Global Health Flashcards
What is global health
health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions
Most important risk factors in poorest countries
- Underweight
- Unsafe sex
- Unsafe water and sanitation
- Indoor smoke from solid fuels
- Zinc deficiency
- Iron deficiency
- Vitamin A deficiency
- High blood pressure
- Tobacco
- High cholesterol
Most important risk factors in developed countries
- Tobacco
- High blood pressure
- Alcohol
- High cholesterol
- High BMI
- Low fruit and vegetable intake
- Physical inactivity
- Illicit drugs
- Unsafe sex
- Iron deficiency
Millennium development goals
eight goals to be achieved by 2015 that respond to the world’s main development challenges
8 MDGs
Goal 1: Eradicate Extreme Poverty & Hunger
Goal 2: Achieve Universal Primary Education
Goal 3: Promote Gender Equality & Empower Women
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV/AIDS, Malaria and Other Diseases
Goal 7: Ensure Environmental Sustainability
Goal 8: Develop a Global Partnership for Development
Key actors in global health
Agencies of the United Nations
Multilateral development banks
Bilateral agencies
Foundations
Non-governmental organisations
Global health issues
Great population growth and Changes in age distribution
Low fertility in developed countries
Digital divide
International migration
Global environmental change
International political crisis
International agreements
What is happening to worlds fertility
Decreasing
Births per woman: less developed countries
Decreasing
Births per woman: developed countries
Remains stable
Developing countries account for what percentage of the worlds population
84%
Developing countries account for what percentage of the burden of disease
93%
Developing countries account for what percentage of the global income
18%
Developing countries account for what percentage of the global health spending
11%
Environmental changes
CFCs and stratospheric ozone depletion
Loss of biodiversity within ecosystems
Freshwater decline and land degradation
Loss of natural fisheries
Increasing desertification
Sustainability
Meeting the needs of today without compromising the ability of future generations to meet the needs of tomorrow
Possible consequences of climate change
Heatwaves- bacteria friendly environment
Sea levels rise
New disease
Scarcity of resources
Solutions to consequences of climate change
Control world population
Reduce energy consumption
Get energy from renewable resources
Key actors in global health
United Nations and their agencies (UNICEF/UNAIDS/WHO)
Multilateral developmental banks (world bank/Asian development bank)
Bilateral agencies (USAID/CIDA/DFID)
Private foundations
Non-governmental organisations
Global health partnerships
Examples of private foundations improving global health
Rockefeller foundation
Bill and Melinda gates foundation
Examples of non-governmental organisations improving global health
Doctors Without Borders
Save the children
Defining a migrant
Country of birth
Country of nationality
Duration of stay
Which countries do asylum seekers come from
Pakistan
Iran
Sri Lanka
Syria
Which countries do economic migrants come from
Romania
Poland
Spain
Italy
Bulgaria
Examples of migrant types
Asylum seekers
Refugees
Trafficked people
Migrant workers
Family workers
Family joiners
International students
Causes of vulnerability to migrants
Persecution, war, political and social unrest
Exploitation, torture, rape and bereavement
Burden of disease and socioeconomic status
Lampedusa
Italian island
Closest European territory to shores of Libya
Primary transit point for immigrants from Africa
Deadliest migrant torture in the world
3 leading causes of death in children in developing countries
Pneumonia
Diarrhoea
Malaria
Health challenges of poorest countries
Underweight
Unsafe sex
Unsafe water and sanitation
Indoor smoke from solid fuels
Zinc/iron/vitamin A deficiency
High blood pressure
Tobacco
High cholesterol
Health challenges of developed countries
Tobacco
High blood pressure
Alcohol
High cholesterol
High BMI
Low fruit and vegetable intake
Physical inactivity
Illicit drugs
Unsafe sex
Iron deficiency
Theories of causation of health inequalities:
Psychosocial
Neo-material
Life course
Proportional universalism
Theories of causation of health inequalities: psychosocial
Stress results in ability to respond efficiently to body’s demands
Impact on BP, cortisol levels and inflammatory and neuroendocrine markers
Theories of causation of health inequalities: neo-material
More hierarchical societies are less willing to invest in provision of public goods
Poorer people have less material goods and of less quality
Theories of causation of health inequalities: life course
Combination of both psychosocial and neo-material
Critical periods posses greater impact at certain points in the life course eg childhood
Accumulation of hazards and their impacts add up
Interactions and pathways eg sexual abuse in childhood may lead to poor partner choice in adulthood
Theories of causation of health inequalities: proportional universalism
Focusing on the disadvantaged only will not help to reduce inequality
Action must be universal
Scale intensity proportional to disadvantaged
Fair distribution of wealth
Responses to health inequalities
Ignacz Semmelweis 1847
The block report 1980
The Acheson report 1998
Ignacz Semmelweis 1847
Campaigned for hand washing
Found correlation between puerperal fever and dissection
The block report 1980
Material- environmental causes, might be mediated by behaviour
Artefact- an apparent product of how the inequality is measured
Cultural/behavioural -poorer people behave in unhealthy ways
Selection- sick people sink socially and economically
The Acheson report 1998
Income inequality should be reduced
Give high priority to the health of families with children
What does QALYs stand for
