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Global Public Health > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is hunger

A

Scientific food deprivation (absense of food)

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2
Q

What is malnutrition

A

Deficiencies, excesses, or imbalances in macro/micro-nutrients

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3
Q

How are poverty and food insecurity related

A

Poverty is a cause of hunger and lack of adequate and proper nutrition is an underylying cause of poverty

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4
Q

What are 3 overlapping global crises with global hunger

A

Conflict (e.g. war in Ukraine), climate change, and economic effects of COVID-19 pandemic

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5
Q

What are 5 underlying factors of global hunger

A

Poverty, inequality, poor infrastructure, low state capacity, and low agricultural productivity

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6
Q

Where is global hunger most prevalent

A

In subsaharan Africa, India, Yemen, etc.

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7
Q

What is food availability

A

The physical presense of sufficient quality food at global, national, regional, and local levels

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8
Q

What is food access

A

A combination of economic resources, physical access, and socio-cultural factors with preferences shaped by cultural, religious, and personal factors

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9
Q

What is food utilization

A

How the body uses nutrients from food, emphasizing proper food preparation, hygiene, diverse diets, and intra-household food distribution

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10
Q

What is stability of food security

A

The consistent availability, access, and utilization of food over time

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11
Q

What are the 4 dimensions of food security

A

Food availability, food access, food utilization, and stability of food security

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12
Q

What are 3 ways climate change affects food availability

A

Decreases crop yields (6% for every 1 C increase), reduces productivity of rain-fed agriculture due to droughts/floods, and decreases fish stocks

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13
Q

What are 3 ways climate change affects stability of food supplies

A

Natural disasters, pest and disease outbreaks, and seasonal variability

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14
Q

What are 4 ways climate change affects access to food

A

Economic access: Price of food and loss of livelihoods
Physical access: Infrastructure damage and climate-induced displacement

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15
Q

What are 4 ways climate change affects food utilization

A

Nutritional quality: Decreased nutritional content and seasonal variability/shifts in diets (from traditional to processed)
Water & Sanitation: Water scarcity and spread of waterborne diseases due to flooding/droughts

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16
Q

What is Forecast based Financing (FbF)

A

An anticipatory mechanism to enable access to funding before a disaster occurs using impact based forecasts (predictions)

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17
Q

What is Famine Early Warning Systems Network (FEWSNET) and what 7 indicators does it use

A

A way to forecast food insecurity looking at crude mortality rate, malnutrition prevalence, food access/availability, dietary diversity, water access/availability, coping strategies, ad livelihood assets

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18
Q

What are experiential indicators

A

How you feel about your status

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19
Q

What are the 3 ways to measure experiential indicators of food insecurity

A

Food Consumption Score (FCS), Coping Strategy Index (CSI), and Household Food Insecurity Access Scale (HFIAS)

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20
Q

What 2 programs developed the Coping Strategy Index (CSI)

A

World Food Program (WFP) and CARE

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21
Q

What does the CSI do

A

Assess the frequency and severity of different types of coping strategies in response to food insecurity experiences (higher scores indicate greater food insecurity)

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22
Q

What 3 things does the CSI help with

A

Measures and monitors impact of food assistance programs, acts as early warning indicator of impending food crises, and identifies areas/pops. with greatest needs

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23
Q

What are the 2 types of CSI

A

Country-specific (for more severe coping behaviors based on context-specific strategies and context-specific severity scores) and reduced (measures several common, less severe coping behaviors to allow comparison among areas and countries)

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24
Q

What is Food Consumption Score (FCS)

A

Proxy indicator for current HH food utilization

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25
Q

What 3 things is FCS based on

A

Dietary diversity, food frequency, and nutritional importance

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26
Q

What is dietary diversity

A

The number of individual foods consumed over a reference period

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27
Q

What is food frequency

A

Number of days (in the past week) that a specific food item has been consumed (e.g. how often you’re eating)

