final3

Question 1

What is the definition of global health vs international health?

Answer 1

• Global health is an area for study, research, and practice that places priority on improving health and achieving equity in health for all people worldwide.
• International health is the application of principles of PUBLIC HEALTH to problems and challenges that affect LOW and MIDDLE income countries and to the complex array of global and local forces that influence them

Question 2

What are the different types of health indicators?

Answer 2

• Health status indicators: mortality by age and sex and cause, fertility and morbidity like HIV
• Service coverage indicators: health service coverage like immunization, non-communicable diseases , maternal health
• Risk factors indicators: e.g. nutrition, infections, environmental, behavioural, injuries and violence.
• Health systems indicators: health workforce, quality of care, health security and financing, governance

Question 3

What is the criteria for selecting global health indicators?

Answer 3

1. Well defined: definition must be applied all countries.
2. validity: The indicator must measure what it is supposed to measure
3. Reliable: replicable and consistent between settings

Question 4

What is medical colonialism?

Answer 4

Involved medicine, economic development, export of “modernity”
Relationship between race, place, and disease

Question 5

What is the transition from tropical medical to global health?

Answer 5

1600-1900: assumed climate caused disease and climate caused different skin colour (monogenism), polygenism (animal and human similarity)
1890-1940: Patrick Manson and Ross proved disease from parasite, malaria was enemy of colonial expansion, white saviour medicine as tool of religious conversion.
1900-1970: international bureaucracies failed multiple times but NGO helped in a way.

Question 6

Why social theories are important?

Answer 6

Theory guides what we observe
Theory guides our measurement and interpretation of data
Theory influence intervention options, design and target population

Question 7

What are the social theories?

Answer 7

1. Unintended consequences of purposive action: actions that have unforseen consequences for example a clinic to do good but then facility become dangerous bc it was actually spreading the disease
2. Social construction of health and illness: ideas and meaning of illness that is culturally constructed that HIV/AIDS seen as “gay plague” or abortion
3. Social suffering and structural violence: global and local politics and culture affecting people like PTSD among veterans.
4. Biopower: The ways political governance increasingly exerts its effects via control of bodies and populations. like CERB you have to meet a certain criteria in order to be qualified.

Question 8

What is the definition of tropical medicine?

Answer 8

It is socially constructed
Instrument of power (tied to colonization) - aimed to keep colonizers and labour force alive in the colonial tropics

Question 9

What are the eras in global health?

Answer 9

1st: Tropical medicine: protection of colonial representatives from tropical diseases.
2nd: International health: wealthier countries helping countries with less.
3rd: Global health: Collective action to address shared risks and responsibilities.

Question 10

What are the moral value frameworks of global health?

Answer 10

1. Utilitarian values: doing good for the greatest amount of people, to make them more happy. Eg: give one dollar to save. However, suffering of the minority gives happiness to the majority
2. Humanitarian values: acting virtuously towards those in need based on compassion, empathy, or altruism (short term)
3. Religion: values influence motivations and actions, doing good in helping others.
4. Human right: about right and freedom
5. Equity and sociaal justice: equity, social inclusion,

Question 11

What are the common uses of moral values?

Answer 11

• To mobilize support for specific actions (crisis)
• Advocacy purposes (social justice(fairness in society))

Question 12

What are the public health emergencies? What is required to after PHEIC?

Answer 12

Public Health Emergency of International Concern is an “extraordinary event” which constitutes a public health risk to others states through the internal spread of disease.
Members are required to:
- Share critical information for risk assessment
- Adjust response plans if deemed necessary
- Implement recommendations formulated by the emergency committee

Question 13

What is the role of WHO, criteria for risk assessment?

Answer 13

• Outbreaks of infectious disease (biological) emerging or re-emerging diseases
• Emergencies due to natural hazards: tsunami, extreme temperatures
• Emergencies due to human-induced hazards: armed conflict, civil unrest
• Events resulting from exposure to toxic or hazardous materials: food or water contamination
  1. Scale (event): number of ppl affected
  2. Urgency (of mounting the response) degree of increase mortality
  3. Complexity: range of health consequences, for example COVID affecting vulnerable population compared to safe population
  4. Context: level of healthy systems resources at the local level, population vulnerabilities…

Question 14

What is Global Health security?

Answer 14

actions taken towards public health events that endanger people globally

Question 15

What are the objective of humanitarian action?
Humanitarian space?
Humanitarian actors?
What are the humanitarian principles?

