Key Issues in Global Health Flashcards
What is the geographical reach for public health, international health and global health?
Public health:
- focuses on issues that affect the health of the population of a particular community or country
International health:
- focuses on health issues of countries other than one’s own, especially those of low-income and middle-income
Global health:
- focuses on issues that directly or indirectly affect health but that can transcend national boundaries
What is the level of cooperation implicated in public, internation and global health?
public health:
- development & implementation of solutions requires community-level or national cooperation
International health:
- development & implementation of solutions usually requires binational cooperation
Global health:
- development & implementaiton of solutions often requires global cooperation
Are public health, international health and global health focussed on individuals or populations?
public health:
- mainly focused on prevention programmes for populations
international health:
- embraces both prevention in populations and clinical care of individuals
global health:
- embraces both prevention in populations and clinical care of individuals
What is the access to health like in public, international and global health?
public health:
- health equity within a nation or community is a major objective
international health:
- seeks to help people of other nations
global health:
- health equity among nations and for all people is a major objective
What are the range of disciplines implicated in public, international and global health?
public health:
- encourages multidisciplinary approaches, particularly within health sciences and with social sciences
international health:
- embraces a few disciplines but has not emphasised multi-disciplinary
global health:
- highly interdisciplinary and multidisciplinary within and beyond health sciences
What does international health emphasize?
- specific diseases and conditions in particular countries
- often in “other” countries and not in one’s own
- more the differences between countries than their commonalities
- one-way flow of ideas for development initiatives
What is global health characterised by?
What does this recognise?
- characterised by health issues beyond the capacity of individual countries to address through domestic institutions
- recognises that health is determined by problems, issues and concerns that transcend national boundaries
Who does global health focus on?
What type of responses does it require?
- focused on people across the whole planet rather than concerns of particular nations
- requires multi-disciplinary responses from many countries
What is the overall aim of global health?
it places a priority on improving health and achieving equity in health for all people worldwide
What is emphasised in the definition of global health and how does it aim to be achieved?
global health emphasises transnational health issues, determinants and solutions
it involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration
it is a synthesis of population-based prevention with individual-level clinical care
What is meant by classifying a disease that is common across countries?
What is required in order to do this?
- suggesting a homogeneity of challenges across countries
- at all levels of socio-economic development
to do this requires
- accessing and using health information in global health context
What are the 3 main classifications of disease according to WHO?
group 1 - communicable disease:
- a category often grouped with maternal, perinatal and nutritional deficiencies
group 2 - non-communicable disease:
- this includes mental disorders
group 3 - injuries:
- this includes falls, RTAs, self-harm and interpersonal violence
What is meant by a communicable disease?
one that is spread from one person to another through a variety of ways that include:
- contact with blood and bodily fluids
- breathing in an airborne virus
- being bitten by an insect
What is meant by the burden of disease?
the impact of a health problem as measured by financial cost, mortality, morbidity or other indicators
it is quantified in terms of quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs)
What factors influence the importance of communicable diseases?
- sheer burden
- economic impact
- rate of spread
- recurrence of diseases
- security and CDs
What is the global burden of disease study (GBD)?
the most comprehensive, global, observational epidemiological study to date
it describes mortality and morbidity from major diseases, injuries and risk factors to health at global, national and regional levels
What was the purpose of the GBD study?
it examines trends from 1990 to the present and makes comparisons across populations
this enables understanding of the changing health challenges facing people across the world in the 21st century
What were the top 10 global causes of death in 2016?
Why is this significant?
- ischaemic heart disease
- stroke
- chronic obstructive pulmonary disease
- lower respiratory infections
- alzheimer disease & other dementias
- trachea, bronchus, lung cancers
- diabetes mellitus
- road injury
- diarrhoeal disease
- tuberculosis
>54% of global deaths were due to the top 10 causes
What is the pattern of death like for group I causes?
Group I is communicable, maternal and nutritional conditions
these conditions occur largely in poorer populations
they typically decline at a faster pace than all causes of mortality during the epidemiological transition
What are the 8 Millenium Development Goals (MDGs) and their aim?
they are aimed at reducing health inequalities between rich and poor countries between 1990-2015
- eradicate extreme poverty and hunger
- achieve universal primary education
- promote gender equality and empower women
- reduce child mortality
- improve maternal health
- combat HIV / AIDS, malaria and other diseases
- ensure environmental sustainability
- develop a global partnership for development
How has child mortality changed in the past 25 years?