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28
Q

What is nutritional importance

A

Food groups are weighted to reflect their nutritional importance

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29
Q

What are the 3 consumption groups in the FCS

A

Poor (0-21), borderline (21.5-35), and acceptable (>35)

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30
Q

What does the HFIAS measure

A

What people do when they can’t access enough food (9 qs about feelings of uncertainty or anxiety related to food supply)

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31
Q

What are critiques of HFIAS

A

It is subjective and not applicable across cultures

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32
Q

What are the 3 nutritional indicators

A

Acute malnutrition (wasting), chronic malnutrition (stunting), and underweight (wasting and stunting)

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33
Q

Nutritional status is usually measured for which populations for WHO

A

Children < 5

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34
Q

What is wasting and how is it calculated

A

Thinness measured by weight for height

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35
Q

What is stunting and how is it measured

A

Shortness measured by height for age

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36
Q

What is mid-upper arm circumference (MUAC) used for

A

Provides assessment of chronic nutritional status over time by comparing to standard

Underweight is MUAC <12.5 in children and <22.5 in women

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37
Q

What are 4 measurement limitations of the MUAC

A

Inaccurate representation (researcher didn’t understand something), under coverage bias (overlooked populations), differing growth trajectories, and standardization (western-centric)

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38
Q

What 2 main institutions were established during the Bretton Woods Agreement post-WWII

A

World Bank (led by US) and International Monetary Fund (IMF)

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39
Q

What was the World Banks Mission

A

To “end extreme poverty and promote shared prosperity in a sustainable way”

1970s: Focused aid on education and health
1980s/1990s: Helped change dialogue from health as a human right to cost effectiveness

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40
Q

How did the World Bank go about accomplishing it’s mission

A

Mainly providing loans to low-middle income countries

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41
Q

What are 2 critiques of the World Bank

A

Governed by wealthiest countries (represents their interests) and structural adjustment programs (loans w/stipulations) often negatively impacted already struggling countries/regions

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42
Q

What did the World Health Organization (WHO) develop out of

A

Pan American Health Organization (PAHO)

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43
Q

What is WHO’s mission

A

“The attainment by all people of the highest possible level of health”

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44
Q

Does WHO provide health services

A

Not usually, but they develop guidelines, convene experts, and provide technical expertise (find people who will help)

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44
Q

How did WHO use to be funded vs now

A

Member states would vote in World Health Assembly (1 country, 1 vote) but now funded by dues from member states and private donations

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45
Q

What are 2 critiques of WHO

A

Inflexible to local circumstances (assume they know best) and voluntary donors now decide financial priorities more than assembly

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46
Q

How has WHOs approach to healthcare changed over time

A

Historically vertical initiatives, then Primary Health Care after the Alma Ata, then Selective Primary Health Care after Bellagio

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47
Q

What are the 4 characteristics of Primary Health Care

A

Access to basic care, equitable distribution of resources, local participation, and achieve a level of health that enables productive lives

–> Epitomizes a “horizontal approach”

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48
Q

What was the bedrock of horizontal approaches to healthcare

A

Community Health Workers (CHWs)

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49
Q

What are the 4 characteristics of vertical programs

A

Often disease-specific, cure-focused, driven by donors/outsiders, and not sustainable w/o continued funding

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50
Q

What are the 4 characteristics of horizontal programs

A

Focus on a range of issues (not 1 disease), prevention-focused, driven by affected community, and integrate into the health system to aid sustainability

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51
Q

Who was invited to the Alma-Ata Conference

A

All UN member countries

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52
Q

What did the Alma-Ata do

A

Identified primary health care as the key to attainment of the goal of health for all

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53
Q

What was the declaration of the Alma-Ata (5 parts)

A

Said health was a human right, support basic needs of entire population, emphasized CHWs, included community into program design, and wanted to attain health for all by 2000

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54
Q

What were 3 problems with the Alma Ata

A

No mechanism identified to fund the plan, no plan on how to accomplish the goals, and signing on just meant a country supported the ideas but didn’t necessitate action

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55
Q

What happened at the Bellagio conference

A

1 yr after Alma Ata, selective primary healthcare was introduced as an interim strategy

