Global health & disasters Flashcards
1
Q
What is the most important health determinant?
A
Income
2
Q
What pulls several African countries down the lifespan/income graph?
Gapminder graph
A
HIV to left bottom of graph
3
Q
How many people die per year?
A
60 million
4
Q
What is the average years people live?
A
72 years
5
Q
What is the most common cause of death?
A
CVD
6
Q
How many people live in another country than they were born?
A
4% of the world pop
7
Q
What % of the world population is above 65 years?
A
10% - country with oldest ppl is Japan
8
Q
In which type of countries are ppl most dissatisfied with their lives?
A
Low-income countries - often a misconception that is HIC
9
Q
How much more money does USA spend per capita on HC compared to DRC?
A
250x more
10
Q
What share of the world pop is living in LMIC?
A
87%
11
Q
Describe the history of life expectancy
A
- Last 200 years changed the world.
- In 1809 all countries had LE under 40 years & income PP less than $3000/ year.
- After WW2 most countries started to improve.
12
Q
Why is ending poverty crucical to stop population growth?
A
Only by raising living standards of the poorest, will population growth stop at 9 billion ppl in 2050.
13
Q
What is the average # of babies per woman?
A
2.3
14
Q
If today there are 2 billion children how many would there be at the end of the century?
A
2 billion
15
Q
What is the relation between child death in Africa and Europe?
A
Child death in Africa today are at the same level as in Europe in 1950
16
Q
What % of children are born through C-section?
A
Out of 130 mil children born each year, 25-30% are born through c-section
17
Q
Why is there a decrease in babies?
A
- girls education increasing
- pill
- decrease child mortality
- economic independence of women
- children not needed to work in the field (due to urbanisation)
- urbanisation everything expensive (day care, education, living, etc)
- religion decreasing
- policies in some countries
- women working more outisde of home
18
Q
When did each continent reach peak child?
A
- Europe - 1968
- Latin America - 2002
- Asia - 2004
- North America - 2019
- Africa - 2080
19
Q
What is the relationship between low income and HIC with LE?
A
Low income countries tend to have a lower LE than HIC
20
Q
Explain the differences within an income group and their LE
A
- Minority groups within countries (in all income levels) have lower LE than rest of pop, but as country gets richer & healhtier, health of minorites also improve.
- No minority group in middle & high income countries that has a LE lower than the average in poor countries
21
Q
How do we measure the burden of disease?
A
Instead of looking at # of deaths, look at life years lost & healthy life yrs lost (DALY).
22
Q
What is DALY used for?
I think
A
Used to compare what makes ppl sick & suffer between populations & over time
23
Q
Are CVD deaths increasing, unchanged or decreasing?
A
- All of them.
- Better prevention & treatment therefore better dealing with CVD.
- But not a good question coz no info about country, time, etc
24
Q
What is extreme poverty?
A
Lowest & is living <$2.15/day
25
What is relative poverty?
* house receive **50% less** than average household incomes.
* have some money but not enough to afford anything above basics.
* **changeable** depending on **economic growth** of country!
26
What is absolute poverty?
* house income below certain level = impossible to meet basic needs
* even if country growing economically = no effect on ppl living below pov line
* compares houses based on set income level
27
What is determinants of health?
range of behavioural, biological, socio-economic & environmental factors that influence the health status of individuals or populations.
28
What are the basic requirements for good health?
in reality not many, but interact in a very complex way
29
What do the determinants of health include?
* Physical environment
* Social & economic determinants
* Individual characteristics & behaviour
30
What are the determinants of health?
* Physical environment
* Social & economic determinants
* Individual characteristics
* Lifestyle
* Food
* Water
* Sanitation
* Housing - does this go somewhere eslse?
* Health services
* Wealth?
31
What are the physical environment determinants?
* Air & energy
* Climate
* Natural disasters
32
What are the socio-economic determinants?
* Gender
* Security
* Occupation
* Education
* Poverty
* Income
* Social support
* Culture
* Equity
33
What individual characteristics are important as a determinant of health?
* Age
* Sex
* Gender
* Family history / genetics
34
What lifestyle/behaviours are important for determinants of health?
* Smoking
* Alcohol consumption
* Diet
* Physical activity
35
How are food & water determinants of health?
food/water security (quality, quantity & accessibility
36
How is sanitation a determinant of health?
* quantity, quality & accessibility
* Protect against disease transmission
* Eliminate bad smell
* Stop insect breeding
* Privacy
37
**how are health services & wealth determinants of health?
* health services - health systems
* wealth - most important determinant?
38
How do diseases, conflicts or disasters infleunce socioeconomic determinants?
* E.g. EQ can cause financial stress = higher mortality rates
* E.g. Unemployment rates increase after hurricane
39
How do diseases, conflicts and disasters influence food as a determinant of health?
* post-disaster environment often rely on processed foods.
* after EQ access to fresh food limited = higher salt intake = exacerbated hypertension & risk for HD
| Examples
40
How does disease, conflict & disasters influence water & sanitation as a health determinant?
* floods & tsunamis often compromise water sources = **outbreaks** of waterborn diseases coz lack of clean drinking water & poor hygiene infrastructure
* **disrupted water supplies** = significant barriers to maintaining health & hygiene
* poor sanitation in overcrowded shelters = **increase prevalence of infectious diseases**
| Examples
41
How do disease, conflict & disasters influnece behaviour as a determinant of health?
* after hurricane = increase in smoking = increase CVD risks
* after EQ = limited opportunities for exercise = increase physical health issues
* poor coping mechanisms e.g. alcohol due to prologned stress & uncertainty
| examples
42
How does inadequate preparation influence vulnerable communities?
Experience **prolonged health impacts** compared to those with DRM plans
43
What can enhance disaster resilience?
**Investments of underlying determinants of health & vulnerability** enhance disaster resilience → **cost-effective & lifesaving**
44
What is climate change?
change in mean and/or variability of climate that continus for extended periods of time
45
How is Earth climate warming?
* Warmer atmosphere & oceans
* less snow & ice
* higher sea-level
46
What are the types of causes of climate change?
* Anthropogenic (human-induced)
* Natural
47
What are the types of anthropogenic causes of climate change?
* GG: industry, generating power, transporation, food production
* Deforestation
* Reflection/absorption of sun's energy
48
What are the natural causes of climate change?
