SOCI 180: Intro to Global Health - Midterm Study Guide

• Study guide for the SOCI 180 Midterm, Spring 2025
• The exam includes multiple-choice, true/false, fill-in-the-blank, short answer, and essay questions
• It covers lecture slides, required readings, and videos
• The exam is written in class, on paper

Global Health Definitions

• Encompasses health problems, issues, and concerns that cross national borders
• Addressed through cooperative actions
• Global health emphasizes transnational health issues and promotes interdisciplinary collaboration

WHO Definition of Health (1946)

• A state of complete physical, mental, and social well-being
• Not merely the absence of disease or infirmity

Bircher's Definition of Health (2005)

• A dynamic state of well-being, characterized by an individual's physical, mental, and social potential
• Meets the demands of life unique to the individual's age, culture, and personal responsibility

Population Pyramids

• Graphical representations of the age and sex of a population
• Males are typically on the left, females on the right

Types of Population Pyramids

• Expansive pyramids have a larger percentage of people in younger age groups with high fertility rates and lower life expectancies; common in many 3rd world countries with a wide base that narrows out
• Constrictive pyramids have a narrow base that widens out in the middle, low birth rates, an aging population, and are common in developed countries
• Stationary pyramids have balanced birth and death rates, a stable population, and are seen in highly developed countries

Population-Level Indicators

• Health indicators include life expectancy, infant mortality rate (IMR), morbidity rates, maternal mortality rate, healthcare access, and vaccination rates
• Social indicators include education levels, social mobility, access to clean water/sanitation, and mental health
• Economic status indicators include unemployment rates, poverty rate, and cost of living

Life Expectancy

• A hypothetical measure of the average number of years a person is expected to live if exposed to the mortality trend of a particular year throughout their life

Neonatal Mortality Rate

• Same as the infant mortality rate but the age is between the first 28 days

Infant Mortality Rate (IMR)

• Calculated as (# deaths in a year aged 0-1 / # live births in the year) x 1000

Child Mortality Rate

• (0-4, 1-4, 0-14) ... most often 0-4 divided by # of live births in that year

Global Burden of Disease

• Largest and most detailed scientific effort to quantify levels and trends in health
• Compares the different health statuses of different populations around the world
• Started in the early 1990s and is now hosted at the Institute for Health Metrics and Evaluation (IHME) at the U of Washington
• Estimates include all-cause mortality, deaths by cause, YLLs, YLDs, and DALYs

Total Fertility Rate

• The average number of children a woman would bear if she survived through the end of the reproductive age span (ages 15 to 49) and experienced a particular set of age-specific fertility rates (ASFRs) at each age
• The most important indicator of fertility

Age-Specific Fertility Rate

• Calculated as (# of births in a specific age group / number of women in that age group) x 1000

Cause-Specific Death Rates

• Add up to the all-cause mortality rate (i.e., CDR)
• Usually determined by the underlying cause (the disease or injury that initiated the events resulting in death)

Maternal Mortality Rate

• Deaths associated with pregnancy, childbirth, and the postpartum period divided by the number of live births in that year

UN Sustainable Development Goals

• 17 goals and 169 targets with a target date of 2030
• One goal explicitly addresses health: "Good Health and Well-Being"
• Four other goals are related to health: Clean Water and Sanitation, No Poverty, Zero Hunger, and Quality Education

Decolonizing Global Health

• Decolonization = undoing colonialism
• Involves decolonization as a social, cultural, and psychological process
• Deconstructing or dismantling colonial ideologies and challenging the superiority of Western thought and approaches
• Calling for equity and justice

Demography

• The scientific study of the size, composition, and distribution of human populations and their changes resulting from fertility, mortality, and migration

Sources of Population Change

• Births, Deaths, In-Migration, and Out-Migration

Balancing Equation of Population Change

• N(T) = N(0) + B[0, T] - D [0, T] + I [0, T] - E [0, T]
• N(0) = number of persons alive in the population at time 0
• B[0,T] = number of births in the population between time 0 and time T
• D[0,T] = number of deaths in the population between time 0 and time T
• I[0,T] = number of in-migrations between time 0 and time T
• O[0,T] = number of out-migrations between time 0 and time T
• N(T) = number of persons alive in the population at time T

Natural Increase Equation

• Births - Deaths

Net International Migration Equation

• In-migrants - Out-migrants
• Immigrants - Emigrants

Definition of a Demographic Rate

• Statistical measure that quantifies changes in a population over a specific period, usually expressed per 1,000 people
• Helps analyze patterns in birth, death, migration, and other population dynamics
• Essential for understanding population growth, decline, aging, and movement trends

Principle Rates in Demography

• Crude Birth Rate
• Crude Death Rate
• Crude Rate of In-Migration
• Crude Rate of Out-Migration

Crude Birth Rate

• CBR[0,T] = (# of births in the Population between Time 0 and Time T) / (Number of Person - years Lived in the Population between Time 0 and T)

Crude Death Rate

• CDR[0,T] = (# of deaths in the Population between Time 0 and Time T) / (Number of Person - years Lived in the Population between Time 0 and T)

Rate of In-Migration

• CRIM[0,T] = (# of in-migrations in the Population between Time 0 and Time T) / (Number of Person - years Lived in the Population between Time 0 and T)

Rate of Out-Migration

• CROM[0,T] = (# of out-migrations in the Population between Time 0 and Time T) / (Number of Person - years Lived in the Population between Time 0 and T)
• CGR[0,T] = CBR[0,T] - CDR[0,T] + CRIM[0,T] - CROM[0,T]

Mean Annualized Growth Rate Formula

• By how much does a population grow or shrink in a year?