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56
Q

Who attended the Bellagio conference

A

Just the wealthiest countries

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57
Q

What is another name for the Bellagio conference

A

The Rockefeller Foundation Conference on Health and Population Development

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58
Q

What does selective primary health care (SPHC) focus on

A

Prevention or treatment of the few diseases which cause the most mortality and morbidity + which have effective interventions

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59
Q

What does SPHC target

A

Kids under 5, pregnant people, and birth control

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60
Q

What is a pro of SPHC

A

It has specific, measurable goals (makes easier to fund)

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61
Q

What is a con of SPHC

A

It is not a plan to meet health care needs of whole populations and it may not address the main concerns of local communities bc/of top-down approach

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62
Q

What is neoliberalism

A

An economic and political theory that emphasized free marked rather than government involvement + thus saw health as a commodity (instead of health as a human right in Alma Ata)

63
Q

Who were the main players in neoliberalism movements

A

Reagan and Thatcher in 1980s who then appointed IMF and World Bank directors with these ideations

64
Q

How did World Bank policy change under neoliberal influence

A

Emphasis on private sector and fees for service (meaning people had to pay to use healthcare systems)

65
Q

What 3 things did the World Bank use to rationalize their neoliberal policies

A

They said it generated money for health services, reduced “overconsumption” of health services, and subsidized rural health care with money collected from urban fees

66
Q

What were 3 results of the World Bank’s neoliberal policies

A

Under-consumption of health services, little revenue (only 5% operating costs recouped through user fees), and didn’t really strengthen public delivery of health services

67
Q

What are structural adjustment programs (SAPs)

A

New, stricter conditions for loans to developing countries (typically countries who had just gained independence)

68
Q

What are 2 critiques of SAPs

A

Keeps countries impoverished and in a cycle of debt and benefits multinational corporations at the expense of the poor

69
Q

What does UNICEF stand for

A

United Nations International Children’s Emergency Fund

70
Q

How was UNICEF funded

A

Via government contributions and fundraising

71
Q

What 4 things did the 1987 UNICEF report do

A

Documented how SAPs undermined health in many contexts, countries paying off debt meant less for education and health services, focused on how large-scale health projects can improve health, but didn’t fully critique neoliberal economic thinking

72
Q

What is UNICEFs mission

A

To provide humanitarian and development assistance to children

73
Q

What 6 things does UNICEF do

A

Provide immunizations and disease prevention, administer treatment for children and moms with HIV, enhance childhood and maternal nutrition, improve sanitation, promote education, and provide emergency relief in response to disasters

74
Q

What was UNICEF’s SPHC strategy

A

GOBI-FFF

75
Q

What does GOBI-FFF stand for

A

G: Growth monitoring
O: Oral rehydration therapy (ORT)
B: Breastfeeding
I: Immunizations
F: Food supplementation
F: Female literacy
F: Family planning

76
Q

What were the 2 main focuses of GOBI-FFF

A

Oral rehydration therapy and immunizations

77
Q

What are 3 strengths of UNICEF

A

Immunization successes with many global health actors involved, involved in working to get ‘days of tranquility’, and GOBI-FFF met many of its targets

78
Q

What are 4 critiques of UNICEF

A

GOBI-FFF didn’t do much for primary health for all, focused mainly on O and I at expense of other interventions, faltered after Grant died in 1995, and acted as band-aids for global health rather than sustainable solutions

79
Q

What did the World Bank look like in the 1990s

A

More directly involved in global health, 1993 World Development Report, and SAPS continued

80
Q

What did the 1993 World Development Report do

A

Promoted cost-effectiveness to set global health priorities and started Global Burden of Disease (DALYs)

81
Q

What are the 4 biggest current players in global health based on resources

A

Classic: WHO and World Bank
Newer: The Global Fund and Gavi (vaccine alliance)

