –> Focuses on interactions
What are the 6 multiple determinants of health according to Healthy People 2020
Behavior, biology and genetics, physical factors, social factors, health sevices, and policies (health or otherwise)
Which determinant/risk factor did not play a role in Type 2 Diabetes among Pima people in Bad Sugar
Genetics
What is the social gradient of health
Wealthier individuals have better health, the opposite is also true
What are health outcomes
A change in health status of an individual or group (e.g. death, diagnosis, symptoms)
What are structural determinants of health
Policymaking, physical factors, health services, and social factors
What are individual determinants of health/risk factors
Behaviors and biology/genetics
What are examples of biological and genetic determinants
Age, biological sex, genetics (e.g. cystic fibrosis), and pre-existing health conditions
What are behavioral determinants
What decisions a person makes (did they choose to eat healthy, exercise, etc.)
What are examples of social factors and determinants
Social norms, education level, race, religion, socioeconomic status, discrimination
What are physical factors and determinants
Natural (weather) and man-made (infrastructure, access to hospitals, etc.)
What are examples of determinants related to health services
Shortage of healthcare workers, physical access to healthcare, economic access to healthcare, and quality of care
What were biological/genetic determinants from Collateral Damage (TB in Marshall Islands)
Stress lowering immune system, malnutrition, frequency of diabetes, high BP, and exposure to radiation
What were biological/genetic determinants from Bad Sugar (Diabetes in Pima)
Stress
What were behavioral determinants from Collateral Damage (TB in Marshall Islands)
Not going to hospitals or taking meds as prescribed, lack of handwashing, lack of proper nutrition, moving to Ebeye
What were social determinants from Collateral Damage (TB in Marshall Islands)
Living in poverty, cultural breakdown, discrimination, jobs/employment, have to have permits to get to clean water
What were physical determinants from Collateral Damage (TB in Marshall Islands)
Overcrowding, no indoor bathrooms, lack of infrastructure, geographically isolated, radioactive fallout
What were health service determinants from Collateral Damage (TB in Marshall Islands)
Driving around to give meds, not a lot of access to healthcare, not adequate sanitation, reactive approach, disparities between islands
What were policymaking determinants from Collateral Damage (TB in Marshall Islands)
Policies on Kwaljalen that forced people out of their homes and onto a new diet, people tested on w/o consent (radioactive fallout)
What were behavioral determinants from Bad Sugar (Type II Diabetes in Pima people)
Not trying to exercise, lack of self efficacy, didn’t track BP, choosing to eat poorly
What were social determinants from Bad Sugar (Type II Diabetes in Pima people)
Lack of education, diversion of water, low income, lack of agency, changes in foods and foods of cultural significance, multigenerational trauma
What were physical determinants from Bad Sugar (Type II Diabetes in Pima people)
No grocery stores, lack of water, only given processed foods, no safe areas to exercise, inability to grow their own food (dry land)
What were health service determinants from Bad Sugar (Type II Diabetes in Pima people)
Treatment for diabetes not really available, access to and quality of healthcare
What were policymaking determinants from Bad Sugar (Type II Diabetes in Pima people)
Coolidge Dam (diverted water) and commodity program only gave them sugar + fat
Why is it bad to focus just on individual risk factors
It puts the blame on individuals and ignores how easy/hard it is to make certain behaviors based on structural determinants
What are the 3 deprivations of poverty that affect the MPI
Health (nutrition, child mortality), education (years of schooling, school attendance), and living standard (cooking fuel, improved sanitation, safe drinking water, electricity, flooring, assets)
What is the Global Multidimensional Poverty Index (MPI)
An international measure used to measure acute poverty
What 2 ways does socioeconomic status influence health
Material deprivation and psychosocial pathways
What are 4 material deprivations relating to low SES
Less access to basic necessities, more exposure to workplace and environmental hazards, less access to social and institutional resources, and disinvestment of public infrastructure in lower-income neighborhoods and regions
What are the psychosocial pathways pertaining to poor health in low SES communities
Perceptions and experience of personal SES in unequal societies leads to stress, poor self agency, discrimination, and poor health
What is the chronic stress of poverty
Too much demand (work-family, deadlines, customers, supervisors) and too little control (skill use, flexible schedule, pace, task decisions)
What does chronic stress result in
Increased risk of heart disease, stroke, and diabetes, as well as potentially decreased immune function as an adult (when a child) or inflammaging (when later in life)
What is prevalence
The number of people suffering from a certain health condition at a certain time
What is incidence
The number of people diagnosed with a health condition over a specific period of time
What is mortality
Death
What is morbidity
The condition of being diseased/unhealthy/injured
What is the Global Burden of Disease (GBD) Project
An international effort to collect reliable data on causes of death and disease in different countries over time
How is the GBD Project described
