What has the trend been for the use of global health vs international health? Flashcards
Global health has been increasing steadily since the 1960s, and international health has been fluctuating but decreasing recently.
What are the predecessors of global health?
- Colonial health (19th-20th century)
- Topical health (late 19th century to 20th century
- International health (20th century)
What is colonial medicine?
Health in European colonies - health of colonized and mainly colonizers
(this was defined by geography and power relations)
What is tropical health?
Health in tropical places (defined by geography)
What is international health?
Health work abroad, typically used to describe practice or research in developing countries; often linked to economic development projects
What is the trend for global health vs. international health?
Global health has been increasing since the 1960s, international health is fluctuating but decreasing overall
What is global health?
Health is the state of complete physical, mental, and social well-being not merely the absence of disease or infirmity.
On a global scale, it is the whole of something, and it implies moving beyond boundaries. It describes a health issue that is bigger than the country’s systems can support/deal with on its own.
How is global health used in practice?
- preventative/ community based focus
- developing countries and vulnerable populations
- Attention to equity and social justice
- Importance of social structures
- collaboration on multiple fronts
What are the characteristics of Ebola that influences the response and consequences to the outbreak?
- high fatality rate
- no approved treatment for it as of yet
- continued risk of transmission even after treatment
- highly stigmatized disease
What are the characteristics of the CONTEXT that influenced response to ebola?
- individual behavior: hand washing, social interaction
- culture: burial practices
- lack of economic resources
- unsophisticated health care systems
- history of conflict making the disease difficult to decrease
- resulted in high rates of orphanhood
Is Ebola a global health problem? Why?
YES, the context of the issue was beyond the realm of what the states could deal with on their own
What were the immediate health consequences of the tsunami and where were they felt?
Tsunami: results were immediate; countries in SEA were impacted, about 183,000 deaths, there was a lot of damage to land and physical infrastructure, Relatively few injured survivors because most deaths are from drowning
What were the long term consequences of the tsunami?
- infrastructure rebuilding
- little to no long term injuries
Who responded to the natural disasters and how?
- the immediate response is primarily local but local leaders died in both natural disasters
- foreign governments and private citizens intervened
How can we think about the social causes of a natural disaster?
- little to no early warning systems in tsunami
- look at inequality and where people were affected more. people with little resources often faced more damage and death
What were the short term consequences of the earthquake?
- immediate loss of life, displacement of people, destruction of infrastructure
- trauma and mental health issues
- health problems related to living in temporary housing (poor sanitation, sexual violence)
What are the long term consequences of the earthquake?
-largely unsuccessful economic development
Social consequences of tsunami
- more women than men died
- death rates for women and children are lower in households with more prime age men
- women and men were more likely to have died if their spouse died
- if son died, parents were more likely to die but not for daughters
- overall both men and women tried to save other family members
What are the long term consequences of the tsunami?
- resolution of political conflict
- largely successful economic recovery
Is it more appropriate to study female genital cutting as a health issue or as a human rights issue?
human rights issue because it was largely unsuccessful as a health issue
- bodily integrity
- freedom from violence
Why is FGMC practiced?
- origins unknown
- religious requirements
- to protect women purity
- to mark social adulthood
Theories of FGMC
- Modernization theory
- Feminist Theory
- Social norms theory
Negative outcomes associated with FGMC
- negative mental health
- short term consequences like infection, bleeding, and shock
- long term bladder and uni infections, poor maternal/infant health outcomes
- exact prevalence is hard to determine
FGMC comparison to other global health issues? Acute or chronic?
Chronic, problem initially defined by outsiders
Modernization theory
- Why?: FGMC practiced because men own land and resources, and women gain access via marriage
- as economic production shifts away from family lineage based, individuals will become less important on land through marriage and it will be come less important
- predictors of change: education, wage labor, urbanization
Feminist theory
- why?: its a way of controlling women sexuality
- persists cus women need to be cut in order to get married
- as women’s roles shift and women gain alternate routes to economic and social support, FGMC will decline
- predictors of change: women education and employment, later marriage and lower birth rates
Social norms theory
- Why?: it is a social norm where it is practiced, people do it because its expected
- social costs of breaking the norm is high for marriage
- if parents think their daughters will be okay not circumcised then they will stop, one tipping point is reached change will happen quickly
- predictors of change: strength of community norms about circumcision, marriage pool for uncircumcised women
Efforts toward abandoning FGMC in the colonial period
-huge backlash and it increased due to independence and national identity from colonizers
Efforts toward abandoning FGMC in early national and international actions
- Feminist activism in 70s from US and Europeans
- WHO involvement in 70s and 80s, 1979 Khartoum Seminar human rights addition
- Unicef and UNFPA involved gradually
Approaches to addressing FGMC - medicalization
early on it was a health consequence, and this wasn’t effective. increased medicalization and so it moved to infancy and doctors doing it
Approaches to addressing FGMC - human rights
- combination of local groups, international orgs, and national governments
- interventions on education, alternative rituals like pricking, women empowerment, public pledges in community
What works for FGMC?
don’t know - little evaluation
its declined in some countries but not in others
ex. Kenya declined before interventions, Senegal no signs of decline but good interventions, central african republic recent decline with little intervention
Two ways change can happen/ be measured with FGMC
- direct intervention and formal evaluation
- variation in prevalence of cutting as a way of understanding people’s decisions and testing theories
What are the social causes of intestinal worms?
