Short Answers Flashcards
Name 2 similarities and 2 differences between the Globalization and Health perspective
described by Woodward et al. and the Planetary Health Perspective described by Horton and Lo.
Similarities:
1) There’s work to be done in all countries (LMIC and HIC), can’t analyze health one country at a time
2) They’re both influenced by political, economic, and social systems
Other: Both support that national boundaries are less important than they once were
Differences:
1) Globalization and Health focuses more on the relationship between health and a nation’s political economy, whereas Planetary Health focuses on the relationship between health and the environment and health of ecosystems.
2) In the Globalization and Health perspective, health is influenced by
global economic and social trends so in order to solve these issues have to bring all countries together at the same table to resolve them and improve the economy. In Planetary Health, the work is more with local governments to alleviate disease burden and establish ecosystem sustainability.
Other: Globalization and Health focuses on the influences of social sciences and planetary health focuses on the impact of natural systems
Name two errors in this statement: “Malaria is common in Dar es Salaam, Tanzania because
there is a lot of crowding, there is no regular trash collection, and low-income communities rely
on poorly-maintained latrines. Large numbers of mosquitoes breed in the trash and latrines,
and transmit malaria to the population.” For each error, explain why it is incorrect.
One error is that the statement assumes that malaria is solely caused by the presence of large numbers of mosquitoes breeding in trash and poorly-maintained latrines. This is untrue because malaria is caused by a malaria parasite in the local mosquito population, so mosquitoes don’t cause malaria, but infected mosquitoes cause malaria.
No regular trash collection doesn’t necessarily increase malaria prevalence, highly contaminated water is highly unattractive for these infected mosquito larva. (contaminated water by the trash cans, mosquitoes don’t like that)
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Describe 4 ways in which the vision for addressing the health needs of populations enshrined in the Alma Ata Declaration stood in contrast to the programs and policies pursued by the
World Health Organization and other global health organizations during the 1950s and the 1960s.
1) The Alma Ata Declaration emphasized the importance of developing primary health care and implementing preventative and curative interventions at the community level in order to achieve health for all. In contrast, during the 1950s and 1960s the emphasis was on vertical and categorical programs that widely neglected the broader context of health and other social determinants of health.
2) The Alma Ata Declaration emphasized community participation and decision-making, in other words horizontal interventions. This is in contrast to the vertical programs of the 1950s and 1960s, that had a military-style chain of command and didn’t take into account community voices.
3) The Alma Ata Declaration called for more comprehensive health interventions, programs that had the potential to reach the rural poor. In the preceding decades, global health widely focused only on the health of some populations, not including rural areas in many countries, which exacerbated the already existing health disparities.
4) The Alma Ata Declaration recognized collaboration among multiple sectors like health AND education in order to achieve health for all. This declaration had a more holistic and intersectional approach to health. In contrast, in the 1950s and 1960s, there was less recognition of the interconnectedness between health and other sectors as well as less consideration taken for these interventions when it came to designing and implementing health interventions.
Name three pathogens causing pneumonia in young children that can be targeted by
vaccination. (3 points) What proportion of pneumonia deaths in young children are attributable
to these three pathogens? (1pt)
- Streptococcus pneumoniae (Pneumococcus), it’s 32.7% of pneumonia deaths.
- Haemophilus influenzae Type B (Hib), 15.7% of pneumonia deaths
- Influenza, 10.9% of pneumonia deaths
Diarrhea remains a major contributor to global under-five mortality. Describe two ways that malnutrition contributes to morbidity and mortality from diarrhea (2 points), and two ways that
diarrhea contributes to malnutrition in children (2 points).
Ways malnutrition contribute to morbidity and mortality from diarrhea:
- Malnutrition can lead to a weakened immune system by children which would make them more susceptible to diarrheal diseases because their bodies have difficulty initiating an effective immune response against pathogens.
- Malnutrition can lead to structural changes in the intestine which could affect nutrient absorption and lead to diarrhea by exacerbating dehydration and vitamin/electrolyte imbalances.
