RCSI Populations, Planning, and Current Global Health Challenges PDF

POPULATIONS, PLANNING AND CURRENT GLOBAL HEALTH CHALLENGES Population Health and Healthcare Delivery (PHHD) Dr. Nitya Kumar PHHD Lead 1  Learning outcomes You will be able to: 1. Describe the factors which determine the size of a...

POPULATIONS, PLANNING AND CURRENT GLOBAL HEALTH CHALLENGES Population Health and Healthcare Delivery (PHHD) Dr. Nitya Kumar PHHD Lead 1  Learning outcomes You will be able to: 1. Describe the factors which determine the size of a population 2. Discuss the demographic factors that need to be considered in relation to health service planning 3. List the main global health challenges facing the world today 4. Discuss the contribution of health care to the climate crisis 5. Outline the role of medical professionals in the fight against climate change 2  Definition and Use of Demography Demography is the study of human population with respect to size, composition, spatial distribution, and changes in the population that occur over time. Populations are never static; they grow or decline through the interplay of population change processes: 1. Fertility (Number of births that occur to an individual or a population) 2. Mortality (Death of an individual or the number of deaths that occur in a population) Why do we need 3. Migration (The movement of people into or out of a specific demography geographic area) Health service planners can only successfully and why to implement plans if they can develop programs measure that meet the present and future needs of population different segments of the population details?  Global Fertility Rate: Babies per woman In the last 50 years 6 fertility dropped drastically. 5 4 Most likely, it will continue to fall to 2 babies per woman 3 or even beyond 2 Today it’s 2.5 babies per woman. 1800 1900 2000 2100 Sources: After 1950: UN World Pop. Prosp. 2012. Before 1950: hundreds of sources combined by Gapminder. www.gapminder.org/teach Free teaching material for a fact-based worldview Version: 1 http://www.gapminder.org/answers/how-did-babies-per-woman-change-in-dif ferent-regions  Global difference in population growth Global population growth, 1950–2050 Where is the growth occurring? Developing countries Developed countries Health Financing Revisited: A Practioner’s Guide. P Gottret, G Schieber, World Bank, 2006  Population Change Processes Inputs Outputs Births Natural Increase Deaths Total Population Immigrants Emigrants Migration  1) Births In Europe the 1800’s women were having 4 -5 children. Since the 1960’s this figure has dropped dramatically. and women are now having on average less than 2 children. Image: Charity or the indigent family 1865. William-Adolphe Bouguere  TPFR is a measure of the average number of children that would be born to a woman if she were to experience the exact current age- specific fertility rates (ASFRs) through her lifetime In EU In EU countries, countries, the the TPFR TPFR remains remains below below the the level level required for required for the the long-term long-term replacement replacement of of the the  2) Migration International migration About 258 million people across the world are international migrants Most migrants are from developing countries and migrate to industrialized countries In 2016, the total number of refugees and asylum seekers in the world was estimated at 25.9 million Migration affects population growth  War and Migration The Syrian war - has created the largest population displacement in current times (6.7million). Half of the people affected are children. Taliban take-over of Afghanistan in 2021 caused 50% increase in displacement Russian invasion caused 6million Ukrainians to be displaced 1. UNHCR Ireland 2. bbcnews.com  Urbanization and Migration More people than ever before now live in cities; Economic development centered in urban areas Better job opportunities, public services etc. Today, 55% of the world’s Manila, Philippines population lives in urban areas, a proportion that is expected to increase to 68% by 2050.  