* Variations in solar activity
* Changes in Earth's reflectivity
* Volcanic activity
* Ocean currents
49
Whar are the main emmissions of GG?
* 80% CO2
* 11% methane
* 6% N20
* 2% HFCs
50
What is the greenhouse effect?
process through which heat is trapped near Earth’s surface by greenhouse gases
51
What are the impacts of climate change?
* Water availability & food production
* Health & well-being
* Cities, settlements & infrastructure
* Biodiversity & ecosystems
52
How does CC impact water availability & food production?
* Physical water availability & quality
* Agriculture/crop production - crops no longer suited to current growing regions
* Animal & livestock health & productivity
* Fisheries yield & aquaculture production
53
How does CC impact health & well-being?
* Infectious diseases
* Heat, malnutrition & harm from wildfire
* Mental health
* Displacement
54
How does CC impact cities, settlements & infrastructure?
* Inland flooding & associated damages
* Flood/storm induced damages in coastal areas
* Damages to infrastructure
* Damages to key economic sectors
* Economies - tourism destination popularity & viability changes. Heating & cooling will increase energy demands
* Urban areas more exposed to extreme heat, precipitation & sea level rise
55
How does CC impact biodiversity & ecosystems?
* Terrestrial ecosystems
* Freshwater ecosystems
* Ocean ecosystems
changes in ecosystem structure, species range & seasonal timing
56
What are the implications for health of CC?
**Mode of action**
* Direct effects
* Indirect effects
**Temporal axis**
* Short-term effects
* Long-term effects
57
What are the **direct** effects of CC for implications for health?
* Direct mode of action of exposure on health
E.g. heatwave leading to heat stroke
58
What are the **indirect** effects of CC for implications for health?
Climate affects health through intermediate pathways
* E.g. heat wave = drought = food & water shortage = malnourishment/starvation
59
What are the **short-term effects** of CC for implications for health?
E.g. heat wave leads to almost immediate increases in daily deaths
60
What are the **long-term effects** of CC for implications for health?
E.g. warming = spread of disease vectors more north in Europe
61
*What are the vulnerability factors of CC?
* Demographic factors
* Geographic factors
* Biological factors & health status
* Sociopolitical conditions
* Socioeconomic factors
62
*What are the exposure pathways for CC?
* Extreme weather events
* Heat stress
* Air quality
* Water quality & quantity
* Food security & safety
* Vector distribution & ecology
63
*What factors of health system capacity & resilience can influence the vulnerability to CC?
* leadership & governance
* Health workforce
* Health information systems
* Essential medical products & technologies
* Service delivery
* Financing
64
*What are the climate-sensitive health risks of CC?
* Health outcomes
* Health systems & facilities outcomes
65
*What are the health outcomes of CC?
* Injury & mortality from extreme weather events
* Heat-related illness
* Respiratory illness
* Water-borne diseases & other water-related health impacts
* Zoonoses
* Vector-borne diseases
* Malnutrition & food-borne diseases
* NCDs
* Mental & psychosocial health
66
*What are the health systems & facilities outcomes of CC?
* Impacts on HC facilities
* Effects on health systems
67
How does CC harm health before birth?
**Prenatal**
* **poor pregancy outcomes** (e.g. low birth weight & pre-term delivery)
* increased risk of **low birth weight** & **neonatal death**
68
How does CC harm health during infancy?
* **Higher risk for heat-related illness** because developing babies are less able to control temperature
* Heightened risk of **water & food-borne infections** while immune system is developing
69
How does CC harm health during childhood?
* Long term **lung problmes** & more frequent **asthma attacks**
* Outdoor exposure increases risks of diseases from insects like **lyme disease**
70
How does CC harm health during adolescence?
* **Post-traumatic stress** & **anxiety** in survivors
* Negative impacts on **ability to think, outdoor recreation & ability to play sports**
71
*Why is there unequal vulnerability in health & climate?
72
What is a heatwave?
* extended period of hot weather relative to expected conditions of area at that time of year & can be accompanied by high humidity.
* differs per country
73
What are the types of factors that influence vulnerability to heat?
* Individual factors
* Contextual factors
74
What are the individual factors that infleunce vulnerability to heat?
* Age
* Health status
* Personal behaviour
* SES
* Medications
* Isolation
* Pregnancy
75
What are the conxtextual factors that infleunce vulnerability to heat?
* Air conditioning
* House type
* Urban design
* Access to HC
* Neighbourhood SES
* Urban heat island
* Green areas
* Air pollution
* Local climate
76
Howe does CC influence wildfires?
* Changes in weather (wind & humidity)
* Rising temperatures = drier forest conditions
* increase in bark beetle infestation
* Earlier snow melt = less water later in the year?
77
What happens during a wildfire?
* Forest destruction & soil erosion
* Property destruction
* Release of pollutants (ozone, CO2, particulate matter)
78
What are the health impacts of wildfires?
* Death
* ED visits
* PTSD (MH)
* Burns (skin)
* Heart issues
* Poor water quality & supply
* Respiratory problems (LC, chest pain, asthma, COPD)
79
Explain climate change & flooding
* Precipitation & runoff patterns are changing
* Hydrologic records can't be used to predit changes in frequency & severity of extreme climate events such as floods
* Frequent wildfires increase risk for flood following fire events
80
What happens with flooding events?
* landslides & mud-slides
* Erosion
* Water contamination
* Property damage
81
What are the health impacts of flooding events?
* MH issues
* Drowning
* Electrocution
* Eye, ear, skin & gastronintenstinal infections from water contamination
* Carbon monoxide
* Injuries or death from structural damage
* Respiratory illnesses from mold after the flood recedes
* Hypothermia
82
What are environmental migrants?
- person who is obliged to move due to environment conditions affecting their life or living conditions.
- Can move temporary or permanently and within country or outside
83
How does CC impact health systems?
* Utilisation
* Costs
* Disruption of care
* Public health
84
How does CC influence utilisation of health systems?
* Poor health from direct & indirect effects → higher utilisation of care
* all parts of system will change
85
How does CC influence costs of health systems?
* Greater demand for care
* Extreme weather events & diversion of resources
* Higher costs for payers as demand increases
86
How does CC impact disruptions of care of health systems?
