Quiz 2 Flashcards
What does a health system consist of?
All the people, policies and programs that work to promote health and prevent disease in a country
What is pooled risk?
Assumes that if many low-risk people and a few high-risk people all pay premiums to the insurance system over many years, then there will be a part of the money that can be used to pay for major illnesses when they occur.
What are health insurance systems funding based on?
Pooled risk
What do universal health care systems do?
Increase equity in access and improve efficiency of health system by decreasing overuse of health services by the poor
In the long run, which form of health care system saves on health care costs?
Universal health care
High-income countries usually spend more on what per person? And have a higher percentage of what than low-income countries?
Health care per person. Percentage of GDP.
Govt of higher-income countries pay what in relation to low-income countries?
Higher percentage of health-care costs.
In privatized health care systems, the insurance companies have what option when their customers are people with pre-existing medical conditions, elderly? What can this result in?
Charge higher premiums. Can prevent individuals/families from accessing health insurance and many are at risk of bankruptcy if serious illness occurs.
Do people living in low-income or high-income pay for health care out of pocket?
Low-income
Payment for health can be divided into what two categories?
Money spent of personal health and money spent on public health.
What are examples of things of money spent on personal health?
Medications, glucose test strips etc
What are examples of things of money spent on public health?
Activities that protect a community (vaccines)
Local and national government funds for health care.. where does this money come from?
Taxes collected by the government providing those services.
What is bilateral aid?
Money given directly from one country to another.
What are the different forms of bilateral aid?
Equipment, commodities (food), training and expert advice, cash transfers or economic infrastructure development (health clinics/schools)
What must a country be a member of to give bilateral aid to a low-income country?
Development Assistance Committee
What are the five donor nations that provide the greatest amount of official development assistance (ODA)?
USA, UK, France, Germany, Japan
What is multilateral aid?
Money pooled from many donors in form of loans
What are two multilateral agencies most involved in offering loans?
World Bank and IMF
What does the World Bank do?
Investment bank that makes loans to developing countries, usually for infrastructure projects
What does the IMF do?
Provides a structure for international monetary policy and currency exchanges and also makes loans to countries of any income level that have a balance of payment needs would otherwise not be able to make payments on other international loans
World Bank interest rates are higher/lower than market rates?
Higher
IMF interest rates are higher/lower than market rates?
Lower
What sort of private foundations give money to global heath?
Bill and Melinda Gates Foundation (>1 billion per year)
What sorts of businesses give funds to global health? In what forms might these funds be?
Pharmaceutical companies (drugs and other products), other companies fund health programs
Some individuals donate money through foundations like Save the Children/World Vision etc. What type of donation is this?
personal donation
What types of global health programs are there?
research and education activities, clinical services provided by hospitals etc, relief aid, community dev programs, advocacy initiatives, logistics
What provides the bulk of health services and payment for health systems?
National government
Which govt is responsible for public health system and sponsoring health research?
National
What is the goal for UN agencies?
Maintain international peace and security, develop friendly relations among nations and achieve international cooperation in solving international problems
What is the main agency of the UN?
WHO
What is “international cooperation” of the national govt?
national govt involved in sponsoring relief and dev work internationally and cooperatively
what are global health partnerships?
non profit public-private partnerships working towards accomplishing goals for selected global health issues
what does an NGO focus on? where do they receive funding from? what are benefits/challenges for NGOs?
focus on particular issues or may address multiple issues, involved in spectrum of relief aid, dev work, advocacy and logistics. funding from private sources. BENEFITS: can do important on-the-ground pub health work CHALLENGES: directed donation, autonomy for local workers, policies and neutrality
which high-income health care system is the only privatized one?
USA
what is GH funding targeted at?
aiding mutual goals
what does the Ottawa charter outline?
Things needed for pub health (food, shelter, peace etc)
what are the main goals of the PHAC?
promote health, prevent and control chronic diseases/injuries, prevent/control ID, prep for/respond to pub health emergencies, central point for sharing Canada’s expertise with world, apply international research and dev, strengthen inter govt collaboration.
How many member countries are apart of UN?
193
What does global affairs Canada do?
Strengthen Canadas contribution to decrease poverty/inequality, support fragile states, build resilience and respond to humanitarian needs
what are some goals of global affairs Canada?
create policy/framework to focus Canadas assistance on helping poorest/most vulnerable, improve health of women/adolescents/children, foster dev/innovation/effectiveness, provide timely effective and coordinated needs-based responses to humanitarian needs
What are the MDGs?
8 goals to decrease global poverty
How many countries endorsed the MDGs
200
How many targets and indicators used to assess whether targets are being reached for MGDs?
8 targets and 48 indicators
What are the 8 MDGs?
- Eradicate extreme hunger and poverty
- Achieve universal primary education
- Promote gender equality and empower women
- Decrease child mortality
- Improve maternal health
- Combat HIV/AIDS, malaria, TB
- Ensure environmental sustainability
- Develop a global partnership for development
What is sustainability?