Did it meet the MDG target?
child mortality rate has reduced >50% in the last 25 years
it fell from 90 to 43 deaths per 1,000 live births globally
it failed to meet the MDG target of a drop of two-thirds
What is the WHO definition of maternal death?
the death of a woman whilst pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and site of the pregnancy,
from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes
How has maternal mortality ratio fallen over the last 25 years?
Has this met the MDG target?
the global maternal mortality ratio has fallen by nearly 50%
this is short of the 2/3 reduction the MDGs aimed for
every day still 830 women die from pregnancy or childbirth related causes
What are the most common causes of women dying from pregnancy or childbirth related causes?
- postpartum bleeding (15%)
- complications from unsafe abortion (15%)
- hypertensive disorders of pregnancy (10%)
- postpartum infections (8%)
- obstructed labour (6%)
Was the halting HIV/AIDs target achieved as part of the MDGs?
the target of halting and beginning to reverse the spread of HIV/AIDs by 2015 was not met
the number of people dying from HIV infections fell by around 48% since 2005
Was the MDG of supplying clean water achieved?
How many people do not have access to clean drinking water?
- 2.6 billion people have gained access to improved drinking water since 1990
- the target of halving the proportion of people without access to improved sources of water was achieved in 2010
- 663 million people across the world still do not have access to improved drinking water
What has happened to the global health economy from 2000-2015?
more resources are available so the global health economy had a 35% growth from 2000-2015
global stewardship emerging:
- shared threats and challenges
- global communication
- global commitments to decrease poverty
What are the 3 main problems influencing the death of 30,000 children each day needlessly of preventable disease?
1. substandard quality of care:
- sick patients - if they can get to a clinic and afford treatment they then face long waits, poor quality of care and limited equipment / drugs
2. severe shortages of health workers:
- critical health information is buried in thick medical files and facilities are plagued with staff shortages
3. inequities in the provision of health care:
- one of the greatest challenges currently faced as global citizens
- these demands are amplified not only in the developing worls
What are SDGs?
a new global partnership to eradicate poverty and transform economies through sustainable development by 2030
What are the 5 transformative shifts involved in the SDGs?
- leaves no one behind. ending extreme poverty in all its forms
- puts sustainable development at the core integrate the social, economic and environmental dimensions of sustainability
- transforms economies for jobs and inclusive growth
- builds peace and effective, open and accountable institutions for all
- forges a new global partnership - new spirit of solidarity, cooperation and mutual accountability
What are the 17 global goals (SDGs)?
- no poverty
- zero hunger
- good health and wellbeing
- quality education
- gender equality
- clean water and sanitation
- affordable and clean energy
- decent work and economic growth
- industry, innovation and infrastructure
- reduced inequalities
- sustainabe cities and communities
- responsible consumption and production
- climate action
- life below water
- life on land
- peach, justice and strong institutions
- partnership for the goals
What is the definition of communicable diseases (CDs)?
any condition which is transmitted directly or indirectly to a person from an infected person or animal through the agency of an intermediate animal, host or vector or through the inanimate environement
What are examples of communicable diseases?
Acute encephalitis, Acute infectious hepatitis, Acute meningitis, Acute poliomyelitis, Anthrax. Botulism, Brucellosis, Cholera, Diphtheria, Enteric fever (typhoid or paratyphoid fever), Food poisoning, Haemolytic uraemic syndrome (HUS), HIV, Infectious bloody diarrhoea, Invasive group A streptococcal disease, Legionnaires’ Disease, Leprosy. Malaria. Measles, Meningococcal septicaemia, Mumps, Plague, Rabies, Rubella, SARS, Scarlet fever, Smallpox, Tetanus, Tuberculosis, Typhus, Viral haemorrhagic fever (VHF), Whooping cough, Yellow fever
How do communicable diseases contribute towards global disease burden?
Which countries tend to be affected?