Answer 15

1. Save lives, maintain dignity, and alleviate suffering.
2. Space= physical or symbolic space which humanitarian actors deliver service
3. Actors: wide range of agencies and networks local and international
   Principles:
   - Humanity: preventing and alleviating human suffering, respecting each individual.
   - Neutrality: not taking sides in a conflict
   - Impartiality: solely base on need not discriminating
   - Independence: maintaining autonomy of their country and objectives

Question 16

What are epidemics social epidemics, and syndemics?
Common source?
Point source?
Continuous common source
Propagated

Answer 16

Epidemicity= a usual frequency of disease in the same area among specificed population at the same at the same season of the year. Ex: small pox, yellow fever, recent chloera, ebola
Common-source epidemic: when a group all exposed to an infectious disease from the same source
Point source: all cases infected from a single source or exposure
Continuous common source: person exposed but for longer
Intermittment common-source: person are exposed to disease source at irregular intervals
Propagated: chain transmission
Social Epidemics: behaviourally based on non communicable disease (suicide, violence, obesity)
Syndemic: 2 or more diseases or health conditions that interact in time and place it also focus on consequences interaction of social, environmental and economic

Question 17

What is global health systems?
What is polylateral interaction?
What is the global system arrangements?
*What are the major governance challenges?

Answer 17

• Global health systems= compromised groups of actors whose primary intent is to improve health, along with the rules and norms governing interaction
• Polylateral interaction= State actors (country) -> non-state actors (NGO)-> Multi-lateral and bilateral institutions (agency organizations)
• Delivery, funding, and governance arrangements
  Governance challenges:
• Sovereignty challenge: primary duty to promote good on population
• Sectoral challenge: determinants of health, bring all sector in one umbrella to promote well-being Ex: tabacco, having to talk to several sector
• Moral challenge: when actors pursue political interest than the health issues
  Accountability challenge: lack of clear mechanism for NGO and legitimacy of intergovernmental organization

Question 18

What is the grading of health emergencies?

Answer 18

Ungraded= a public health event or emergency that us being monitored by WHO but that does not require a WHO operational response
Grade 1: a single or multiple country event with minimal public health consequences that requires a minimal international WHO response. Technical: remote technical assistance from international level. Financial and human resource: minimal to none.
Grade 2: a single or multiple country event with moderate health consequences that require a moderate international response. technical: time limited response. Financial: access to WHO regional resources; international resource mobilization on request. Human resource:surge emergency expert.
Grade 3: a single or multiple country event with substantial public health consequences requires a substantial international WHO response.similar to grade 2

Question 19

What are emergency response gaps? and what are the drivers of emergency response gaps?

Answer 19

• Life saving response: food, water, shelter, health
• At the right place: where need is greatest not where access is easiest
• At the right time: within first 6 month
  1. Increasingly overstretched humanitarian sector as it tries to respond to an ever-growing workload of both new and increasingly protracted crises (so theres a lot going on that we don’t have enough resources take care of it
  2. Surbordination (lower rank) of value of humanitarian action
  3. Frequent insecurity in humanitarian settings
  4. Competition among humanitarian actors trump delivery
  5. Financial gaps which can compromise independence
  6. Lack of expertise and capacity
  7. Humanitarian dilemmas both limit and increase humanitarian dilemmas both limit and increase humanitarian action
  8. Environmental condition

Question 20

True or false: Humanitarian space can be defined as an environment where humanitarian can work without hindrance and follow the humanitarian principles of humanitarian action

Answer 20

true

Question 21

Which of the following is a principle of humanitarian
a) Impartiality
b) Neutrality
c) Independence
d) All of the above

Answer 21

d) All of the above

Question 22

The EU has provided more modern guidance on the precautionary principle, clarifying that the application of the precautionary principle should be:
a) Non-discrminatory
b) subject to review, in the light of new scientific data
c) inconsistent with similar measures already taken
d) a & b
e) b & c)

Answer 22

D

Question 23

True or false: In the case of COVID, the precautionary principle holds that action (e.g. laws that restricts civil rights) should be taken to mitigate potentially catastrophic risks, even in the absence of complete evidence of the benefits of the action or the nature of the risk posed by COVID-19

Answer 23

True

Question 24

Emergency contexts such as pandemics that involve diseases of unknown origin characteristically result in
a) individuals experience of greater fear
b) the state restriction of civil liberties
c) the state expansion of civil liberties
d) a & b
e) a & c

Answer 24

d

Question 25

What is governance like in the COVID pandemic?

Answer 25

Vulnerability: we are not all in this together (bc existing vulnerabilities existed before
Inequality in educational opportunities
Migrant workers on frontline
Housing and homeless populations
Elderly and long term care homes
Women (bc female dominated health prof
Public health and civil liberties (public health: measures taken to protect against a risk, civil liberties: rights and freedom)
-Precautionary principle takes action to avoid catastrophic risk even when there is no evidence of benefits of intervention or nature of risk with certain measures
Infodemic: misinformation, unanswered questions

Question 26

What are transnational actors engaged in?
a) improving health
b) protecting health security
c) promoting human rights
d) responding to humanitarian crises
e) facilitating international development
f) all of the above

Answer 26

F

Question 27

*What are the functions of the global health systems?