Largest Countries

• Population size is India, China, U.S.A

Fastest Population Growth

• The fastest population growth rate is South Sudan, Niger, and Angola

Total Fertility Rate

• The highest total fertility rate is Niger; the lowest is South Korea

Life Expectancy

• The highest life expectancy is Monaco, and the lowest is Chad

Infant Mortality

• The highest infant mortality rate is Afghanistan, and the lowest is Slovenia

Sex Ration at Birth

• 105 male births per 100 female births

Importance of Population Age Composition for Crude Rates

• Populations with an older age structure tend to have higher CDR, driven by high mortality at higher ages
• The rate of death varies extensively by age
• Populations vary extensively in age structure

Age-Specific Mortality Rate

• Mortality rate limited to a particular age group

Role of Age Standardization

• To make sense of richer countries having higher CDR and to “control out” age
• We are interested in mortality itself and NOT the age composition
• Goal is to apply the same age composition to different sets of age-specific rates, and come up with a new crude rate (ASCDR)

Prevalence

• The number and proportion of people in a population suffering from a certain health condition at a given point in time (or over a specified time period)

Incidence

• The number or rate of new cases that develop in a given time period in a defined population, often expressed as the number of people per 100,000 who newly develop the condition in a year

Variation by Age

• The rate of death varies extensively by age
• Different age groups have different crude death rates

Epidemiologic Transition Theory

• Developed by Abdel Omran (UNC)
• A theoretical framework that characterizes the patterns, determinants, and consequences of health and disease changes in a variety of social contexts

Stages of the Epidemiologic Transition

• Stage 1: Age of pestilence and famine
• Stage 2: Age of receding pandemics
• Stage 3: Age of degenerative and man-made diseases

Modern Medicine & Epidemiologic Transition

• Modern medicine had little to do with the decline in infectious diseases

Social Determinants of Health Framework

• Social determinants of health as the conditions in which people are born, grow, live, work, and age, and how these conditions shape health outcomes across populations

Health Inequity Definition

• Unfair and avoidable or remediable inequalities or differences in health status between groups of people (population groups defined socially, economically, demographically, or geographically)

Measures of Social Status

• Links between social status and health

Socioeconomic Status

• Diffeerences between individuals and groups in the possession of highly valued societal resources, most importantly educational attainment, occupational status, income, and wealth

Social Class

• Individuals' relationship to the means of production, economic based

Educational Attainment

• Significant reduction in odds of death for those with high school degree

Income

• Personal, household (who in the household), hourly, weekly, monthly, yearly, IRS records, cash income, missing data

Wealth

• Assets minus debts

Causual Relationship Between Education/SES and Health

• Mounting evidence that SES is causally related to population health

Fundamental Cause Theory

• Educational attainment provides access to an array of flexible resources

Flexible Resources

• Money, Knowledge, Power, Prestige, Social Connections

Race

• The assumption that individuals can be divided into groups based on phenotype or genotype and that those groups have meaningful differences

Ethnicity

• A group of people with a common cultural identification, based on a combination of language, religion, ancestral origin, or traditional practices

Racism

• A social system that systematically restricts access to society's goods to members of socially constructed racial and ethnic minority groups

Types of Racism

• Everyday forms of prejudicial treatment

Nativity

• The distinction between persons who are born outside the country in which they are living (foreign-born, or immigrants) and persons who are living in the country in which they are born (native-born)

Health of Immigrants

• Immigrant health profile is very favorable at time of entry to the US

Visa Categories for US Immigrants

• Family Reunification & Employment needs

Immigrant Health Selection

• The immigration of especially healthy individuals to a destination country, as well as the emigration of especially unhealthy individuals back to their home countries

Gender

• One's biological category, male, female, or intersex, based on anatomy and physiology

ARTICLE SUMMARIES

Koplan

• Highlights lack of universally accepted definition of global health, which leads to confusion
• Compares public health, international health and global health

Kwete

• Critiques the colonial legacy in global health and argues that true decolonization requires structural changes rather than just symbolic efforts

Strauss

• Article critiques the well-meaning but often misguided efforts of U.S. students (and other Westerners) who travel to low-income countries with the intention of "doing good."

Omran

• Article discusses shifts in patterns of disease and mortality as societies develope

Study guide for SOCI 180 Midterm, Spring 2025, covering global health definitions from various sources like WHO and Bircher, emphasizing physical, mental, and social well-being. Includes understanding population pyramids.