CDs account for major global disease burden
- account for 12% of total global burden of disease, and 52% of the BoD in africa
- CDs typically affect lower middle income countries disproportionately
- most communicable diseases are preventable or treatable
Why are communicable diseases a global health issue?
diseases do not recognise international boundaries
diseases can emerge anywhere on the globe and spread quickly to other regions
Why are communicable diseases a global health issue with relation to globalisation?
globalisation has strengthened the link between international economics and public health
local outbreaks have global implications because of disruption of travel and trade
- COVID-19
- ebola
- impact of SARS on East Asian economies
- bird flu in asia
- swine flu
What are the threats presented by antimicrobial resistance?
antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi
What is meant by the relationships between demographic, epidemiologic and health transitions?
- when there are improvements in all these areas, we begin to see lifestyle changes and an improvement in people’s hygiene
- urbanisation
- industrialisation
- rising incomes
- expansion of education
- improved medical and public health technology
- infectious disease mortality declines
- fertility then declines
- with less communicable diseases, the population ages and chronic and non-communicable diseases emerge
What is meant by epidemiological transition?
changing population patterns in terms of fertility, life expectancy, mortality and leading causes of death
What is meant by demographic transition?
theory which refers to the historical shift from high birth rates and high infant death rates in societies with minimal technology, education (especially of women) and economic development
to low birth rates and low death rates in societies with advanced technology, education and economic development
What is meant by a chronic disease?
one that requires ongoing medical care, limits what one can do and is likely to last longer than one year
it can be controlled, but not cured
chronic conditions are responsible for 60% of the global disease burden
What are examples of chronic diseases?
Who tends to have them in the UK?
- diabetes
- hypertension
- COPD
- dementia
- obesity
- depression
- arthritis
- mental health, many cancers and AIDS
in the UK, people with chronic diseases:
- 60% of adults, 45% of which have multiple conditions
- 75% of all over 75s
- incidence in >65s will double by 2030
Where do most smokers in the world live?
nearly 80% of the world’s one billion smokers live in low- and middle-income countries
What % of deaths worldwide is insufficient intake of fruit and vegetables estimated to cause?
low fruit and vegetable intake is among the top 10 selected risk factors for global mortality
insufficient intake of fruit and vegetables is estimated to cause:
- 4% of GIT cancer deaths
- 11% of ischaemic heart disease deaths
- 9% of stroke deaths
What is meant by global health determinants?
What are the different levels?
- general socio-economic, cultural and environmental conditions
- living and working conditions
- social and community networks
- individual factors
- age, sex and constitutional factors
reducing inequities looks at making changes to policies and decisions in the highest level
this then trickles down to affect living and working conditions, which then indirectly affect communities and individuals
What are examples of determinants of health affecting living and working conditions?
- housing
- health care services
- water and sanitation
- unemployment
- work environment
- education
- agriculture and food production
What is meant by a condition affecting “beyond health”?
ill health affects not only people but also economies and development
e.g. HIV/AIDS leads to 1% yearly reduction in GDP economic growth in some sub-saharan african countries
TB costs the average patient 3 or 4 months which can represent up to 30% of annual household income
WHat is meant by urbanisation?
over half the world’s population lives in urban areas and this is likely to reach 70% of the population by 2050
What is meant by “urban slums”?
What proportion of the world’s population lives here?
1 in 4 of the world’s urban population live in slums
densely populated, neglected parts of cities where living conditions are exceptionally poor
there are many socio-economic and health problems
What are the risks associated with urban slums?
- poor access to safe water
- sanitation
- overcrowding
- poor housing
- rat infestation leading to high rates of communicable disease
caused by rapid population growth, rural to urban migration and failure of urban governance
What are the 3 main predictions for healthcare in the future?
- risk of dying before the age of 5 could be halved
- cigarettes will kill half as many again as at present
- tobacco-related deaths will go from 5.4million in 2005 to 8.3 million, accounting for 1 in 10 deaths globally by 2030
- depression will be second only to AIDS as a cause of debilitating illness
What are predictions about healthcare in the future based on?
predictions of:
- population growth
- population ageing
- growing prosperity - affording hygiene and vaccination reduces infectious diseases
- economic growth - shift from death in infancy to old age
