Global Health: Concepts and Approaches

• World Health Organization (WHO) concerns itself with international public health, advocating for the highest standard of health for all people

Holistic Health

• Principles to achieve holistic health include improving basic daily life conditions, distributing power, and understanding and evaluating problems

Equality vs. Equity

• Equality means giving everyone the same thing, implying sameness and everyone starting in the same place
• Equity involves giving people what they need, through positive discrimination, fairness, and justice

Public Health Approach

• A public health approach involves defining a problem, identifying risks, selecting and implementing an intervention, and then evaluating the intervention's effectiveness

Intervention Types

• Interventions can be active/behavioral or passive/environmental

Lalonde Report

• The Lalonde Report was released in 1974 by the Canadian government
• It focuses on health promotion and disease prevention
• The report introduces the concept of the "health field," encompassing lifestyle, environment, and healthcare organization
• It emphasizes personal health practices and coping skills
• It advocates for moving from a purely medical model to a broader approach to health
• The report highlights the influence of social and economic factors on health outcomes
• Encourages collaboration across sectors to improve public health
• It is a foundational document for future health policies in Canada
• It has influenced global health promotion strategies and frameworks
• The report is recognized for its impact on community health initiatives

Determinants of Health

• Health in Canada is shaped by social determinants like income, housing, and employment, and not just medical care
• Government policies impact social determinants leading to health inequalities
• Canada's support lags behind other wealthy nations, necessitating policy change and public awareness

Key Reading Quotes - Determinants of Health

• Health of Canadians are shaped by their living and working conditions, known as the social determinants of health
• Well-being is determined by health and social services, education, food, and housing.

Analyzing Social Determinants of Health:

• Importance to health
• Comparison to other wealthy, developed nations
• How the specific determinant can be improved

Definition of Health:

• Health is defined as the state of being free from illness or injury

Holistic Model of Health:

• The holistic model considers a complete state of physical and mental well-being
  • It provides richer data but is harder to measure

Data Sources

• Measurements can be ongoing (e.g., census) or intermittent/one-time (health surveys)
• Data can be collected from the entire population or a sample

Stratification

• Data is stratified by socioeconomic status
• Types of data include:
  • Demographic (census every 5 years, population registers)
  • Mortality (death certificates, coroner reports)
  • Morbidity (hospital administrative data, health surveys, registries, disease notifications, ambulance data)
  • Police collision reports

Data Quality

• Data for prevention needs details on the crash (location, time, date, point of impact), the vehicles (type, condition, restraints), and the persons involved (age, sex, injuries)
• Public health often uses data collected for other purposes

Data Sources:

• Ambulance data: Provides first response data and location
• Police-reported collisions: Used to examine collision locations and environmental factors

Common Health Measurements:

• Life Expectancy at Birth - More is better
• Health-Adjusted Life Expectancy (HALE) - More is better
• Disability-Adjusted Life Years (DALY) - Less is better
• Incident: The number of new cases of a disease or injury over a specific time
  • Incident rate: Number of cases during a specific time period relative to the population
• Prevalence: The measurement of individuals affected by a disease or injury at a specific time
  • Prevalence rate: Number of new and pre-existing cases during a given time period relative to the population

Economica Reading Summary:

• The Canadian Census provides key income data for personal injury and fatal accident cases
• The replacement of the mandatory long-form Census with the voluntary National Household Survey (NHS) raised concerns about data reliability in 2011
• Statistics Canada addressed issues of:
  • Small Community Data: Data withheld on these communities to maintain accuracy
  • Sample Error: Increased the number of surveyed households (1 in 3 instead of 1 in 5)
  • Non-Response Bias: Comparisons made between NHS respondents to other records to ensure representative data

Person-Years:

• Estimate of the actual time at risk

ICES:

• Not-for-profit research institute with data, research and clinical experts, and health data
  • Includes:
    • Demographical data
    • Morality and Morbidity data

Socioeconomic Status (SES):

• It Includes income, education, and employment
• Lower SES is generally a risk factor for disease/ injury

Disease Patterns:

• Disease of Poverty: Largely communicable (e.g., tuberculosis, HIV/AIDS)
• Disease of Affluence: Non-communicable/chronic (e.g., heart disease, stroke, diabetes)

Sex and Health:

• Men experience:
  • More physical work (construction, mining),
• Women experience:
  • More mundane work and lower wages

Intensification of Work:

• Increase of hours, demands, and stress

Qualities of a Good Job:

• Measured by the Organization for Economic Cooperation and Development (OECD)
• ItAnalyzes:
  • Earning quality
  • Labor market security
  • Working environment
• Employment is directly related to income, housing, and food security

Importance of Employment:

• A good paying job enables:
  • Healthier neighborhoods
  • Education for kids
  • Childcare, which lets parents go and work
• Four dimensions that directly influence health include:
  • Job security
  • Physical conditions at work
  • Work pace, working hours and stress
  • Job satisfaction and opportunities for development

Job Security:

• "Working poor": People who work many jobs but struggle to make ends meet
• Types of “precarious” work:
  • Part-time
  • Temporary
  • Self-employed

WHO Reading Summary

• Many workers lack health coverage and safety protections
• Poor working conditions lead to health problems like back pain, hearing loss, lung disease, and depression
• Work-related health issues cost countries 4–6% of GDP, Insurance is absent for 70% of workers
• Better ventilation and safer equipment, can prevent workplace diseases
• WHO urges better occupational health services through training, prevention, and stronger workplace health policies