* Access to services is reduced or completely stopped
* Damage/destruction to electricity, sewage systems, water supply, roads, communication networks & supply chains
* Maintaing care for both new & routine needs
87
Why is CC a global health emergency?
- **increasing** burden of heatwaves
- infectious diseases
- malnutrition
with impacts on **vulnerable populations**
88
Why are health systems under pressure due to CC?
* increased demand
* disruptions to infrastructure
* need for enhanced preparedness & surveillance
89
What are essential strategies to **protect global health** & **promote equity**?
both **mitigation** (reducing emissions) & **adaptation** (implementing heat action plans, EWS & resilient health systems)
90
What is a Heat Action Plan (HAP)?
strategic framework designed to reduce health impacts of extreme heat events.
91
What are the key objectives of a HAP?
* Prevent heat-related illness & deaths
* Increase preparedness
* Mitigate long-term impacts
92
How do we prevent heat related illness & deaths according to HAP?
* Address immediate healthrisks during heatwaves
* Protect vulnerable populations
93
How do we increase preparedness according to HAP?
build **capacity** within health systems & communtities to respond effectively
94
How do we mitigate long-term impacts according to HAP?
adapt **urban planning** & **infrastructure** to reduce future vulnerabilities
95
96
What are core elements of a heat-health action plan (HHAP)?
1. Agreement on lead body
2. Accurate & timely alert systems
3. Heat-related health information plan
4. Reduction in indoor heat exposure
5. Particular care for vulnerable population groups
6. Prep of health & social care system
7. Long-term urban planning
8. Real-time surveillance & evaluation
97
Example: heatwave in Ahmedabad 2010. What was their HAP (key interventions)?
* Building public awareness & community outreach
* Initiating an EWS & Inter-Agency Coordination
* Capacity building among HC professionals
* Reducing heat exposure & promoting adaptive measures
* Monitoring of impact of heat action plan on health
98
What is a health system?
consist of all organisations, people & actions whose primary interest is to promote, restore or maintain health (WHO)
99
Why are health systems important?
Health systems that can deliver services **equitably** & **efficiently** are critical for achieving **improved health status**
100
What are the objectives of a health system?
* improve health of ppl they serve
* respond to people’s expectations
* provide financial protection against the cost of ill health
101
What are characteristics of NCDs?
* Not passed from person to person
* Of long duration
* Generally with slow progression
102
What are the big 4 NCDs?
1. CVDs
2. Cancers
3. Chronic respiratory diseases
4. Diabetes
103
Why is there a debate on renaming NCDs?
Name of NCDs give sense of security coz its not communicable - it gives a wrong sense of security
104
What causes most deaths in Sweden, India & SA?
**Sweden:**
* Ischemic heart disease (IHD)
* Alzheimers disease
* Stroke
**India:**
* COVID
* IHD
* COPD
**SA:**
* COVID
* HIV/AIDS
* Stroke
105
What are the most causes of deaths in Indonesia?
* Stroke
* IHD
* COVID-19
106
What risk factors contribute most to death & disability in Indonesia?
* High BP
* Tobacco
* Dietary risks
107
What are common misunderstandings of NCDs?
* CDs mainly affect **rich**
* CDs mainly affect **old**
* CDs **can't be prevented**
* CDs prevention & control is **too expensive**
* CDs mainly affect **HICs**
* LMIC should **control** infectious diseases before CDs
* CDs result of **unhealthy** lifestyles
| CD = chronic diseases
108
What is global health governance (GHG)?
use of formal & informal institutions, rules & processes by states, intergovernmental organizations, and non-state actors to deal with **health challenges** that require **cross-border collective action** to address effectively.
109
*What is the IHR?
- Legally binding regulations for countries to manage PH risks that have the potential to cross borders
* adopted in 1969
* Revised in 2005
110
What does IHR require?
all countries detect, assess, report, and respond to public health events.
111
Who are the key institutions for GHG?
1. **WHO**
2. **UNAIDS**
3. **UNICEF** - children emergency fund
4. **UNFPA** - fund for pop activities
5. **World Bank Group**
6. **GAVI** - vaccine alliance
7. **GFATM** - Global funds on aids, tb, malaria
8. **BMGF** - bill & melina gates foundation
9. **Rockefeller** foundation
10. **Welcome Trust**
112
Who are the **NGOs** in GHG?
* Red Cross, ICRC
* MSF
* Faith-based organisations
113
Which **private sectors** are involved in GHG?
* pharmaceutical industry
* manufacturing industry
* private providers in HC
114
Which civil societies are involved in GHG?
* Civil rights movements
* Patient organisations
115
What organs are part of the immune system?
* **Skin** - very imp
* mucus membranes
* tonsils
* gastro-intestinal
* **spleen** - important
* lymph vessels & nodes
* thymus
* bone marrow
116
What happens when there are disturbances to the immune system?
greater susceptibility to communicable diseases
117
What are diagnostics for CDs?
| CD = communicable disease
* Patient history
* Examination
* Bacterial culture
* PCR
* Serology
* Antigens
* Radiology
118
Why are diagnostics important?
Essential for monitoring & evaluation
119
What are the types of treatments?
* Antibiotics
* Antivirals
* Antimycotics
* Antiparasitics
* Anti-inflammatory drugs
* Surgery
* Supportive treatment
120
*Why would you treat an communicable disease with anti-inflammatory drugs?
121
Why would you treat an infectious disease with surgery?
Sepsis, necrotizing faciatis, abcess
122
What are prevention methods for communicable diseases?
* Vaccines
* Infection control?
* Treatment
* Support of the immune system
* Infrastructure, water, sanitation, hygiene
123
How are communicable diseases transmitted?
* **Airborne** (e.g. COVID, measels)
* **Droplets** (e.g. airway viruses)
* **Contact** (direct or indirect) (e.g. fecal-oral, airway viruses, STIs)
* **Blood** (e.g. hep B & C, HIV)
* **Vectors** (e.g. malaria, dengue)
124
How is TB transmitted?
through air by coughing, sneezing, etc
125
How should TB infection be controlled according to CDC?
* **Administrative controls**
* **Environmental controls** - control air around environment
* **Respiratory protection** - personal respirator
126
What are the administrative controls for TB infection control?
* Ministry of health - CDC
* Guidelines, routines, "best-practice"
* Infection control responsible person in every HC facility
* National, regional & local infection control plan
* Training of staff
* **Early diagnosis & treatment**
* Follow up, registers, M&E, accountability
127
*What are the environmental controls for TB infection control?