Quality adjusted life years
Use of QALYs
Used in some economic evaluations to measure health
Combines length and quality of life
Allows one to compare interventions that have different types of effects
Makes funding decisions easier
Health economics:
Basic economic problem
Opportunity cost
Economic efficiency
Health economics: basic economic problem
Finite limit to resources
Desire for goods and services is infinite
No country treats all treatable ill health- rationing
Choose cannot be avoided
Health economics: opportunity cost
Cost of any decision measured in terms of the next best alternative that had to be sacrificed /forgone in the making of the decision eg balancing time and money
Loewy approach
Efficiency approach
Loewy approach to health economics
Select a few from all treatment options
Efficiency approach to health economics
More from the cheapest areas
Ignores expensive treatments
Health economics: economic efficiency
Resources are allocated to maximise benefit (defined in terms of health)
Economics evaluation used to assess whether health is maximised
What is economic efficiency sometimes incorrectly referred to as
Cost effectiveness
Economic evaluation
Measures economic efficiency
Cost and effects are a a,used in terms of their differences
Types of economic evaluation
Cost minimisation analysis
Cost effectiveness analysis
Cost utility analysis
Cost benefit analysis
Cost minimisation analysis
Outcomes equivalent to
Cost effectiveness analysis
Outcomes measured in natural units
Cost utility analysis
Outcomes measured to QALY
Cost benefit analysis
Outcomes measured in monetary units
Effectiveness ration equation
Incremental costs/ difference in QALY
Incremental costs equation
New treatment cost - old treatment cost
QALY equation
Years increase x utility time
There are large geographical inequalities in mortality and morbidity in the UK: Tudor-Hart (1970) suggested that access to health care tends not to be proportionate to the actual need for care in the population served. Which term below best describes this concept?
Inverse care law
Factors that are important when deciding what to fund in nhs
Size of problem
Effectiveness of intervention
Alternatives”
Fault?
Health problem?
Is NHS responsible?
Special population
Large payback for treatment?
Is the disease population particularly deserving?
Scarcity
Resources are limited
Desire for goods and services exceeds current resources
Opportunity cost of a choice
The lost benefit of the best alternative
- the sacrifice in terms of the benefits forgone from not allocating resources to next best activity
Eg spending spare budget on hip replacements means it can’t be spent on mental health services. The opportunity cost is the lost benefit of the mental health services.
Economic efficiency
Achieved when resources are allocated between activities in such a way to maximise benefit
-maximum health benefit from fixed budget
Economic evaluation
Assessment of economic efficiency
Comparative study of the costs and benefits of health care interventions for some given disease
Analysed in terms of their increments or differences between the interventions
Natural units examples
Blood pressure
Pain score
Number of cases detected
Walking distance
Blood cholesterol
QALYs
Quality adjusted life years
Combines length and quality of life
-full health has a utility of 1
-death has a utility of 0
Advantages of QALYs
Allows comparison across diseases
How to calculate QALYs
Length (years) x quality (utility) weighing (0 - 1 scale)
1 year perfect health = 1 QALY
2 years with utility of 0.5 = 1 QALY
Monetary value
Health is measured in monetary terms
This draws on the idea of “willingness to pay”
How much is someone prepared to pay for some health benefit?
Difficult to determine in a healthcare system that is free at the point of use
Has various problems: richer people might be willing to pay more than poorer people. Does this mean their health is more valuable? Is this fair?
What are measured to calculate monetary units
All relevant costs eg drug treatment, hospital stay, outpatient appointments
-costs to nhs
How is health benefit measured
Natural units
QALYs
Monetary value
4 types of economic evaluation
Cost-effectiveness analysis
Cost-utility analysis
Cost-benefit analysis
Cost-minimisation analysis
What can reduce senescence burden
Exercise
Drugs
Cost-effectiveness analysis
Outcomes measured in natural units
Costs in monetary units
Cost-utility analysis
Outcomes = QALYs
Cost = monetary units
Cost-benefit analysis
Outcomes = monetary units
Costs = monetary units
Cost-minimisation analysis
Outcomes = any units
Equal in both treatments
So just minimise cost
Incremental cost effectiveness ratio
The incremental cost of one treatment versus another, divided by the incremental benefit of one treatment versus another
Cost New - Cost Old
Benefit New - Benefit Old
Incremental cost effectiveness ratio example
New drug
Costs £25,000 per person
6 QALYs of benefit
Existing drug
Costs £10,000 per person
5 QALYs of benefit
ICER = (£25,000 – £10,000) / (6 – 5)
= £15,000 per QALY gained
What department decides if a new treatment should be available on the NHS
NICE (national institute of health and care excellence)
How much is the NICE threshold
£20000
How we value a QALY
NICE thinks that any services that are closed down to fund new services probably generate benefits at a cost of about £20,000 per QALY gained
Taking £20,000 from somewhere else in the NHS to fund a more expensive drug therefore loses 1 QALY
So, it only makes sense to fund new things if we get at least 1 QALY per £20,000
Equivalent to requiring the cost to be less than £20,000 per QALY gained for something to be cost-effective
£20,000 is called the “NICE threshold”
Equity
Fairness or justice of the distribution of costs and benefits
Rationing
Choose not to fund some treatments