A “Four C” database - Combined morbidity and mortality, Complete (as possible), Consistent definitions of disease states, and Coherent
What is DALY
Disability Adjusted Life Year
What is the equation for DALY
YLL + YLD
What is YLL
Years of life lost (due to mortality)
What is YLD
Years lost to disability
What is the equation for YLL
N (number incident deaths) * L (life expectancy minus age at death for that cause)
What is the equation for YLD
P (prevalence of disease) * DW (disability weight between 0-1)
What are the 3 categories of disease according to Dr. Rosling
Non-communicable diseases (NCDs), diseases of extreme poverty, and accidents/injury
What makes up the highest global DALYs
NCDs (a little over 1/2)
What are diseases of extreme poverty
Nutritional deficiencies, infectious diseases, pregnancy and childbirth-related (maternal), and newborn diseases (neonatal)
What are 8 potential uses of the DALY
Combine morbidity and mortality, compares impact across diseases, sets health care and research priorities, identifies disadvantaged and underserved groups for health interventions, allows better evaluation of health interventions, understands transnational burden of disease, allocates resources for interventions based on cost-effectiveness, and has led to more evidence-based health practice
What are are 5 critics of the DALY
Reduces subjective and multifaceted experience of ill-health into an objective index, doesn’t deal with the social suffering by those not diseased (family, community), doesn’t account for how suffering varies across time and space, minimized differences in suffering in different contexts, and mental health separate from physical health
What is the 6th and biggest critic of the DALY
Health care as a human right vs. health care based on cost-effectiveness
What is the demographic transition model
How demographics change over time (5 stages: transition from high birth and death rates to low birth and death rates)
What is stage 1 of the demographic transition
Typically in least economically advantaged countries, high birth rates (due to culture, lack of contraceptives, sex education, power differentials between men and women, etc.) and high death rate (due to poor healthcare, lack of access to clean water, poor nutrition, etc.)
What are stages 2-3 of the demographic transition model
High but decreasing birth rates (cultural norms take a while to catch up, changing role of women), and decreasing death rate (due to economic development)
What is stage 4 of the demographic transition model
Low birth rate (due to the expense of having a child, kids living longer, wider access to contraceptives, changing role of women, and education), and low death rate (better healthcare and standards of living)
What is stage 5 of the demographic transition model
Birth rates getting below replacement levels in some countries, populations declining (e.g. in Japan)
What are 3 critics of the DTM
Theory based on evaluation of data mostly from European societies that went through Industrial Revolution, timescale and curve may not apply to all countries, and doesn’t consider migration
What is the epidemiological transition
Focuses on the causes of death (diseases) within the demographic transition, and how those have changed over time
What does the epidemiological transition model show
Shifting dominance from diseases of extreme poverty to noncommunicable diseases
What is phase 1 of the ETM
Pestilence and famine (infectious diseases, war, and famine)
What is phase 2 of the ETM
Receding pandemics due to nutrition, sanitation, and medical care
What is phase 3 of the ETM
Degenerative diseases (e.g. CVD, stroke, and diabetes)
What are 4 problems with the ETM
Based on experiences of high-income countries, different countries go through transition at different pace, not all infectious diseases declined with development (e.g. COVID), and some evidence that specific injuries and accidents decline with development while other increase
What is a the double burden of the ETM
Countries that experience Group 1 (infectious) and group 2 (NCD) diseases at the same time, straining their health care systems
What 4 sources does WHO use to collect data from
Vital statistics (civil registration), census data, population surveys, and health service records
What is the standard/goal for civil registration and vital statistics
To have accurate cause of death data for at least 90% of population
What are civil registration and vital statistics (CRVS)
Recording births and causes of death
What are 3 common census questions
How many people live here, rent/own, and each person’s name, sex, age, and race
What are population surveys based on
Sampling (doesn’t count everyone)
What is ICD-10 coding
A way to report diseases to health departments (used globally)
What is the social construction of knowledge
What we know takes place is a social, historical, political, and cultural context depending on shared assumptions and institutionalization
What is medicalization
Process by which nonmedical problems become defined and treated as medical problems, often requiring medical treatment (depends on social norms of the time)
What are the 6 legacies of colonialism in global health
- Construction and institutionalizaiton of racial/ethnic stereotypes and divisions that contribute to structural violence
- Extraction of products and knowledge of disease treatments for colonizer’s gain
- Paternalism/discounting local knowledge of health/disease
- Targeting specific diseases rather than all health concerns
- Focusing on techinal fixes for complex health issues
- Top-down decision making and no accountability
- Lack of attention to SDHs and lack of sufficient effort at broader health care
