Introduction to Global Perspective of Health Care PDF

Global Perspective of Health Care Introduction  Learning Objectives Define the terms health, public health and s global health. Identify some examples of public health efforts. Identify some examples of global health issues and risk – factors. Recogni...

Global Perspective of Health Care Introduction  Learning Objectives Define the terms health, public health and s global health. Identify some examples of public health efforts. Identify some examples of global health issues and risk – factors. Recognize– the key differences between approach in medicine– and approach of public health. Explain –why study global health? Highlight– some important global health challenges. Highlight– the key concepts in relation to global health. Understand the link between global MDGs, SDGs and global health. Recognize the health system & service delivery in Saudi Arabia.  Basic Definitions and Concepts Health: According to the World Health Organization (WHO), “Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity”. (WHO, 1948) Good health is a high level of wellbeing: Physical wellbeing – good structure (anatomy) and function (physiology) E I Mental wellbeing – psychological balance and good mood Social wellbeing – well-adapted to the traditions of a community and able to interact well with other people within it Public Health: (Winslow) Is the science and art of preventing disease, prolonging life and promoting physical and mental health and efficiency through: ✓ Organized community efforts toward a sanitary environment,. ✓ Control of community infections. ✓ Education of the individual in principles of personal hygiene. ✓ Organizing of nursing and medical services for the early diagnosis and treatment of the disease. ✓ The development of social machinery to ensure the every individual in the community a standard of living adequate for maintenance of health.  Global health is an important new term, and an important new concept. The United State Institute of Medicine refers to global health as "health problems, issues and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions." The Concept of Global Health should imply that: One consider health problems from a global perceptive rather than from the – point of view of any individual country. Country work together not only to – – understand critical health issues but – also to solve them. – This term has replaced the term of – international health. Historical Development of Term  Public Health: Developed as a discipline in the mid 19th century in UK, Europe and US. Concerned more with F national issues. Data and evidence to support action, focus on populations, social T  justice and equity, emphasis on preventions vs cure.  International Health: Developed during past decades, came to be more concerned with  the diseases (e.g. tropical diseases) and  conditions (war, natural disasters) of middle and low income countries.  Global Health: More recent in its origin and emphasises a greater scope of health problems and solutions  that transcend national boundaries  requiring greater inter-disciplinary approach Disciplines involved in Global Health  Social sciences  Behavioural sciences  Law  Economics  History  Engineering  Biomedical sciences  Environmental sciences Some Examples of Public Health Activities 1. The promotion of hand washing. I 2. The promotion of bicycle and motorcycle helmets. 3. The promotion of knowledge about AIDS/HIV. 4. Large scale screening for diabetes and hypertension. 5. Mass dosing of children against worms. 6. The operation of supplementary feeding program E for poorly nourished young children. J  Some global Health Issues & Concerns 1. The burden of different infectious and noncommunicable diseases worldwide and what can be done to control including T.B, Malaria & HIV/AID. 2. The impact of environment on health globally and the effect of natural disaster and conflicts. Some global Health Issues & Concerns 3. Women Health 3.1 The factors that contribute to women dying of pregnancy related causes in so many countries. 3.2. Sexually transmitted infections (STDs) in young women. 3.3. Violence against women.  Some global Health Issues & Concerns 4. Children Health  4.1. The exceptional amount of malnutrition among young children.  4.2. The number of low birth weight babies being borne.  4.3. The high rates of death of babies in the first month of life.  4.4. Measles in young children.  4.5. Diarrhoea and pneumonia in young children.  4.6. The health of HIV/AIDS orphans. Some global Health Issues & Concerns 5. The search for new technologies to improve global health problems. Ethiopia Haiti India Key Differences Between The Approach of Medicine and The Approach of Public Health Point of Differences Medicine Public Health Focus: Individual Population Ethical basis: Personal service Public service Emphasis: Disease diagnosis, Disease prevention and treatment and care for health promotion of the individual. community. Interventions: Emphasis on medical care. Broad spectrum that may target the environment, human behavior, life style and medical care. Source: Harvard School of Public Health (HSPH) available at www.hsph.harvard.edu/about.htlm  Why Study Global Health?  To understanding better the progress made in health worldwide so far addressing global health problems.  