* Reducing amounts of bacilli in air
* **Ventilation** - isolation rooms with negative pressure, high turnover of air in room
* UV light - sunlight & lamps?
128
What is respiratory protection for TB infection control?
* Respirator - filters 65-85% of aersol in air
* Surgical mask & "cough hygiene" - for patient. This reduces amount of droplet nuceli in air by about 50%
129
What factors contribute to spread of CDs?
* AMR
* Emerging & re-emerging infectious diseases
* Urbanisation
* Social inequality
* Political instability (war)
* Lack of access to essential medicine
* Increased mobility (refugees, IDP, tourism)
* Climate change (hydrological/meteorological disasters, water scarcity, vector mobility)
130
What is prevalence?
number of cases within a population
131
What is incidence rate?
number of **new** cases within a pop during certain time
132
What is basic reproduction #, R0?
Expected number of cases directly generated by one case in a population where all individuals are susceptible to infection
133
What is attack rate?
Proportion of at risk population that contracts disease during a specified time interval
134
What is case fatality rate?
Proportion of cases that die from the disease
135
What is virulence?
A microorganisms ability to cause damage to a host
136
What is antimicrobial resistance (AMR)?
ability of microbes to protect themselves against antimicrobials
137
What are the types of antimicrobials?
* antibiotics/antibacterials
* Antivirals
* Antiparasitic agents
* Antifungals
138
What are antibiotics/antibacterials used for?
against bacteria e.g. drugs for bacterial pneumonia
139
What are antivirals used for?
against viruses, e.g. drugs for herpes & HIV
140
What are antiparasitic agents used for?
against parasites e.g. drugs for malaria
141
What are antifungals used for?
against fungi e.g. drugs for yeast infections
142
What is the global action plan on AMR?
* **improve awareness** & understanding of AMR
* Strenghten knowledge & evidence through **surveillance** & research
* Reduce incidence of infection through effective sanitation, hygiene & **infection prevention**
* optimize use of antimicrobial medicines
* **increase investment in new medicines**, diagnostic tools, vaccines, etc
143
What is health?
state of complete, physical, mental & social well-being & not merely the absence of disease or infirmity
144
What is global health?
area for study, reserch & practice that places a priority on **improving health** & a**chieveing equity in health** for all people worldwide.
145
What is health financing?
improving effective service coverage & financial protection for UHC
146
What are the health system building blocks of WHO?
1. Service delivery
2. Health workforce
3. Information
4. Medical products, vaccines & technologies
5. Ginancing
6. Leadership/governance
147
What are the system goals/outcomes of WHO health systems framework?
1. Improved health
2. Responsiveness
3. Social & financing risk protection
4. Improved efficiency
148
What are the WHO system building blocks not?
Aren't metrics to see how well the HC system operates, you need **indicators** for that
149
How do people fund their OOPs?
| WHO building block: Financing
* Salary or other regular income
* Savings
* Loan, borrowing
* Sale of house, land, livestock or assets
* Other sources
150
What is UHC?
everyone has access to full range of quality health services they need, when & where they need them, without financial hardship
151
What objectives does UHC refer to?
1. Access to high quality services
2. Financial protection
152
How is financial protection measured?
Indicators that assess impacts of OOPs:
* Impoverishing health spending/OOPs
* Catastrophic health spending/OOPs
153
What is impoverishing health spending/OOPs?
push households below the poverty line or further below it
154
What is catastrophic health spending/OOPs?
OOP payments greater than 40% (>40%) of household capacity to pay for HC
155
What is service delivery?
effective, safe, and accessible healthcare services to meet the population’s needs.
156
What can happen if there are increased inputs for service delivery?
Increased inputs should = improved service delivery & enhanced access to services
157
What is health workforce as a WHO building block?
all ppl engaged in actions whose primary intent is to enhance health.
Includes:
* clinical staff (e.g. physicians, nurses, etc)
* management & support staff (don’t deliver services directly but are essential to performance of health systems, e.g. managers, ambulance drivers & accountants)
158
What is the purpose of health information systems?
* generate info to enable decision-makers to **identify problems & needs**
* make evidence-based decisions on health policy & allocate scarce resources optimally
159
160
Are CVD deaths higher than heat-related deaths or opposite?
CVDs cause of death exceed heat-related deaths
161
When can people experience financial hardship or unmet need?
Where there are OOPs with implications for poverty, health & inequalities
162
How is financial protection measured?
Indicators assess impact of OOPs on ppl:
* **imporverishing healh spending/OOPs**
* **catastrophic health spending/OOPs**
163
What is impoverishing health spending/OOPs?
push households below poverty line or further below it
164
What is catastrophic health spending/OOPs?
OOP payments greater than 40% (>40%) of household capacity to pay for HC
165
What are problems with the financial protection indicators?
capture financial hardship arising from use of health services, but don’t indicate whether OOP payments create barrier to access = in unmet need.
166
What can happen with a lack of financial protection?
can lead to or deepen poverty, undermine health & exacerbate health and socioeconomic inequalities
167
What are 4 ways to fund health facilities?
* Input-based funding
* Fee for service
* Case based payment
* Capitation
168
*What is input-based funding?
Allocate resources accoridng to how
168
What is fee for service?
payment for each unit of service, such as a visit or surgical procedure.
169
How has the health system transformed in the 20th century?
* **from "colonial" to national**(Alma-Ata decl, 1978, health for all, focus on primary HC & UHC)
* **From public to private** (& partnerships, PPP)
* **Refoucs on primary HC** (Astana decl, 2018, commemorated Alma-Ata)
170
How do the WHO building blocks interact?
* e.g. strong HC staff (trained) is ineffective if poor financing
* good governance ensures policies that promote equitable service delivery & access to meds
171
What is the purpose of health information systems?
| WHO building blocks
generate info to enable decision makers at all levels to:
* identify **problems & needs**
* make evidence-based **decisions on health policy**
* allocate scarce **resources** optimally
172
What is health information systems essential for?
| WHO building blocks
* health system policy development & implementation
* governance & regulation
* health research
* human resources development
* health education
* training, service delivery & financing
173
What does a well-functioning health system ensure?
| WHO building blocks
Equitable access to essential medical products, vaccines & technologies
174
Which building blocks if monitoring access to essential medicines closely intertwined with?