Ways diarrhea contributes to malnutrition in children:
- Nutrient loss, diarrhea leads to excess loss of electrolytes, vitamins and minerals. Chronic/severe diarrhea can deprive a child’s body of nutrients essential for their growth and development, thus contributing to malnutrition.
- Diarrhea can lead to malabsorption in a child’s intestine which would prevent them from taking in all of the nutrients their bodies’ need, leading to malnutrition over time.
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Describe three reasons that malnutrition in children is greatest between 6 and 23 months of
age (2 points), and name three interventions that are promoted to reduce malnutrition among
this population (2 points).
Three reasons:
1) End of breastfeeding, children go from having all of the nutrients they need with breastmilk to foods that may not have all of the nutrients they need.
2) Despite increased intake of solid foods, the foods that infants consume may have low nutritional content which can lead to malnutrition.
3) Passive feeding, infants may not be actively encouraged to eat their food which could lead to inadequate intake.
Three Interventions:
1) Exclusive breastfeeding, breast milk provides all of the nutrients that infants need as well as equips their immune system, exclusively breastfeeding for the first six months can reduce the risk for malnutrition.
2) Encourage nutrient dense complementary foods. Infants have increasing nutritional needs and providing/educating parents with nutrient-dense foods will help support the children in healthy growth and development.
3) Micronutrient supplementation, provides essential vitamins and minerals through syrups or drops alongside a perhaps not nutritionally-dense diet to ensure adequate nutrition intake.
What questions are women asked when the Sisterhood Method is used to measure maternal
mortality (3 points)? When is this a good way to estimate the maternal mortality ratio (1 point)?
Sisterhood Method Questions:
1) How many sisters have you ever had, born to the same mother, who ever reached the age 15 (or who were ever married), including those who are now dead?
2) How many of your sisters who reached the age of 15 are alive now?
3) How many of these sisters are dead?
4) How many of your sisters who are dead died during a pregnancy or during childbirth, or during the six weeks after the end of a pregnancy?
This is a good way to estimate the maternal mortality ratio when the country has a high Total Fertility Rate.
Name 4 reasons that neonatal mortality may be unrecognized as a major cause of mortality in
many low-income countries. (4 points)
1) In LMIC, many births occur at home without skilled birth workers. Neonatal deaths that occur in these homes may go unreported.
2) Death occurring in the first hours of life can be recorded as a stillbirth.
3) If a baby dies before being registered with the government, then they may be perceived as not existing in the eyes of the government and so their deaths don’t need to be reported.
4) In some cultures, mothers and newborns undergo postpartum confinement meaning they isolate themselves in the immediate postpartum period for a varying time period. During this time, if illness and death happens it may be less likely to be reported considering the cultural beliefs around postpartum confinement.
Other: Death before the naming ceremony, the baby may not be considered a person yet and so their count wouldn’t count/less likely to be reported.
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Describe 2 social and 2 health systems factors that contribute to death from obstructed labor in
rural areas of low-income countries (4 points)
Health System Factors:
1. In rural areas of LMIC, there often is a lack of adequate healthcare infrastructure, which can lead to there being facilities unequipped to handle obstetric emergencies, and the nearest one that is equipped may be farther away which can be limit timely care for women experiencing obstructed labor.
- Healthcare facilities in rural areas, while materially equipped to treat obstructed labor, the quality of care may be suboptimal. This could include experiencing providers untrained in maternal care, inadequate labor management, and delays for emergency interventions.
Social Factors:
1. Lack of education in rural areas of LMIC could lead to women not knowing the signs of obstructed labor and so they don’t know to seek medical care until it’s too late.
- A promotion of teenage marriage in LMIC can lead to teenage pregnancy which could mean narrower birth canal if the mother isn’t done growing. (cultural practices)
In the demographic transition, mortality drops quickly, early in the transition. Fertility decreased gradually over time. Give two reasons that mortality drops quickly and early (2 points). Give
two reasons that fertility takes much longer to drop (2 points).
Quick Mortality Drop:
1) In the early days of the demographic transition, societies often experienced a relatively quick turnaround for public health interventions such as having access to clean water and sanitation which leads to a decrease in infectious diseases and reduction in mortality.