To understanding better the most important global health challenges that remain and what must be done to address them effectively.  The important link between health and development, for example: ✓ Poor health mother is linked to poor health of babies and the failure of children to reach the full mental and physical abilities. ✓ Countries with major health problems as Malaria or HIV have difficulty attracting the investments needed to develop their economy. Why Study Global Health? 4. Having large number of unhealthy, poor nourished and ill-educated people is destabilizing and represents health economic and security threats to all countries. 5. The nature of many global health problems and concerns and the need for different actors to work together to deal with them. Some problems such as ensuring access to drugs to treat HIV require more financial resources than any individual country can provide. Some health issues can only be solved using global approach. Why Study Global Health? Still other global health issues require technical cooperation across countries such as: ✓ Set protocol for treatment of certain health problem as malaria. ✓ Set standards for drug safety. 9. The spread of HIV, SARS scares and the fear of Avian Flu have all brought attention to global health.  Global Health Challenges  In 2018, there were 140,000 measles deaths globally*.  In 2018, 1.5 million People died in the world due to TB*.  In 2017, 295 000 women died during and following pregnancy and childbirth*.  Nearly 9 million children under the age of five die every year, according to 2007 figures. *WHO -2020  Shrinking of the world and the health of people everywhere must be of concern to all of us because many diseases are not limited by national boundaries as: ✓ TB, HIV and Polio can spread from one country to the next. ✓ Dengue fever used to be concentrated in Southeast Asia, but cases are now seen in many other countries.  The expected disparities in the health of some groups compared to the health of other, for example: ✓The life expectancy in Japan is 82 years compared to 52 years in Haiti.  The term “life expectancy” refers to the number of years a person can expect to live. The 13 biggest threats to global health, according to WHO The World Health Organization (WHO) recently released a list of 13 urgent health challenges the world will face over next decade, which highlights a range of issues including climate change and health care equity.  d Climate crisis. z g Health care delivery in areas of conflict and crisis.  Health care equity.  Access to treatments.  Infectious disease prevention.  Epidemic preparedness. The 13 biggest threats to global health, according to WHO  Unsafe products.  Underinvestment in health workers.  Adolescent safety.  Improving public trust of health care workers.  Capitalizing on technological advancements.  Threat of anti-microbial resistance and other medicines.  Health care sanitation Fact Sheet about Measles ❑ Even though a safe and cost-effective vaccine is available, in 2018, there were more than 140 000 measles deaths globally, mostly among children under the age of five. ❑ Measles vaccination resulted in a 73% drop in measles deaths between 2000 and 2018 worldwide. ❑ In 2018, about 86% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. ❑ During 2000- 2018, measles vaccination prevented an estimated 23.2 million deaths making measles vaccine one of the best buys in public health. ❑ Source: WHO 2019 Key Concepts in Relation to Global Health 1. The determinants of health 2. The measurement of health status 3. The importance of culture to health I 4. The global burden of disease 5. The key risk factors for various health problems 6. The organisation and function of health systems  1. Determinants of Health  Genetic make up  Age  Gender  Lifestyle choices  Community influences  Income status  Geographical location  Culture  Environmental factors  Work conditions  Education  Access to health services 2. The Measurement of Health Status I  Cause of death  Obtained from death certification but limited because of incomplete coverage e  Life expectancy at birth  The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-born's life  Maternal mortality rate  The number of women who die as a result of childbirth and pregnancy related complications per 100,000 live births in a given year The Measurement of Health Status II  Infant mortality rate  The number of deaths in infants under 1 year per 1,000 live births for a given year  Neonatal mortality rate  The number of deaths among infants under 28 days in a given year per 1,000 live births in that year  Child mortality rate  The probability that a new-born will die before reaching the age of five years, expressed as a number per 1,000 live births 3. Culture and Health  Culture:  The predominating attitudes and behaviour that characterise the functioning of a group or organisation  Traditional health systems  Beliefs about health  Influence of culture on health  Diversity and vulnerability due to race, gender and ethnicity 4. The global burden of disease  Predicted changes in burden of disease from communicable to non-communicable between 2004 and 2030  Reductions in malaria, diarrhoeal diseases, TB and HIV/AIDS  Increase in cardiovascular deaths, COPD, road traffic accidents and diabetes mellitus  Ageing populations in middle and low income countries  Socioeconomic growth with increased car ownership What is the meaning of global burden of disease? The global burden of disease (GBD): This term describes the biggest health problems around the world. National statistics are used to identify the most common causes of death and the major causes of disability in low, middle, and high-income countries, and to produce a composite measure of disability-adjusted life years (DALYs). How is the burden of disease measured? Disease burden is often quantified in terms of quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). As the DALY has been the most widely-used measure, and can be applied across cultures. The DALY combines in one measure the time lived with disability and the time lost due to premature mortality. 