Socioeconomic Status (SES)

• Determined by:
  • Income and income distribution
  • Education
  • Unemployment and job security
  • Employment and job security

Raphael D Summarized:

• Income shapes living conditions that affect physiological & psychological functioning

Income and Health Links:

• Health is related to:
  • Actual income of family members or an individual receives
  • Distribution of income across the population
• Low income leads to material and social deprivation, impacting access to the basic prerequisites of health like food, clothing, and housing
• Deprivation leads to social exclusion, affecting one's health and abilities to live fulfilling lives
• Policy Implications:
  • Addressing income inequality
  • Increasing the minimum wage and social assistance levels
  • Reducing inequalities through progressive taxation and universal programs and services

Additional Raphael D Summary Points:

• Unionized workplaces reduce income and wealth inequalities -> improve health
• Education increases literacy and understanding of health promotion
• The effects of education on health are shaped by public policies
• High tuition fees influence whether low-income families can afford college/university

Employment:

• Employment provides income and a sense of identity
• Unemployment leads to material deprivation, social deprivation, psychological stress, and unhealthy coping ->Part-time work reflects greater income and employment insecurity
• Consequences of unemployment:
  • Material deprivation and poverty through reduced income and lost benefits
  • Decreased self-esteem, disrupted routines, and increased anxiety
  • Increased likelihood of unhealthy coping behaviours
• Insecure employment features intense work with non-standard hours
• Intense working conditions are associated with increased risk of stress, bodily pains, and injury
• Excessive work hours affects ones chances of physiological and psychological problems
• There are some policy implications to consider:
  • Provide basic standards of employment & work for everyone internationally
  • Reduce power inequalities between employers and employees via legislation
  • Provide access to income, training, and employment through enhanced government support for unemployed Canadians
  • Develop a new vision of healthy and productive work

Aspects of Policy and relevant research:

• Policy-relevant research must support government decision-making and provide current job security information
• Researchers have identified work dimensions shaping health outcomes:
  • Employment security
  • Physical conditions at work
  • Work pace and stress
  • Working hours
  • Opportunities for self-expression and individual development
• Imbalances between efforts and rewards lead to health problems
• High-stress jobs predispose ones chances of high blood pressure, cardiovascular diseases and physical and psychological difficulties
• High-strain jobs are common among low-income women in the sales and service sector
• Canadian women reported higher stress levels than men from over working

Sex vs. Gender:

• Sex: What you are born with (male/femal)
• Gender: How you identify as

The 6 Ways Gender Affects Health:

• Resources and Opportunities
• Decision Making In the Household
• Health Seeking Behaviour
• Access To Health Information
• Harmful Traditional Practices
• Harmful Social Expectations

2016 Gender and Morality Statistics:

• Men have a lower life expectancy than women
• Women see a doctor more often
• Men may be exposed to dangerous work
• Women have a slightly different lifestyle
• The number of significant differences that exits between men and women with chronic health issues at higher vs lower income ranges
• Better diagnosis not an explanatory factor for mortality rates
• Men's health equality is not a long issue

Women:

• Oppression
• Neglected health status throughout history
• Battle against neglect/burden of disease
• Inequity

Men:

• More recent
• Not-oppression based
• Complacent
• Established attitudes

2SLGBTQI+ Populations:

• Impacts experiences of services, cultural, religious, and personal beliefs
• Can impact comfort in accessing services/disclosing concerns
• Possible negative judgements/feelings of disconnect from professionals

Raphael Reading Summarized-Ch 16:

• Women face greater social and economic disadvantages due to caregiving
• Unequal pay
• Lack of affordable childcare limits ones job
• Men face diff challenges: higher suicide rates, involvement in crime and expectations for masculinity
• LGBTQ+ individuals experience discrimination.
• Policy solutions include pay equity enforcement, affordable childcare, better access to employment insurance, and stronger labor protections through unionization.
• Built Environment: Things built

Physical Environment Changes/Issues:

• Smoke released from infrastructure
• Availability of parks and green spaces
• Examples of areas: housing, schools, health care

Housing Related Issues:

• Affordability
• Overcrowding
• Ventilation
• Access to local things

Canadian Mortgage and Housing Corporation:

• Adequate housing
• Suitable housing
• Affordable housing/ costs less then 30%

Road Design/ Safety:

• Motor vehicles have focus, not pedestrians or cyclists
• Changes in environment = better safety, very effective
• Health settings/ Cities has clean, public events, high standards of quality
• All settings must include: Water/Shelter/Safety

Healthy Toronto Details:

• Major hub, generating 20% GDP. As urbanization occurs the success occurs with skilled people
• Great because:
  • High employment
  • Better access to quality health/social services
  • More opportunities
• Challenges:
  • Income inequality
  • Commuting

4 Priorities of Road Safety are recommended:

• Active Livings
• Road Safety
• Quality Food
• Social Capital and well being

Characteristics Of Healthy Cities:

• Housing of quality
• Long Term stability
• Strong support
• Equality to all decision making
• Meet needs

Great cities must also include:

• Employment/ Education
• Housing
• Better access to healthcare

Explores key concepts in global health, including the WHO's role, holistic health principles, and the differences between equality and equity. It covers the public health approach, intervention strategies, and the impact of the Lalonde Report on health promotion and disease prevention.