82
Q

What are the 3 main sources financing global health actors

A

USA, UK, and Bill and Melinda Gates Foundation

83
Q

What are 4 impacts of changes to how DAH is financed

A

1.) Consolidation of influence (Powerful donors impose priorities on low-income countries)
2.) More discretionary funding (less long-term)
3.) More multi-stakeholder governance
4.) Towards narrower mandates/problem-focused vertical initiatives

84
Q

What 3 diseases does the Global Fund focus on

A

AIDS, TB, and Malaria

85
Q

What kind of initiatives are the Global Fund, Gavi, and the Gates Foundation involved with

A

Vertical initiatives

86
Q

What are 6 characteristics of NGOs

A

Private (nongovernmental), voluntary citizen’s group organized on local, national, or international levels, uncoerced collective action, shared interests, purposes, and values, not for profit, and bring local community concerns to govt. to spark change

87
Q

What are 3 main advantages to NGOs

A

They are seen as an alternative to government, vehicles of democratization, and in absence of the state, they can fill a political vacuum

88
Q

What are 6 smaller advantages of NGOs

A

Innovative, more cost-effective in service delivery, more able to target impoverished and vulnerable, better to develop community-based institutions, better able to promote popular participation, and can correct failures of govt.s and states

89
Q

What are 5 critiques of NGOs

A

Dependent on donor money (often tied to policies of donor states abroad), not really democratic (top-down), not really innovative (often recycle ideas from other donors), can’t say whether it’s cost-effective, and doesn’t always reach impoverished individuals

90
Q

What is the International Committee of the Red Cross and Red Crescent (ICRC)

A

An independent, neutral organization that ensures humanitarian protection and assistance for victims of armed conflict and other situations of violence

91
Q

What is a defining characteristic of the ICRC

A

Strict doctrine of neutrality and discretion

92
Q

What is Medecins Sans Frontiers (MSF) / Doctors Without Borders

A

An organization combining local journalists and doctors who focus on medical care (and broader health efforts) in response to war/conflict, natural disasters, outbreaks and epidemics, and refugees and internally displaced people

93
Q

How does MSF approach neutrality

A

They balance operational neutrality with a willingness to speak out

94
Q

What are 4 things MSF and Red Cross have in common

A

They both emerged in response to conflict, respond to suffering through a health framework, provide health care and humanitarian aid during conflict, and work together despite differences

95
Q

How do MSF and Red Cross differ

A

On principals of neutrality, confidentiality, impartiality, and independence (MSF goes as soon as possible even if illegal, while ICRC works with legal authorities)

96
Q

What is the purpose of the global development goals

A

8 time-bound targets to reduce extreme poverty by 2015

97
Q

What did the global (millennium) development goals focus on

A

Achievable, sustainable, and multisectoral action and development

98
Q

What did the final MDG report find

A

That the 15-year effort of millennium development goals had produced the most successful anti-poverty movement in history

99
Q

What are the sustainable development goals

A

17 practical strategies to combat extreme poverty

100
Q

What 4 crises threaten SDG progress

A

Climate crises, gloomy outlook, COVID, and governmental

101
Q

Where have the SDGs made progress

A

Access to electricity and internet, treatment for HIV/AIDS, and under-5 mortality

102
Q

What are 4 benefits of vertical health programs

A

Minimize or eliminate threat of disease in a given population, can lead to benefits of other health outcomes (co-morbidities), can improve heath infrastructure, and often easier to fund

103
Q

What is herd immunity

A

When very few people are able to carry a disease, the virus can’t find a host and therefore can’t spread in that population

104
Q

What is r naught

A

As estimate of how many people an infected person will get sick

105
Q

What is the expanded programme on immunization (EPI) called today

A

The essential programme on immunization

106
Q

What is the primary goal of the EPI

A

To immunize all children < 5 by 1990 to 6 vaccine-preventable diseases

107
Q

What was the secondary goal of the EPI

A

To promote countries delivering immunizations themselves withing their own comprehensive health services to strengthen overall infrastructure