How are legacies of colonial medicine tied to institutions today
Leaders of U.S. colonial medicine were higher by Rockefeller IHB to create 2 influental schools of public health
What is the IHB
International Health Board
What 2 schools of public health did Rockefeller create
London School of Hygiene and Tropical Medicine and Johns Hopkins School of Hygiene and Tropical Medicine
Is race a biological determinant
No, often genetic diseases more common in certain racial/ethnic groups are single-gene disorders (race is a social construct)
What 6 things were believed about enslaved peoples during slavery
Higher pain tolerance, weaker lungs, higher tolerance to heat, immune to some illnesses (and susceptible to others), thicker skin, and better able to labor in tropical climates
How is dispropotionate incarceration related to health risks
Inadequate nutrition, sanitation, healthcare, uncomfortable housing, and lack of social/economic support for individuals and their families
What are 2 ways colonial legecies stille exist in healthcare today
Spirometers have a “race correction” and many medical professionals believe Black individuals to have a higher pain tolerance
What 3 ways does colonial medicine still impact global health initiatives today
Top-down approaches, focusing on specific diseases, adn focusing on technical fixes
What is one way to decolonize global health
Person-first language
What classifies a people as a marginalized group
Being excluded from full access to resources, rights, and opportunities
What is intersectionality
Everyone falls into different categories which creates different levels of privelege or maginalization/discrimination
What are health inequities
Unequal health outcomes that are unequal, unjust, and unfair
How are health inequities related to health disparities and health inequalities
Health inequities cause health inequalities and disparities
Why are their health disparities based on race even after controlling for education and income
Due to chronic stress related to percieved and experienced discrimination
What are the 2 kinds of racial discrimination
Interpersonal (microaggresions) and structural (redlining, etc.)
What is weathering
Marginalized groups being worn down by constant stressors of racism/discrimination
What is allostatic load
Wear and tear on body systems deue to repeated cycels of stress response and inefficient termination of these responses that causes premature aging and increased health risks
How can weathering be measured
Via allostatic load
What is redlining
Home Owners’ Loan Corporation (HOLC) created maps for many cities where neighborhoods were designated risk categories that affected their ability to recieve a loan (racial groups disproportionatley affected)
What are the 5 biological determinants of health related to sex
Iron deficiency anemia related to menstruation, complications of pregnancy and breastfeeding, increased susceptibility to some infections based on genitalia, ovarian cancer, and prostate cancer
What are the 5 social determinants of health related to gender
Female abortion or infanticide, malnutrition and undernutrition, male dominance leading to physical/sexual abuse, gendered division of labor, and lower social status limiting access to healthcare
What is maternal mortality
Annual number of deaths from any cause relaed to or aggravated by pregnancy or its management during pregnancy and childbirth or w/in 42 days of terminaiton of pregnancy, irrespectiv eof the duration and site of pregnancy
What are 5 causes of maternal death
Severe bleeding, infections, high BP during pregnancy, complications from delivery, and unsafe abortion (rest is from infections like malaria or chronic conditions)
What are the trends in maternal mortality globally
Persisten high rates in Sub-Saharan Africa and improvements in South Asia (though disparities persist)
What is one health concern related to pregnancy and childbirth
Obstetric fistula (hole between bladder and vagina or rectum and vagina that can cause incontinence)
What is the Mexico City Policy/ “Global Gag Rule”
Foreign non-governmental organizatoins (NGOs) have to certify that they won’t “perform or actively promote abortion as a method of family planning” if they want to recieve aid from US govt.
What are 3 health concerns for LGBTQIA+ individuals
Gender identity/sexual orientation questions not asked on most health surverys, they face health disparities linked to societal stigma, discrimination and denial of civil/human rights, and have higher rates of substance absue, psychiatric disorders, and suicide (linked to discrimination)
What are 6 barriers LGBQTIA+ individuals face when seeking health care
- Inadequate understanding of status-specific conditions
- Denial of care
- Inadeuate care
- Restricting inclusion of significant individuals in family treatment or in support or decision-making roles
- Inappropriate assumptions about cause of health or behavioral health conditions
- Avoidance of treatment
Do diseases of extreme poverty, NCDs, or accidents/injuries make up the highest global DALYs
NCDs
Which countries met the SDG for maternal health in 2013
The US and China
What is a life-course perspective
Timing of discrimintion exposures influences health effects (e.g. experienced in utero can lead to chronic disease as an adult)
Which determinants of health do LGBTQIA+ individuals in Japan face
Societal (conservative norms, fear of attack, and social stigma) and political (lack of anti-discrimination laws and far right religious groups in power)
What health concerns did the “mainstreaming gender shift” expand to focus on
STIs, reproductive cancers, abortion, and unequal quality of healthcare