-poor sanitation and hygiene
What are the social consequences of worms?
- diarrhea and ab pain
- weakness
- loss of appetite
- anemia
- long term: reduced ability to absorb nutrients and slow growth
- chronic poor health reducing school attendance, lower earnings and employment
Basics of intestinal worms
more than 25% of the world’s population, transmitted through soil, east to treat (cheap and few side effects)
Approaches to worm treatment
- treat only those infected
- treat everyone at regular intervals of primary care
- mass treatment on one day in schools - some kids may be missing from school
Recommendations for WHO levels
- 1-2 times per year for regular
- at risk: women of childbearing age and school kids
Externalities
benefits or consequences for someone who didn’t choose the action - positive ones are good for interventions
Philosophical complications with cost benefit analysis
-are economic metrics appropriate for making health decisions?
How to gather evidence on what works other than cost-effectiveness analysis
-RCT and observational data
Issue with observational data?
-unable to see confounding factors
Issue with RCTs?
-only highly controlled settings which doesn’t come often and hard to account for errors
Cluster randomization
-cluster to receive treatment instead of individuals
Costs of mass deworming programs
- 1-6 cents US
- low side effects
- in total 50 cents per child BUT this can still be expensive for developing countries
Early success vs recent success in mass deworming?
- initially successful at decreasing hookworms, increased school performances
- recently decrease worms but little impact on overall health, increases school attendance but not test scores
- not effective as health intervention, mainly as educational
Common measures of health
- mortality
- morbidity
- summary measures - more info
- individual measures - easiest to deal with
Measures must be ____ and ____
consistent and widely applicable
Death rate
number of deaths divided by population size
Vital statistics
centralized records of births and deaths kept by government agencies
Government statistics
- vital stats
- health info/surveillance systems
- census data “gold standard”
Dealing with incomplete government stats
- verbal autopsies
- survey data
Challenges to measuring maternal morbidity
- unreliable hospital records
- maternal deaths not classified properly
- unable to ask moms directly cus they died
- surveys have to have large samples for reliable results
Solutions to measuring maternal morbidity
- expand data collection to third parties
- improve death classification
- use demographic techniques to adjust numbers from existing and measures
Stages of demographic transition theory
- high birth rates, high death rates
- high birth rates, declining death rates, high population grown
- declining birth rates and low pop growth
- low birth and death rates, low pop growth
demographic transition as modernization theory
- coincides with both
- some say that den change is as a result of economic growth, some say its vice versa
Nutrition transition theory?
undernutrition (hunger, malnourishment) –> to over nutrition (obesity)
Proposition 2:
communicable –> non communicable disease
- age of pestilence and famine
- age of receding pandemics
- age of man made diseases
Proposition 3:
changes in age specific death rates
-declined most drastically for kids and teens
Proposition 4:
epi transition as component of modernization
-related to economic development
Causes of epi transition
-standards of living, public health, medical technology
but this has very little role in declining disease in 20th century
Proposition 5:
3 models
- classis or western model: gradual decline in death and birth rates
- accelerated epi model: gradual decline in mortality then rapid change
- contemporary delayed model: mortality declines that started in 20th century
- transitional variant of the delayed model: late transition but eventually had declines in birth and death
epidemiological transition as modernization theory
-one path toward progress of a shared goal
Critique of ETM
- Omran didn’t anticipate reveals in mortality decline ex. HIV
- different phases of epi transition aren’t always clearly distinguished
- Omran’s approach didn’t adequately account for different pathways through the epi transition
Critiques of modernization approach
- assumes that all countries follow same pathway and that change happens automatically
- inequality within and between countries
Proximate causes
closer to the health condition
Distal causes
farther away from health condition, don’t have a relationship unless there is a pathway
Distal vs fundamental
distal dont relate unless pathway is drawn, fundamental will always be connected
Biomedical approaches to health
- focus primarily on carriers of disease and physiological processes
- social causes can be important to the extent that they inform biomedical understandings (ex. hand washing, burial practice, clean water, air pollution) but they aren’t the REAL causes
contextualizing risk factors
-understanding causes of health is to work toward uncovering more and more proximate causes
distribution vs causation
way of understanding theory
-is it explaining the cause or why things are spread out?
level of analysis in theory
-can be micro or macro
structure vs agency in theory
- agency: people ability to make and implement decisions
- structure is bound by institutions and social rules at the macro and mess levels
social construction of health and illness
- people create meaning through social interactions, knowledge is constructed not discovered
- health and illness are socially constructed
- ex. ADHD LGBTQ+
Health behavior theories
behavior is determined by attitudes, self-efficacy, norms and social environment, risk and emotional response, intentions and planning
structural violence
structural conditions can cause illness and sugaring, especially in social inequalities