108
Q

Is the EPI vertical or horizontal

A

Diagonal

109
Q

What is misinformation

A

False information shared by people who didn’t intend to mislead others

110
Q

What is disinformation

A

False information deliberately created and disseminated with malicious intent

111
Q

What is an eradication campaign

A

Permanent reduction of a disease through deliberate measures such that interventions are no longer needed (doesn’t always use vaccines)

112
Q

What is one example of an eradication campaign without a technical fix

A

Guniea Worm involved mostly behavioral changes, cloth/nylon filtration, deep well digging, and some larvicide

113
Q

What 5 characteristics made smallpox eradicable

A
  1. Direct human-human transmisison (not zoonotic)
  2. Permanent immunity from single vaccination or infection (not recurrent)
  3. Short and known latency period (7-14 days)
  4. Easily identifiable cases (obvious and distinctive rash)
  5. Vaccine was extremely effective and didn’t require a cold chain
114
Q

What is surveillance

A

A system that tracks diseases in the population

115
Q

What are the 2 surveillance methods for polio

A

Nationwide Acute Flaccid Paralysis (AFP) surveillance and environmental surveillance (testing sewage)

116
Q

What is AFP surveillance

A

Reporting children with AFP, sending in stool samples, identifying diseases in labs, and mapping the virus to determine the origin of the virus strain

117
Q

What are the 5 characteristics of malaria that made it an unsuccessful campaign

A

Transmitted via mosquitoes, recurrent, lays dormant in RBCs for a long time, can be confused with other diseases, and many preventions that are becoming less effective as mosquitoes adapt

118
Q

How many people are symptomatic with polio

A

72% asymptomatic, 25% flu-like symptoms, 1% impact on brain or spinal cord (Paresthesia, Meningitis, or Paralysis of extremities)

119
Q

What are the 5 characteristics of polio that made it a semi-successful campaign

A

Transmitted fecal-orally or via respiratory droplets, recurrent (20-40% also get post-polio syndrome), long latency period, hard to identify because so many asymptomatic, and vaccine needs a cold chain and often multiple doses

120
Q

What was the eradication strategy for smallpox

A

Surveilling and containing while selectively vaccinating people who’d been in contact with an infected person

121
Q

What was needed to eradicate polio in addition to surveillance

A

100% immunization (national immunization days, mop-up campaigns, outbreak response immunization) and political will

122
Q

What else is needed for a successful global health campaign aside from diseases with characteristics like smallpox

A

Coordination among numerous organizations (government, international, and NGO) and political will

123
Q

What were the unintended consequences of Polio Vaccines and Osama Bin Laden due to the actions of the CIA

A

People in Pakistan are now distrusting of community health workers and vaccines, and the Taliban has actually banned vaccinations

124
Q

What is a potential drawback of traditional global health training in high-income countries (HICs)

A

Training should focus instead on low-middle income countries (LMICs) and marginalized communities of HICs

125
Q

What is a potential benefit of traditional global health training in high-income countries (HICs)

A

Training in HICs then travelling to LMICs could be personally transformative and teach people about their privilege

126
Q

What are 3 advantages of a ‘glocal’ health program

A

Addresses local health challenges, provides training and capacity building w/in HICs to foster deeper understandings of vulnerable/marginalized populations, and encourages collaboration as allies to support newcomers settlement and student’s growth

127
Q

Does a ‘glocal’ approach discourage students from HICs from engaging in LMICs

A

No

128
Q

What is medical tourism

A

Short-term medical interventions in resource-poor settings led by health professionals from resource-rich settings

129
Q

What is medical voyeurism

A

When medical professionals go to other countries to do short-term work, they treat the situation like a zoo (patients, conditions, way the health system functions)

130
Q

How can student’s (and staff) presence in developing countries be drains on health systems

A

Student’s can’t add anything, so rely on community support where resources are already scarce (e.g. nurses acting as translators, bringing appearance of better care, taking away from local med students, etc.)