* service delivery
* governance
175
When is UHC present?
when everyone has access ot high-qualioty health services & is protected from major health associated financial shocks via a tax-based financnig system or a health insurance plan.
176
When can brain drain happen?
when health system staff are talented but demoralized who either go abroad or move into private practice
177
What can happen when health system staff in LIC are inadquately trained, poorly paid & work in facilities with chronic shortages of equipments?
can = brain drain
177
What are the 3 levels of income taxation?
* state
* regional
* municipal
178
Explain the state income taxation
* social insurance
* pensions
* housing benefits
179
Explain regional income taxation
* health care
* public transport
180
Explain municipal income taxation
* social services
* care of elderly
* social assistance
181
What role does access, coverage, quality & safety have?
| WHO building blocks (middle seciton)
Act as intermediate objectives that link the building blocks to the final health outcomes
182
How does **access** contribute to final health outcomes?
| WHO building blocks
* ensuring ppl can reach & use health services when needed
* access to HC = a human right
* availability, accessability, affordability, acceptability
183
How does **coverage** contribute to final health outcomes?
| WHO building blocks
proportion of population receiving essential health interventions
184
How does **quality** contribute to final health outcomes?
* ensuring that health services are effective & meet safety standards
* quality of care is bigger issue that access to HC
185
How does **safety** contribute to final health outcomes?
preventing harm from medical care e.g. infections or medication errors
186
What is missing from the WHO building blocks framework?
* the patient
* different levels & logics
* system
187
Why is HC system a complex adaptive system (CAS)?
* not just hospitals, docs, meds & polciies
* multiple interconnected components that interact in **dynamic, unpredictable & evolving** ways
188
What are characteristics of a complex adaptive system?
1. Mutliple interacting components
2. Non-linearity (small changes have big effects)
3. Emergent behaviour
4. Adaptability & self organisation
5. Feedback loops
6. Uncertainty & unpredictability
189
Explain **multiple interacting components** as a characteristic of CAS in health
* health system includes patients, providers, hospitals, policymakers & technology
* each component affects & is affected by others (e.g. new health policy changes how hospitals operate which influences patient care)
190
Explain **non-linearity** as a characteristic of CAS in health
small policy change (e.g increasing nurse wages) can lead to unexpected consequences (e.g. improve patient care but higher HC costs)
191
Explain **emergent bahviour** as a characteristic of CAS in health
* outcome emerge from interactions, not just from individual parts
* e.g. even if hospitals & doctors function well, poor communication between can lead to inefficient care & poor patient outcomes
192
Explain **adaptability & self organisation** as a characteristic of CAS in health
* health systems constantly respond to new diseases, policies, technologies & population needs
* e.g. rapid adaptation of health services during covid
193
Explain **feedback loops** as a characteristic of CAS in health
* decisions in the system crate feedback loops that shape future actions
* e.g. if government reduces HC funding, less doctors may be trained = long-term shortage
194
195
Explain **uncertainty & unpredictability** as a characteristic of CAS in health
* health systems don't always behave in predictable, cause & effect ways
* e.g. policy to reduce hospital wait times can lead to overburdened ER instead.
196
Why is viewing health systems as CAS important?
* traditional models see system as mechanical & predictable but they're **dynamic & evolving networks**
* policy & intervention design should be **flexible, iterative & adaptive** instead of rigid
* system thinking approaches (e.g. **improving communication** across sectors) are more effective than isolated solutions
197
Why systems thinking?
* every intervention has affect on overall system & overall system has effect on every intervention
* ST can provide way forward for operating more successfully & effectively in complex, real-world settings
* ST can increase likelihood that health system strengthening investments & interventions will be effective
198
.
199
What is health system resilience?
Capacity of health system to absorb shocks, adapt to changing circumstances & transform itself when necessary to continue delivering esential health services.
199
What are the risk factors for NCDs
* smoking
* alcohol
* physical inactivity
* lifestyle?
200
Describe NCDs in poorest populations
* lower financial or physical access to prevention, diagnosis & treatment
* increase in structural challenges that diminish effectiveness of interventions
= late diagnosis, lower treatment adherence, low quality of care received.
201
What is multi-morbidity?
co-existence of 2 or more chroic conditions in same individual
202
What are significant threats to the poverty trap?
Comorbidities of chronic NCDs & COVID
203
What is the global north & global south concept?
distribution of wealth & power between specific countries in the world
204
What is the global south?
countries with lower-middle income background mostly in Southern hemisphere
205
What is the global North?
wealthy & powerful regions predominantely in the north
206
What is decolonisation?
process by which colonies become independent of the colonizing country
207
What are the types of coloniasm?
1. Settler colonialism (e.g. US)
2. Extractive Colonialism (e.g. DRC)
208
What was wealth of the global north built on?
built on slavery, colonialism & exploitation of global south
209
What shapes the current state of GH?
political & economic interests of former colonial powers & neo-colonial powers
210
How is coloniality in GHs present?
* parachute research (north goes to south with superior/white perspective)
* research tools & metrics used
* hiring policies, international policies
* GH governance
* conduct & publication practices
211
What is positionality?
how individual’s **social identity, background & experiences** shape their perspective, biases, and interactions with the world.
212
What is intersectionality?
examines how **different aspects of person's identity** (e.g. race, gender, class, disability, sexual orientation, etc) **interact & create unique experiences** of privilege or oppression.
213
What is decolonising GH?
ongoing movement aimed at addressing & dismantling historical & contemporary power imbalances, inequities & colonial legacies within the field.
214
How can we decolonise GH?
* look at where the power imbalances are
* understand local & global context
* address historical legacies
* dismantle contemporary inequities
215
What is equality?
* assumption is tht everyone benefits from same supports.
* considered equal treatment
216
what is equity
everyone gets the support they need
217
what is justice?
* cause(s) of inequity is addressed.
* systemic barrier is removed
218
What is reflexivity in decolonising GH?
refers to a continous, collaborative & multifaceted practice of self examination & critical awareness
219
What does reflexivity in decolonising GH involve?
* self-understanding
* dialogue approach
* aciton-oriented process
220
Why reflexivity in decolonising GH?
serves key purposes:
* addressing power asymmetries
* improving research practices
* promoting transformation
* enhancing cultural safety
221
How did COVID affect gender & sex differently?