Aims to provide for current human needs without compromising the ability of future generations to meet their needs.
What is cost-effectiveness analysis?
Aim to ensure that funds are used for a global health initiative are effective at achieving planned outcomes and make efficient use of financial and other resources
In the 1800s, what was the theory of disease causation?
Miasma atmospheres - epidemics spontaneously occurred in places with poor sanitation/accompanying foul odours from human waste
What aspects does environmental health look at?
Where people live, work, materials used to construct buildings, food, air quality etc.
What 5 factors need to be considered for safe drinking water?
Quality, quantity, proximity, reliability and cost.
What is considered when discussing quality of drinking water?
Water must be clean enough to drink safely.
What is considered when discussing quantity of drinking water?
Enough water available to drink
What is considered when discussing proximity of drinking water?
Water is easy to access and people don’t have to walk far to get water.
What is considered when discussing reliability of drinking water?
Water source must be available and functioning
What is considered when discussing cost of drinking water?
Water must be affordable
What percentage of urban and rural population has access to improved drinking water?
Less than 90% urban and less than 40% rural
What percentage of fresh water is used for irrigation and livestock?
70%
What are the “6 F’s” contributing to diarrheal diseases?
Feces, fluids, fingers, food, flied, fields.
6 F’s: Feces
Feces not properly disposed of
6 F’s: Fields
Feces not being properly disposed of contaminate fields (soil)
6 F’s: Fluid
Feces to properly disposed of contaminate body of water
6 F’s: Fingers
Feces not properly washed off of hands
6 F’s: food
Feces not properly washed off of hands transmitting to food
6 F’s: flies
Flies spread faces to food
What is the issue in households without electricity?
Burning fuel for light leading to air pollution.
What are some hazardous compounds found in the smoke in homes when fuel is burned?
Sulfur oxides, nitrous oxides, aldehydes etc.
What issues can chemicals in the air cause?
Lung diseases
What are some ways to decrease exposure to indoor air pollution?
Improved cooking devices, use alternative energy sources (solar panels), increase ventilation, change behaviours (keep kids away from smoke etc)
What was one of the first public health specialities?
Occupational health
What is toxicology?
Study of harmful effects the chemicals and other environmental hazards like radiation have on living things
What are carcinogens?
Can cause genetic mutations that lead to CA
What are teratogens?
Things that cause birth defects
What is ecotoxicology?
Examine the impact of toxic exposures on populations, communities, and ecosystems
What are some of the main hazardous substances present in the USA?
Arsenic, lead, mercury, vinyl chloride, PCB, benzene, cadmium,PAH
What are the two main types of eukaryote parasites?
Protozoa and helminths
What are the characteristics of protozoa?
They are single-celled organisms that have animal-like characteristics and often live in water.
What is becoming a concern for many parasitic infections?
Drug resistance
When do fungal infections typically occur?
After bacteria normally live in or on the body are disrupted by antibiotics or immunosuppression
Where does fungi thrive?
Dark, moist environment.
Natural history of an infectious disease?
Usual timeline from exposure to a particular agent to either recovery or death
Infectivity?
Capacity of an infectious agent to cause infection in a susceptible human
How is infectivity sometimes measured?
Secondary attack rate
What is the secondary attack rate?
Average number of other people that one contagious person infects
When is it considered “infection”?
When the infectious agent begins to reproduce inside a person
What occurs in the latent phase/incubation period?
Infectious agent multiplies in the host but the infected individual doesn’t feel sick, even if he or she is contagious.
Do all infections lead to disease?
no
What is pathogenicity?
Capacity of an infectious agent to cause disease I an infected human.
How is pathogenicity measured?
By the proportion of individuals with lab-confirmed infection who became ill
What is virulence?
Ability of an infectious agent to cause severe disease or death in a host
How is virulence measured?
Measured by the proportion of severe or fatal cases among all people who have the disease
Virulent infections will have what?
A high case fatality rate
What is a reservoir?
Environmental home for an infectious agent
What is anthroponoses?
Infectious diseases that only occur in humans
What is zoonoses?
Infectious diseases that usually occur I animals and only occasionally infect humans
What is the cycle of infection?
Describes how an infectious agent cycles between different species
How can diarrheal diseases and food borne diseases be prevented?
Safe food handling, frequent hand washing, consistent access to clean drinking water, community-wide sanitation
What are arthropods?
Insects and arachnids (spiders, ticks, mites)
What are arboviruses?
Viruses spread by arthropods
How can vector-borne diseases be prevented?
Minimize insect bites via use barriers/chemical repellents, insecticides to decrease insect population
What are neglected tropical diseases (NTDs?)
Infectious diseases that primarily infect the poorest regions of the world and haven’t been a priority for funding agencies, pharmaceutical companies, or global policy makers
What is the health belief model?