5. Key Risk Factors for Various Health Conditions  Tobacco use – related to the top ten causes of mortality world wide  Poor sanitation and access to clean water- related to high levels of diarrhoeal/water borne diseases  Malnutrition – Under-nutrition (increased susceptibility to infectious diseases) and over-nutrition responsible for cardiovascular diseases, cancers, obesity etc.  Lack of physical activity Reliance on automobile transport Stress Urbanisation  6. The Organisation and Function of Health Systems  A health system comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health (WHO, United Nations…)  Most national health systems consist: - public, private, - traditional and informal sectors Millennium Development Goals  Millennium development goals are the most broadly supported comprehensive and specific development goals worldwide. Collectively they provide benchmarks for resolving extreme poverty, hunger, maternal and child mortality, disease, inequality, environmental degradation and global partnership for development.  adopted by world leaders in 2000 and set to be achieved by 2015 , the MDGs are both global and local , adopted by each country to address it is specific development needs. MDGs provide a framework for the entire International community to work together towards a common end for everyone.  MDGs included eight goals and 21 targets Targets for health-related Millennium Development Goals. Goal Targets G4: Reduce child mortality Reduce by two-thirds among children younger than 5 between 1990 and 2015 G5: Improve maternal health Reduce maternal mortality ratio by three-quarters between 1990 and 2015 G6: Combat HIV/AIDS, malaria, and other Stop HIV/AIDS and begin to diseases reverse their spread by 2015 Stop malaria and other major diseases and begin to reverse their incidence by 2015 Introducing the SDGs The Sustainable Development Goals  The SDGs are  A set of 17 goals for the world’s future, through 2030  Backed up by a set of 169 detailed Targets  Negotiated over a two-year period at the United Nations  Agreed to by nearly all the world’s nations, on 25 Sept 2015 What is new and different about the 17 SDGs? First, and most important, these Goals apply to every nation … and every sector. Cities, businesses, schools, organizations, all are challenged to act. This is called Universality IET Second, it is recognized that the Goals are all inter-connected, in a system. We cannot aim to achieve just one Goal. We must achieve them all. This is called 21 Integration3 And finally, it is widely recognized that achieving these Goals involves making very big, fundamental changes in how we live on Earth. This is called 21Transformation3 47  The goals within a goal: health targets for SDG 3 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100 000 live births. 3.2 By 2030, end preventable deaths of new-borns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. 3.4 By 2030, reduce by one third premature mortality from non- communicable diseases through prevention and treatment and promote mental health and well-being. The goals within a goal: health targets for SDG 3 3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. 3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents. 3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. 3.8 By 2030, Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. Organization and Management of Health Care in Saudi Arabia The Healthcare sector in the Kingdom of Saudi Arabia is primarily managed by the Government through the Ministry of Health (MOH). There are number of semi public organizations which specifically operate hospitals and medical services for their employees. The private sector operators also play a key role in providing quality healthcare. The MOH is the major government provider and financer of health care services in Saudi Arabia. In accordance with the Saudi constitution, the government provides all citizens and expatriates working within the public sector with full and free access to all public health care services. Levels of health care services: The Ministry of Health (MOH) provides health services at 3 levels: primary, secondary and tertiary. Primary Health Care (PHC) centres supply primary care services, both preventive and curative, referring cases that require more advanced care to public hospitals (the secondary level of care). while cases that need more complex levels of care are transferred to central or specialized hospitals (the tertiary level of health care). (Refer. Health Statistical Year Book, MOH) 54