* men more at risk for worse outcomes & death coz of gender-based norms, making men more vulnerable
* biological sex of women provides females protection against covid
222
What is a syndemic?
interaction between multiple health threats, often exacerbated by societal circumstances, which together contribute to an excess burden of disease
223
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/
224
Why are there emerging infectious diseases?
* Driven by ecological changes
* Viruses
* Zoonoses
225
What is Re-Act?
Global network working to ensure sustainable access to effective antibiotics for ALL in need
226
Why is there a decrease in pharmaceuticals for antibiotics?
* stricter regulations on each ingredient
* antibiotics only few days & NCDs for longer
227
What is antimicrobial/antibiotic stewardship?
systematic approach to educate & support HC professionals to follow evidence-based guidelines for prescribing & administering antimicrobia
228
What is WHO-AWARE?
* A - access
* Wa - watch
* Re - reserve
229
What is meant by **access** in WHO-AWARE?
* indicates antibiotic of choice for each of 25 most common infections.
* antibiotics should always be avialable, affordable & quality assured.
230
What is meant by **watch** in WHO-AWARE?
* most of the 'highest priority critically important antimicrobials' for human medicine & veterinary use
* recommended only for specific, limited indications
231
What is meant by **reserve** in WHO-AWARE?
antibiotics only used as a last resort when all antibiotics have failed
232
What are the contextual factors that can there be in a humanitarian crisis & that fuels the problem of antibiotic resistance?
233
What is article 25.1 in the Universal declaration of human rights?
“Everyone has the right to a standard of living adequate for the health & well-being of himself & of his family, including food, clothing, housing & medical care & necessary social services & the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood in circumstances beyond his control”
234
What is article 12.1 of the International Covenant on Economic, Social & Cultural Rights (ICESCR)?
the right of everyone to the enjoyment of the highest attainable standard of physical & mental health
235
What is sexualy & reproductive health?
state of physical, emotional, mental & social well-being in relation to all aspects of sexuality & reproductive, not merely the absense of disease, dysfunction or infirmity.
236
Why is there a slow increase in use of modern contraceptive methods?
* Limited choice of methods
* Limited access to services, particularly among young, poorer & unmarried people
* Fear or experience of side-effects
* Cultural or religious opposition
* Poor quality of available services
* Users & providers bias against some methods
* Inconvenience or discomfort
237
What is gender-based violence (GBV)?
Any act of violence that is inflicted upon an individual because of his or her gender or sexual orientation. The voilence can take different forms, physical, sexual or psychological & it encompasses harmful practcis such as child marriage, sex trafficking, honour killings, sex-selective abortion, female genital mutilation & sexual harassment & abuse.
238
What is maternal mortality **ratio** (MMR)?
number of maternal deaths during a given time period per 100,000 live births during the same time period
239
What is maternal mortality **rate** (MMRate)?
number of maternal deaths during a given time peirod divided by person-years lived by women of reproductive age (age 15-49 years) in a population during the same time period
240
What is adult lifetime risk of maternal death?
Probability that a 15-year old girl will eventually die from a maternal cause
241
What is DALY?
number of years lost due to ill-health, disability or death
242
What are the main causes of maternal mortality?
* Bleeding
* Infections
* High blood pressure
* Need of surgical care
* Unsafe abortions
243
What is the package according to Guttmacher Institute?
package of SRH services for approx $10.60 pp/year (in LMIC) could provide health, social & economic benefits
244
What are the benefits of Guttmacher Institute package?
* decrease in **unintended pregnancies** (68%), **unsafe abortions** (72%) & **maternal deaths** (62%)
* increase participation of girls in schools & women in labour market
245
Who are in higher need of SRHR?
* adolescent ages 10-19
* adults ages >60 years (cancerss, dysfunction)
* sex workers
* LGBTQI+ ppl
* Displaced people & refugees
* ppl with disabilities
* ppl who inject drugs (HIV risk)
* ppl living in rural areas (probs with anonimity, access, sexual education)
246
How does access to sex ed infleunce vulnerability?
lack of knowledge required to making decisions responsibly = vulnerable. to coercion, STIs & unintended pregancies
247
What is Comprehensive Sexuality Education (CSE)?
beyond anatomy, addressing gender issues & psychological, social & emotional issues
248
What is meant by international technical guidance on sex ed?
sex ed should be:
* scientifically accurate
* based on human rights
* culturally relevant
* context appropriate
249
Does restricting access to abortions, reduce the number of abortions?
No
* 6/10 intended preg = induced abortion
* 25 mil unsafe abortions/yr
* most deaths in LIC
* unsafe abortion can = death/complications
250
What are most causes of cervical cancers?
99% linked to human papillomaviruses (HPV) transmitted thru sex
251
What is the 4th most common cancer among women globally?
Cervical cancer
252
How can most cervical cancers be prevented?
primary (HPV vaccination) & secondary (screening for & treating) prevention approaches
253
When should HPV vaccines be given?
prior to exposure
254
How many doses of HPV vaccination should be given based on ages?
* 1 or 2 dose schedule for ages 9-14
* 1 or 2 dose schedule for 15-20 yrs
* 2 doses within 6 month interval for 21+
255
How should menstrual health be framed/recognised according to the WHO?
* recognised, framed & addressed as a **human rights issue**, not only a **hygiene issue**
* MH has many dimensions: risk of infection, missing school, stigma, economical, etc
256
# **
How many women are menstruating world wide per day?
300 million per day & roughly 500 million lack access to products & adequate facilities
257
Why do women & girls in emergency situations have a hightened need for SRHR services?
coz of increasd risk of STIs (inc HIV), unwanted pregnancy, maternal deaths & illness, sexual & GBV
258
How are changes in size & composition of populations affecting SRHR?
needs concentrated on women & men of reproductive age, size of age group will increase in poorest coutnries
259
Which population group is SRHR problems focused on?
displaced & refugees whose nmrs have increased dramatically
260
What characteristics are associated with fewer deaths & disabilities due to SRHR?
* higher education
* greater household wealth
* urban residence
261
What are strategies to achieve SRHR for all?
* dismantle discriminatory legislation
* changing harmful social norms around sexuality, reproduction & gender
* invest in access to CSE & quality health systems
* inolve, protect & fund civil society organisations working for gender equality & SRHR
262
What is neonatal mortality rate?