Decision of an individual to engage in a healthier behaviour is dependent on person’s perceptions about susceptibility to disease, severity of disease, ability of behaviour to prevent disease, barriers to implementing change and the cost-benefit ratio for taking action.
What environmental control methods can be done to reduce infection transmission?
Change breeding groups, sanitation, increase drinking water quality, waste management, decrease air pollution, decrease mosquito/rodent/snail population, food safety regulation.
What is active immunity?
Body has lasting memory of infection
What is passive immunity?
Acquired through breast milk
What is herd immunity?
Contains epidemics. People who aren’t vaccinated are safer because of people who are.
What is mass-drug administration (MDA)?
Routine distribution of antibiotics/antiparasitics to population with increased prevalence of treatable infections. Often used to de-worm school children.
What does surveillance do?
Tracks ID reports from hospitals and other sources to look for patterns and outbreaks
What is spatial clustering?
High incidence of disease in a particular place
What is temporal clustering?
High incidence disease in a particular time
What is passive surveillance?
Collects reports or notifiable disease diagnoses from medical labs
What is sentinel surveillance?
Information from continuous monitoring at several selected ‘sentinel’ sites issued to alert public health officials to possible changes in community health status
Active surveillance?
Public health officials contact healthcare provider to ask about whether they’re seeing a particular disease
Endemic disease?
Always present in a population
Epidemic/outbreak?
Disease is occurring more often than usual and there are more than a few sporadic occurrences of a disease
Pandemic?
Worldwide epidemic, like some influenza epidemics
What is elimination of an infectious agent?
Control measures remove all risk of new infection in a region?
What is quarantine?
Limit movement of ill individuals
What is eradication of an infectious agent?
Achieved when there is no risk of infection or disease anywhere in the world even in abstinence of immunization or any control measures
What is extinction of an infectious agent?
Complete when an agent no over exists in nature or in the lab
What are the ‘big three’?
HIV, TB, malaria
How is HIV transmitted?
Blood, semen, vaginal fluid, breastmilk. Sharing needles, sexual contact, MTCT.
What does the HIV virus do?
Destructs CD4 cells necessary to fight infections.
What is AIDS?
A syndrome that occurs as a result of the destruction of the immune systems
What are opportunistic infections?
Occur when the body’s immune system is weakened enough to give the infectious agents an opportunity to invade
Clinical stages are grouped into 4 stages. What happens in the 1st and 2nd stages?
Asymptomatic, or if symptoms are present they’re mild.
Stage 3 clinical stage of HIV?
More severe manifestations, increased viral load and decreased CD4 count
Stage 4 clinical stage of HIV?
Serious OI’s mark onset of AIDS. Very low CD4 count/undetectable CD4 levels
What is HAART?
Best current treatment for HIV extending lives from years to decades
AIDS orphans?
Children who have lost both parents and at least one of them to HIV/AIDS
Are people with latent TB contagious?
No
What is the number of people who have been exposed to TB bacteria? What percentage actually develop active TB?
1/3. 10%
What is DOTS?
Observer must watch TB patient take all medications every single day.
Case detection rate?
Proportion of those with TB disease who are diagnosed as having the disease.
Default rate?
Proportion of people who are diagnosed but don’t complete full course of treatment.
If someone stops their treatment part way through for TB and develops MDR-TB, what type of regimen are they put on? How much longer is the course of treatment extended?
DOTS-plus. Extended from 6 months to 2years.
What are new concerns in regards to TB?
Extensively drug resistant TB (XDR-TB) and totally drug resistant TB (TDR- TB)
The BCG vaccine protects what proportion of individuals who get it?
50%
What is the screening for TB?
PPD test (intradermal injection of TB proteins) then if that comes back positive need to get CXR
What are the manifestations of malaria?
Cyclic fevers, headaches, joint pain, organ failure (maybe)
What transmits malaria?
Female anopheles mosquitoes
Where do more than 90% of deaths due to malaria occur?
Sub-Saharan Africa
What is the growing concern with malaria?
It is becoming resistant to many anti-parasite drugs (chloroquine)
What is Artemisinin-Based Combination Therapy (ACT)?
Treatment regimen for malaria. Slows the emergence of drug resistant malaria
What is a good method of preventing malaria?
Insecticide-treated bednets (ITN) acts as a barrier to mosquitoes and kills them too
Who is most at risk for death related to influenza?
Elderly and immunocompromised
Does influenza only affect humans?
No, it affects chickens, ducks, horses, dogs, whales, and bats too.
Which strains of influenza are most common in humans?
A and B
The influenza A virus is further classified how?
By the surface antigens (hemagglutinin and neuraminidase)
Antigenic drift
Small genetic mutations bring about small changes to surface antigens of influenza virus
Antigenic shift
Occurs when two very different influenza viruses attack the same cell and genetic material from both recombines to form a new type of influenza