131
Q

What are 6 ethical issues of medical volunteering

A
  1. Students or health professionals may misunderstand their roles and goals
  2. Language and cultural barriers may interfere with respectful engagement
  3. Working in resource-poor settings may raise issues that students haven’t considered before and are unprepared to address (beyond qualifications)
  4. Presence of volunteers can burden communities and waste resources
  5. Students may participate in research w/o knowing it and w/o appropriate training
  6. Risk that being in a resource-poor environment can serve to reinforce existing stereotypes
132
Q

How can the ethical issues of medical volunteering be addressed

A

Understanding cultural competency, humility, learning local language, preparing students/staff, putting systems to keep people from doing work out of their scope, learn vs. help, ask what supervision is necessary, ask what resources are available, donate instead, get ethical training, build relationships w/people from local communitites

133
Q

What is the proposed curricula to combat ethical issues of medical volunteering

A

Create a curricula designed by students, faculty, and staff of universities, community stakeholders, and experts in inter-cultural relationships and global health

134
Q

How does HIV function

A

It attacks CD4 T cells

135
Q

What is the difference between HIV and AIDS

A

HIV is the presence of Human Immunodeficiency Virus in the blood

AIDS is having 200 or fewer CD4 T cells per liter of blood or having an opportunistic infection and being HIV positive

136
Q

What can HIV latency look like

A

People often get flu-like symptoms then are asymptomatic for ~8 yrs (4-20 yr avg) but ~5% stay in latency for over 20 yrs before developing weight loss and fever

137
Q

What is ART

A

Antiretroviral therapy is a standard daily treatment w/ a combination of drugs that suppress HIV replication to reduce viral load to undetectable (prospect of a normal lifespan)

138
Q

What is PrEP

A

Pre-exposure prophylaxis is a daily medication for people at high risk for acquiring HIV (90% effective but high stigma)

139
Q

What is PEP

A

Post-exposure prophylaxis is taken ASAP after a possible exposure to HIV (w/in 72 hrs) and is 80% effective (used by medical practitioners after a needle stick, etc.)

140
Q

Why was US initially unsupportive of generic drug use in Africa

A

Because they didn’t care since US had access to cheap drugs and thought that African people would misuse the drugs and create a resistance that would affect them

141
Q

Why did low-income countries back off from challenging drug patents

A

Bc/ US interests aligned w/drug companies and they threatened to withhold aid

142
Q

What is a health system

A

All actors, institutions, and resources that undertake health actions

143
Q

What are health actions

A

An action where the primary intent is to improve health

144
Q

What are the 3 goals of a health system

A

To keep people healthy/prevent disease, treat people who are sick, and protect people from financial ruin due to costs of medical care

145
Q

What are the 3 levels of health care

A

Primary, secondary, and tertiary

146
Q

What does primary care deal with

A

1st point of contact (e.g. PCP) for illness, injury, acute medical problems, and referrals (acts as barrier to other levels of health care)

147
Q

What does secondary care deal with

A

Specialists with specific expertise in health issues (e.g. simple surgeries, emergency obstetrics, allergists, etc.)

148
Q

What does tertiary care deal with

A

Highly specialized equipment and expertise (e.g. cancers, complex surgeries, etc.)

149
Q

What is the difference between primary care and primary health care

A

Primary care is the first level of health services, primary health care (PHC) is the goal of universal, community-based essential health services

150
Q

What are the 4 models of health care systems

A

National Health Service (UK model), National Health Insurance Model (Canada, Germany), Out-of-pocket system, and pluralistic model

151
Q

What is the National Health Service Model

A

Comprehensive health services to all people regardless of ability to pay (universal and considered a human right)

152
Q

What are the strengths and weaknesses of the National Health Service Model

A

Universal but can take a long time (esp. for specialists)

153
Q

Who pays for the National Health Service Model and how

A

Government with taxes

154
Q

What are the 2 kinds of the National Health Insurance Model

A

Public (Canada) and Private (Germany)

155
Q

What is the Public National Health Insurance Model

A

Universal coverage for hospital and doctor’s visits (private or out-of-pocket for other visits), paid for via taxes by national government-run health insurance

Global Public Health (2 decks)

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