Number of deaths during the first 28 completed days of life per 1000 live births in a given year or other period.
263
What is uneder 5 mortality rate?
probability per 1,000 that a newborn baby will die before reaching age five
264
Why are mothers important for children?
children without mothers are:
* 10x more likely to die prematurely
* less likely to receive proper nutrition, HC & education
* continued cycle of poverty & poor health
265
What are interventions that may save lives for pregnant women?
* Oxytocin to reduce bleeding
* Magnesium in pre-eclampsia
* antibiotics & anti-retroviral treatment (HIV)
* trained health staff
* HC facilities
266
Why do women not get the care they need?
* poverty
* distance to facilities
* lack of information
* inadequate & poor quality services
* cultural beliefs & practices
267
Is there a risk with or abuse of surgical care in sexual & reproductive heath?
* unncessary interventions may cause short & long term complications
* impact on lifetime health aspects in the offspring
* demand for c-section without medical intervention is growing
268
Why is surgical care still neglected?
* lack of trained medical personnel
* lack of economic resources (society & personal)
* difficult access due to safety & security
* Bureaucracy
269
What influences the rate of abortions?
* access to effective contraceptive methods
* legal issues - legal status of abortion has no effect on womens needs for abortion but **affects access to safe abortion**
270
What can happen with unsafe abortions?
* Infection
* Bleeding
* Injury to the reproductive organs or other internal abdominal organs
* Long time consequences of pain & risk of infertility
271
Why is there an unmet need of contraception?
* limited access
* limited choice of methods
* fear/experience of side effects
* cultural/religious opposition
* poor quality of available services
* gender-based barriers to accessing
272
How many children die globally each year before 5th birthday?
5 million
273
How many children die globally each year before 1 month of age?
2.4 million
274
*What are the 4 income levels?
275
How can DALY be calculated?
years lived with disability + years of life lost
276
What are the IMCI goals?
* accurate identification of childhood illness
* appropriate treatment of major conditions
* strengthen counselling of caretakers
* speed up referral of severly ill
* promote care-seeking behaviour
* improved nutrition & support
* correct implementation & adherence to treatment
277
What is the diagnosis of pneumonia in children <5 ?
* coughs and/or difficulty breathing, with or without fever
* fast breathing or lower chest wall indrawings
278
What are the IMCI general danger signs in all diseases for children?
* not able to drink or breastfeed
* vomits everything
* convulsions
* lethargic or unconscious
279
*What is IMCI?
280
What is the treatment for pneumonia in children?
Antibiotics --> amoxicillin 3-5 days
281
What are key protective & preventive factors for pneumonia?
* exclusive breastfeeding for first 6 months & adqueate complimentary feeding
* vaccination
* reducing indoor air pollution
* good hand hygiene
282
What is diarrhoea?
loose stools at least 3x a day
283
What are the types of diarrhoeal diseases?
1. Acute water diarrhoea
2. dysentry - bloody diarrhoea
3. persistent diarrhoea - 14+ days
284
What are the signs of dehydration?
* pinch abdomen to test for decreased skin turgor & slow return of skin pinch in severe dehydration
* sunken eyes
* lethargy or unconsciousness
* unable to drink or drinks poorly
285
What are treatmnets for diarrhoeal diseases in children?
* continue feeding (or increase breastfeeding)
* Oral rehydration therapy (ORT) or intravenous electrolyte solution
* zinc supplementation
* antibiotics
286
What are key preventive & protective factors in children for diarrhoeal diseases?
* exclusive breastfeeding for first 6 months
* rota virus vaccination
* WASH
287
What is the most dangerous type of malaria?
plasmodium falciparum
288
What are the symptoms of a malaria attack?
* sudden onset
* fever
* muscle stiffness
* headache
289
What are key interventions for reducing neonatal mortality & morbidity **prior to birth**
* syphillis screening
* detecting treatment of urinary infections
* tetanus prophylaxis
* malaria prophylaxis
* nutritional support
290
290
What are key interventions for reducing neonatal mortality & morbidity **for delivery**
* education of brith attendants e.g. clean practices
* referral of complicated cases to hospital
290
291
What are key interventions for reducing neonatal mortality & morbidity **early weeks of life**
* resuscitation of children not breathing
* skin-to-skin care
* breasfeedings
* identification & treatment of infections
292
Where do global inequities come from?
* general improvement of richest countries
* former colonies progress
293
How did the improvement of richest countries lead to global inequities?
* rathern than deterioration in rest of world
* before industrial revolution, health was relatively similar globally
294
How did former colonies progress lead to global inequities?
* pre-requisities at time of independence
* chosen strategy forward
* world economy controlled by richer countries
295
What is mental health (MH) acc to WHO?
state of well-being in which person:
* realizes their own potential
* can cope with usual stressful life events
* can work productively
* is able to make contributions to the community
296
*What are the mental health indicators?
*
297
*What are massive crises?
* emergencies that affect large numbers of ppl, generates media interest & commit resources.
* can damage infrastructure & endanger processess of social & community cohesion
* e.g. fires, floods, EQs
298
*What are everyday crises?
* When ppl lack resources & capacities to survive
* experience or testiomony of experiencing traumatic situations
* sudden, unexpected, frequent, urgent situations that affect a family
* e.g. unemployment, serious illness, etc
299
When should people receive psychological first aid?
| in an ideal world
* ppl who receive bad news, witnessed accident or experience a catastrophe
* within first 72 hrs after event
300
How should psychological first aid help?
* reduce stress level
* promote physical & emotional safety
* connect the person with your support network
* enhance coping strategies
* increase autonomy & self efficacy
301
What is malnutrition?
deficiencies or excess in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization
302
What are the forms of malnutrition?
1. Undernutrition
2. Micronutrient-related malnutrition
3. Overweight, obesity & diet related NCDs
303
What are the types of undernutrition?
* stunting (low height-for-age)
* wasting (low weight-for-height)
* underweight (low weight-for-age)
304
What is stunting?
* chronic malnutrition
* inhibited growth & development
* result of chronic or recurrent undernutrition & poor health
305
When is stunting determined?
largely determine by **first 1,000 days** but is **reversible** if addressed **early**
306
How is stunting measured?
Height for age (HAZ) (childlren <5y) - 'too short for their age'
307
What are the standard deviations for HAZ?