2) With the demographic transition, people begin to change their behaviors toward things that will directly help their health like a change in diet.
Slower Fertility Drop:
1) It takes time for attitudes to shift in favor of having smaller families. Think about traditional families where a woman’s primary role is childbearing and caregiving.
2) There’s a lack of access to contraceptives and family planning.
Name 4 reasons for the increase in non-communicable diseases during the Epidemiologic
Transition. (4 points)
- Changes in Diet and Nutrition: Society transitioned to diets of high processed foods, unhealthy fats, salt, etc which increased NCDs like obesity, cancers, type 2 diabetes, and cardiovascular diseases.
- Urbanization and industrialization have led to more sedentary lifestyles because there’s been an uptick in desk jobs, motorized transportation, and overall less physical activity which leads to NCDs like obesity, hypertension, cardiovascular diseases, etc.
- Environmental and Occupational Exposures: With urbanization and industrialization came an increase in potential to be exposed to environmental pollutants which lead to poor air quality, contaminated water, etc. and so leads to NCDs like respiratory diseases, cancers, and cardiovascular diseases.
- Tobacco Use: Tobacco use has increased in many societies due to marketing and social norms which leads to NCDs like respiratory diseases, cancers, and cardiovascular diseases.
Other: Population Aging, aging is a significant risk factor for NCDs such as cardiovascular diseases, cancer, and neurodegenerative diseases. As the proportion of older people in the population increase, so does the number of NCDs.
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What is the difference between a Crude Birth Rate and a Total Fertility Rate (3 points)? Which
rate is better for comparing patterns of age-specific fertility rates between countries (1 point)?
The difference: The CBR offers a general overview of fertility patterns within a population because it doesn’t account for differences in age distribution of women of childbearing age whereas the TFR offers a more comprehensive assessments because it accounts for age-specific fertility rates and provides a more nuanced understanding of populatory fertility patterns.
The TFR is better for comparing patterns of age-specific fertility rates between countries because it accounts for differences in the age distribution of women of childbearing age which allows for meaningful comparisons between different demographic structures.
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Name the 3 durable solutions for refugees. Which one could benefit the greatest number of
Syrian refugees in Turkey over the short term (next 1 to 2 years)?
- Voluntary Repatriation: Returning to place of origin once conditions have improved and conflict has ended.
- Local Integration: Settling and integrating in place of first asylum (local settlement). (Turkey for the Syrians)
- Resettlement in Third Country
The solution that could benefit Syrians most in the short term is local integration in place of first asylum, in this case Turkey. This is due to how large the Syrian refugee population is in Turkey, how their government has already implemented various policies and programs to support their integration. This would allow/support the Syrians in being able to fully participate in Turkish society and begin to contribute to the economy and local community.
What is meant by the term “double burden” in relation to malnutrition during the Nutrition Transition (1 point)? Name two factors that contribute to each of the two burdens in low-income countries (3 points)?
The “double burden” refers to the simultaneous presence of undernutrition and over nutrition within a individual, household, and/or population.
Undernutrition:
1) Famine or food insecurity contributes to feeding practices and how food is distributed
2) Inadequate Healthcare and Sanitation: This impacts vulnerable populations like women and young children and increases their risk of infectious diseases which could further exacerbate undernutrition.
Over nutrition:
1) Safety, having access to safe places to exercise and play: This combines with availability of high calorie UPFs leads to a sedentary lifestyle and obesity
2) After the nutrition transition, there’s a shift towards higher consumption of UPFs, mirroring Western dietary patterns. This shift contributes to over nutrition and increase in NCDs.
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What are ultra-processed foods (UPF) (1 point)? What are three factors driving high UPF
consumption in low-income urban populations in low- and middle-income countries (3 points)?
UPF: Food products that undergo extensive processing like atomization and have additives like colors, preservatives, flavors, and more. These foods are typically high in unhealthy fats, sugars, salts, and artificial ingredients.
Factors:
1. There may be lack of materials to cook and/or store food in refrigerator so packaged foods are more convenient.
- Concerns about infectious diseases, they get reassurance from pre-packaged foods.
- UPFs are very common and easy to sell, cheap and just at any small shop.