Answer 27

1. Production of public goods (research and development) eg. COVAX initiative
2. Management of diseases and facilities across borders (international surveillance, epidemic preparedness and response etc. guidelines on how to respond)
3. Mobilization of solidarity (finance, technical assistance, humanitarian assistance)
4. Stewardship (goals and priorities and negotiations example UN agency

Question 28

What are the ways to understand global health issues are priorities?

Answer 28

1. Considering the actors involved because actors:
   - Legitimacy
   - Power and resource (where located)
   - Motive and interests (eg. focusing on poor or everyone)
2. The types of frames they advance: For example, obesity can be framed differently in behavioural, genetic, socioeconomic. Types of frame used to advance global health issues include:
3. Securitization (global security issue)
4. Moralization
5. Technification (science and technology)
6. Forms of collective action they organize

Question 29

What is MDGs and NTD?

Answer 29

Millennium Development Goals (2000-2015): include improving maternal health, extreme hunger, universal education, promote gender equality, reduce child mortality, combat diseases, ensure environmental sustanability, and develop partnership.
Success: disease, child mortality, maternal, and immunization.
Fail: considering major diseases
therefore Neglected tropical diseases (NTD) are low income countries where diseases affect them (17 diseases)

Question 30

What’s the drug development pipeline for NTD?

Answer 30

When trying to conduct a research study to find medications that can alleviate tropical disease there are gaps in developing a drug.
Gap 1: Preclinical research is not considered because there is no funding, with no profit no point and only implies to the poor.
Gap 2: Validated drugs don’t enter clinical development because again no funding for clinical trial
Gap 3: Drug never gets to patient because high cost, lack of production and poorly adapted to local condition

Question 31

What is SDGS? Sustainable Development goals

Answer 31

Applicable to all countries, indivisible, global in nature and universally applicable
It recognizes political factors in countries
No poverty, zero hunger, good health and wellness, quality education, gender equality, clean water, affordable and clean energy, decent work and economic growth, industry, reduced inequalities, sustainable cities, responsible consumption, climate action, life below water, life on land, peace and justice , partneship for the goals (17)

Question 32

What is DAHs? Canada’s foreign assistance policy, DAH & politics?

Answer 32

Development Assistance for Health (DAH) refers to financial assistance for low- and middle-income countries, by international development agencies and high-income countries to maintain or improve health. It reflects public interest (values in society), policy priorities (politicians want) and economic interest of donor country
In Canada we see big investment for maternal health and child health because of FIA (feminist) whereas US is big on HIV AIDS
In pandemic preparedness not that big for DAH
Politics:
- USA for reproductive service is entangled with domestic politics

Question 33

Is health spending in LMICs provided by DAH?

Answer 33

No, comes from domestic sources to fund their health

Question 34

What is food insecurity?
*What are the four dimension of food security?
Levels of food security?

Answer 34

The lack of safe and nutritious food for normal growth and development and an active and healthy lifestyle.
Availability
Stability
Utilization
Access
- Mild, moderate, severe

Question 35

What are the drivers of food insecurity?

Answer 35

• Political stability matters (prevalence of stunting)
• socioeconomic status
• power of corporation (power of infant-feeding lobby)
• Climate variations and extreme matters
• Power of policy makers to effect change matters

Question 36

What is the nutrition paradox?

Answer 36

Double burden when the issue of obesity and stravation are an issue. For example most low to middle income countries face the issue of beng overweight or under-weight or stunting

Question 37

What are the types of Food assistance?

Answer 37

• International Food Aid: providing food to another country free of charge in order to assist the country to meet its food needs
  -Relief Food Aid: short term crises, targeted situations
• Project food aid: aid targeted at house hold to improve status
• Program Food Aid: government to address in need for fundamental or structural, cultivate their own food.
• Food Aid in Canada: short term similar to relief
• Development food aid: medium to long term response to vulnerable population, not about giving food butt giving tools or technology transfer, more resilient farmers

Question 38

What is Tied food aid?

Answer 38

When country A gives money to a country B to address food aid, but food needs to be from country A. Disadvantage to economy on local farmers and markets.

Question 39

What are the minimum standards for food aid in humanitarian crisis?

Answer 39

Food quality and safety
Equitable distribution
Appropriateness and acceptability
Transparent supply chain management (purchasing food where it’s coming from

Question 40

Which of the following statements correctly identifies the two primary aims that set the World Health Organization apart from its predecessors at its formation?

A) To provide emergency medical assistance during times of war and conflict.
B) To establish standards for healthcare delivery in developing countries.
C) To promote health as a basic human right and to ensure the attainment of the highest possible level of health for all people.
D) To conduct research on infectious diseases and develop vaccines.