* Moderate <-2 SD
* Severe <-3 SD
| SD = stdev
308
What are the consequences of **stunting** in **childhood**?
* increase morbidity-mortality risks
* poor child development & learning capacity
309
What are the consequences of **stunting** in **adulthood**?
* higher risk of overweight
* NCDs
* low productivity
310
What are the consequences of **stunting** for **next generations**?
* poor social capital
* adverse maternal & reproductive outcomes
311
What is wasting?
* acute malnutrition
* result of rapid & severe weight loss or failure to gain weight coz of low nutritional intake and/or disease
312
What are the types of wasting?
* **Marasmus** --> wrinkled skin, very skinny you see ribs
* **Kwasiorkor** --> distended abdomen, the 'outwards belly'
313
What are the measurements for wasting?
* Weight for height (WHZ) (children <5y) - 'too thin for their height'
* MUAC
* presence of malnutrition oedema
* BMI in adults
314
What is MUAC?
Middle upper arm circumference
315
What are the SDs for wasting for WHZ?
* Moderate Acute Mal (MAM): <-2 SD - >-3 SD
* Severe Acute Mal (SAM): <-3 SD
* Global Acute Mal (GAM): <-2 SD
316
What are the consequences of wasting?
* decreased immune system capacity = increased risk of infections
* increase mortality risk
317
What is meant by direct & indirect deaths as a consequence of wasting?
Undernutrition lower immunity = increase risk of disease = when hae infect disease = absorb nutrients less effectively = need more energy to fight then again if no access to food = circle continues → double check
| see image
318
What is overweight?
* Obesity & diet related NCDs
* result of imbalance between energy consumed & expended (high energy foods-sedentarism)
319
How is overweight measured?
* BMI adults
* WHZ & BMI-for-age for children <5 & >5
320
What BMI is considered overweight & obese?
* BMI = >25: overweight
* BMI = >30: obesity
321
What are diet related NCDs?
* CVDs
* certain cancers
* diabetes
being overweight is top risk factor
322
What is overweight associated with?
* Maternal morbidity
* preterm birth
* increased infant mortality
323
What is micronutrient related malnutrition?
inadequacies in intake of vitamins & minerals that enable body to produce enzymes, hormones, etc that are essential for proper growth & development
324
What are most important for global health impact?
* Iron
* Vitamin A
* Iodiine
325
What are consequences of micronutrient related malnutrition?
* poor pregnancy outcomes
* child growth failure
* cognitive impairment
* increased morbid & mortal
326
Which sub region has the highest wasting prevalence?
South Asia (2022)
327
Why is there so much focus on maternal & child nutrition?
* high global burden, esp in LMICs
* asso with high morb & mort risks
* lifelong consequences
* intergenerational consequences
333
What is global surgery?
area of study, research, practice & advocacy that seeks to improve health outcomes & achieve health equity for all people who need surgical & anaesthesia care, with a special emphasis on underserved populations & populations in crisis.
334
What are harmful myths about global surgery?
1. surgical conditions aren't important on pop level in low resource
2. impossible to do clinical research with (high) follow up (rates) in Africa
3. surgery is costly with low cost effectiveness
335
Why is the belief that surgical conditions aren't important on pop level in low resource settings a myth?
* Surgical conditions cause more deaths than Malaria, TB & HIV/AIDS combined
* To reach SDG3, surgery is needed
336
Why is it "impossible to do clinical research with (high) follow up (rates) in Africa a myth?
* 10 basic needs for safe surgery
* possible to carry out clinical research with high follow up rates
* patients are interested & appreciate extra assessment
337
Why is "surgery is costly with low cost effectiveness" a myth?
* Cost & cost-effectiveness analyses done for most hernia studies
* But hernia repair is affordable & cost effective
338
What is a disaster?
“A serious disruption of functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts”
339
What does UHC include?
full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation and palliative care.
340
What is rehabilitation?
set of interventions designed to optimize the **functioning** & reduce the disability of ppl with health problems as they interact with their environment
341
What is rehabilitation needs?
anyone who experiences one or more health conditions that limit his/her functionng in one/more domain(s)
=> not limited to “persons with disabilities”
342
How many people could benefit from rehab?
* Approx 1 in 3 ppl could benefit from rehabilitation
* 2.4 billion ppl experienced conditions that could benefit from rehab
343
Who are persons with disabilities?
those who have **long-term** physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full & effective participation in society on an equal basis with others.
344
What is an injury?
damage to the body caused by transfer of energy or absence of energy hat have relatively sudden visible effects
345
What do unintentional injuries include?
* Road traffic injuries
* Poisoning
* Falls
* Fires
* Drowning
* Other unintentional injuries (e.g. animal bites, electrocution)
346
What are the types of intentional injuries?
* Self inflicted
* Interpersonal vioelnce
* War
* Other intentional injuries
347
What are the types of injuries?
1. Unintentional injuries
2. intentional injuries
3. undetermined intent??
348
What is a flood?
Generic definition: water covering land that’s normally not covered by water
* Does not account for cause, scale, duration or severity
* Floods can be beneficial
349
Why do floods have different definitions?
depending on their cause
* human generated
* naturally generated
350
What are the human causes of flooding?
* Intentional & unintentional
* Dams
* Land use & repurposing
* Accidents & negligence
351
What are the types of naturally generated floods?
* Coastal & estuarine floods
* Fluvial floods
* Surface water floods
* Flash floods
352
What is a coastal & estuarine flood?
* Flooding over or near costal areas
* Caused by storm surges, tsunamis
* Common in major delta areas like Ganges when storms occur
353
What are fluvial floods?
* Rise in water level of river which then recedes at a slower rate
* Caused by precipitation upstream
* Longer duration - days to months
* Common on major rivers e.g. Mekong, Nile, Amazon
354
What are surface water floods?
* Rainwater that does not drain & lies on/flows over ground
* Caused by heavy precipitation/storms & factors like dryness & drainage systems
355
What are flash floods?
* Localised floods of short duration (4-6hrs) with very high discharge
* Many causes e.g. dam break, extreme precipitation
* Exacerbated by draining, dryness, steep terrain - little warning
356
3 dimensions of UHC
* populaiton: who is covered
* services: which services are covered?
* direct costs: proportion of the costs covered
