International Public Health: Introduction

Global Health

• Focuses on improving the health of the entire population
• Issues extend beyond national borders
• Attention is specifically related to social injustice
• Low- and middle-income countries have high morbidity and mortality rates, and fragile health system functions

Key Concepts

• Morbidity: having a disease
• Mortality: being subject to death
• Health services should be delivered in an affordable, accessible, appropriate, acceptable, and with good quality manner

Factors Affecting Health Outcomes

• Social, political, and economic forces increase the risk of poor health outcomes (structural violence)
• Social and cultural aspects: poor hygiene or sanitation, stigmatized diseases (e.g. HIV in SSA)
• Political aspects: political instability in countries
• Economic aspects: income inequalities and unemployment

Global Health vs. Medicine

• Global health: population-based, focus on health equity and social justice, health promotion
• Medicine: individualized care, diagnosis and treatment, varies by healthcare system

Global Health Actors

• Families and individuals: first line of defense
• Communities: health workers, advocate for more support and better health
• Epidemic: unusual occurrence or increase in the frequency of a disease in a certain area
• Pandemic: global epidemic, spreads over several countries affecting large numbers of people

Response to Infectious Diseases

• Control: reduction of disease incidence, prevalence, mortality, and morbidity
• Elimination: reduction of disease incidence in a specific area to zero
• Eradication: termination of all cases of a disease and its transmission globally
• Extinction: specific infectious agent no longer exists in nature or lab

Herd Immunity

• Indirect protection from a contagious infectious disease that happens when a population is immune
• Achieved through vaccination or immune development through previous disease
• The more infectious a disease, the greater the population immunity needed to ensure herd immunity

Health Systems

• Definition: all activities whose primary purpose is to promote, restore, improve, or maintain health
• Components: goals, objectives, and functions
• Factors influencing health system design: income, education, and Others

Performance Assessment

• Inputs: financial, material, HR, patients
• Outcomes: health status, responsive fair contribution
• Quantitative data (input and outputs) used for benchmarking

History of Health Systems

• Pre-modern states: before the 19th century, epidemic, hospitals run as religious charity, state intervention
• Modern states: 19th and later, emergence of welfare state, responsibility of state for population health measures and health care services

Efficiency and Effectiveness

• Efficiency: use resources in the most convenient way to reduce costs
• Effectiveness: doing it right, measured by clinical outcomes, cost-effectiveness analysis, and resource utilization

Health Services

• Formal/informal, Western medicine/traditional medicine, public/private/NGO (not for profit) providers
• Special hospitals for certain groups (e.g. army, police)
• HIC: strong health system structures and less diverse services
• LIC: formal private sector small, informal private sector large, sometimes large NGO sector

Financing Healthcare

• Revenue collection: tax-based, social health insurance-based, voluntary/private health insurance schemes, out-of-pocket payments
• Fund pooling: spreading risks, cutting ties of funds with individual contributor
• Purchasing: allocating funds into health services