Answer 40

C) To promote health as a basic human right and to ensure the attainment of the highest possible level of health for all people.

Question 41

True or false: Global governance is distinct from national governance in one critical respect there is no government at the global level.

Answer 41

true

Question 42

Which of the following is likely to influence current prioritization of health issues in a global context?
a) 2021 Climate Change Summit
b) the Sustainable Development Goals
c) the Millennium Development Goals
d) The Global Gag Rule

Answer 42

B

Question 43

True or False: Canada’s Feminist International Assistance Policy recognizes that supporting gender equality and the empowerment of women and girls is the best way to build a more peaceful, more inclusive and more prosperous world

Answer 43

true

Question 44

True or false: Canada’s International Development Assistance is currently guided by the Feminist Development Assistance Policy Agenda?

Answer 44

true

Question 45

QUESTION: What are some of the negative effects religion has on health outcomes?

Answer 45

Some religions are opposed to certain medical procedures
Islam and Hinduism are opposed to organ donations and blood transfusions
Could be a procedure that saves someone’s life
Some religions have dietary restrictions
Seventh-day adventists advocate for a plant-based diet
May not be suitable for everyone long-term
Some religions may be against certain preventative measures such as vaccinations and social distancing
During COVID, some churches still continued to meet in large gatherings
Some churches also discouraged getting vaccinations during COVID

Question 46

Question: What is universal primary healthcare? What is a benefit to implementing this system?

Answer 46

Answer: Universal primary healthcare means that all people have access to a full range of healthcare services when and where they need them with no financial hardship. It is based off the recognition that quality healthcare is a fundamental human right for everyone.

A benefit to universal primary healthcare is that it protects people from negative financial consequences of paying for healthcare out of pocket. Reducing the risk that people will be bankrupt or pushed into poverty when they fall ill.

Question 47

What is the purpose of intercultural approaches to health?

Answer 47

The purpose of intercultural approaches to health is to minimize the gap between Western and Indigenous health systems, which allows the promotion of health equity, the respect of cultural differences, and overall improvement of health outcomes regardless of ethnicity.
An example is the the use of Indigenous medicine and western medicine alongside one another. This approach would demonstrate that combinations can effectively promotes everyone’s well-being. It also further respects people’s beliefs and gives them options to choose what they’re comfortable with.

Question 48

What is planetary health and why is it important?

Answer 48

Planetary health is a field of study that focuses on the interconnectedness between the health of the planet and the health of humans and other living beings. It recognizes that environmental changes, such as climate change, pollution, and biodiversity loss, can have serious impacts on human health and well-being. It is important because it highlights the urgent need for sustainable practices and policies that support the health of the planet and all its inhabitants.

Question 49

What is Global Health security?

Answer 49

actions taken towards public health events that endanger people globally
involved in preventing, detecting, and responding to public health emergencies.

Question 50

What is the global health security index?
What is the limitation of this?

Answer 50

1. Prevention
2. Detection
3. Responding
4. health system
5. Compliance with international norms
6. Risk environment
   Limitation:
   - Ignores social and political determinants of preparedness
   - Draw upon history
   - Focus on biosecurity and biosafety not enough on weak government
   - Ignores past experience in pandemic response

Question 51

What are the 2 types of food aid in Canada?

Answer 51

1. Emergency food aid: short term, to address the immediate needs of population of refugees or displaced people. Giving food, giving schools meals, etc.
2. Development food aid: long term, focuses on helping vulnerable people to enhance their own income and become more self reliant. (tools, technology transfer)

Question 52

What are three key reasons why they didn’t declare a PHEIC before hand?

Answer 52

1. Risk of restriction of travel and trade
2. Risk of airlines stopping flights to that area
3. Risk of border closure

Question 53

What are three common features of NTD?

Answer 53

1. Disease of poverty and disadvantage
2. Neglected by researchers
3. Important factor of morbidity and mortality
4. Do not travel widely (distribution restricted by climate)

Question 54

What are the 4 disadvantages of tied food aid?

Answer 54

• Limited local food markets: loss of their businesses and economic growth loss and long-term dependence on other country
• Political motivation- there is a political reason rather than humanitarian like economic reasons rather than focusing on need
• Ineffective and expensive - transportation of food is expensive and it takes a long time to transport food
• Lack of choice and cultural sensitivity: not all the food may be appropriate for the local population and may lack choices of food which is lack of respect to the culture and traditions.

Question 55

You are part of a WHO team of experts tasked to conduct emergency risks assessment of public health emergencies of international concern. Describe four criteria that would guide your assessment.

Answer 55

1. Scale: number of ppl affected
2. Urgency: response degree of increase mortality
3. Complexity: range of health consequences
4. Content: number of vulnerable people, level of health resources