But what are the negative public health impacts of this? Overcrowding Slums that lack proper sanitation Unplanned urban housing, Inadequate transport, and food systems, Air pollution, Dhaka, Traffic injury Bangladesh Increase in mental health issues Urban health risks are distributed unequally among social groups Hong-kong  3) Deaths - People are now living longer The pace of population ageing is much faster than in the past. By 2050, the proportion of the world’s population over 60 years will nearly double from 12% to 22%. The number of very elderly people (85+) is a key consideration with an ageing population  Age Dependency Ratio (Total) Age dependency ratio (total) is the ratio of dependents - people younger than 15 or older than 64 - to the working-age population - those aged 15-64. Calculated as the proportion of dependents per 100 working-age population Population 0-14 + ≥ 65 = ------------------------------ X 100 Population 15-64 ‘Dependency Ratio’ is relevant to health planners Those under 15 and aged 65 and over have highest need for health services; those in the ages in between potentially work and pay taxes to pay for public services,  Age Dependency Ratio Can Have Two Types Age dependency ratio, young, = ratio of people younger than 15 - to the working-age population (15-64). Calculated as the proportion of dependents per 100 working-age population. Population 0-14 ------------------------------ X 100 Population 15-64 Age dependency ratio, old = ratio of people older than 64 - to the working-age population--those ages 15-64. Calculated as the proportion of dependents per 100 working-age population. Population ≥ 65 ------------------------------ X 100 Dependenc y ratios are likely to increase in the coming years. Why?  Projections for Bahrain’s Ageing Population https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019- Highlights.pdf  MOH Initiatives for Elderly Care in Bahrain Ministry of Health (MOH), Bahrain provides mobile health units for home visits for elderly since 2008 Home visit team includes nurses, homecare technicians Gender-specific teams https://www.moh.gov.bh/Services/  Major global health challenges What were the ten major global health threats predicted in 2019 ?  Ten major global health threats 2019 1. Air pollution and climate change 2. Non-communicable diseases 3. Global influenza pandemic 4. Fragile and vulnerable settings 5. Antimicrobial resistance 6. Ebola and other high threat pathogens 7. Weak primary care 8. Vaccine hesitancy 9. Dengue 10. HIV 1. https://covid19.who.int/ 2. Monash.edu 3. Zhao et al 2021 4. Vicedo-Cabrera et al 2021 Watts e al The 2018 report of the Lancet countdown on health and Pathways climate change: shaping the health of nations for centuries to come Vol 392 pp 2479-2514. through which climate change affects health Extreme weather exposure Altered infectious disease pattern Famine Water crisis  Direct Health Effects 1. Increased burden of non-  Vector-borne diseases communicable disease, heat stress – malaria – dengue 2. Increased migration, displacement and disruption in access to health  Incidence water-borne services diseases (especially in the 3. Food shortages tropics/sub-tropics) 4. Change in patterns of infectious – cholera diseases – giardiasis 5. Drowning and trauma from disasters 6. Mental health issues 7. Violent and antisocial behaviour  Mortality  Exercise Recognition of pollution as a major cardiovascular risk factor that is often overlooked in clinical practice opens up multiple opportunities for prevention and control. How might it be incorporated into clinical practice?  Strategies for Preventing Pollution Exposure & Pollution- Related Cardiovascular Disease Panel A shows a patient-centered strategy for reducing air-pollution exposure and pollution-related CVD. Assessment of exposure includes evaluation of exposure to air pollution based on patient’s ZIP Code Susceptible patients - those with atherosclerotic CVD (ASCVD) and coexisting conditions, a recent hospitalization for an acute coronary syndrome, heart failure, COPD, or asthma, diabetes, stage 3/ 4 chronic kidney disease with >=1 risk factors. Other Patients at risk - pregnant women, elderly persons, and transplant recipients S Rajagopalan, PJ Landrigan. N Engl J Med 2021;385:1881-1892.  Role of health professionals and public health policy Health professionals must be leaders in responding to the health threat of climate change. This is far more tangible. Opportunity for leadership -> actively promote sustainable healthcare. Healthcare system activities responsible for ~4-5% of global greenhouse gas emissions ridged from Watts et al. Health and climate change: policy responses to protect public health. The Lancet. Volume 386. pp1861-1964  Questions? Discussion Forum on VLE E-mail: [email protected] THANK YOU 27