GLPH 271 Final Exam Notes PDF

GLPH 271 Final Exam Notes GLPH 271 Week 1 Lecture (Module 1) Introduction to Global Health Health defined  Heath is a state of complete physical, mental, and social well-being and not simply an absence of disease or infirmity Health-promoting conditions 1. The availability of healt...

GLPH 271 Final Exam Notes GLPH 271 Week 1 Lecture (Module 1) Introduction to Global Health Health defined  Heath is a state of complete physical, mental, and social well-being and not simply an absence of disease or infirmity Health-promoting conditions 1. The availability of health services 2. Adequate housing 3. Safe working conditions 4. Nutritious foods World Health Organization (WHO)  Formed on April 7, 1948 and its constitution came into effect  April 7th is celebrated every year as World Health Day Health as a Human Right  According to the Constitution of the WHO, “the enjoyment of the highest attainable standard of physical and mental health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic, or social condition  In support of this mandate, WHO acts as the directing and coordinating authority for health within the UN system by: o Providing leadership on global health matters o Shaping the health research agenda o Setting norms and standards o Articulating evidence-based policy options o Providing technical support to countries o Monitoring and assessing health trends  December 10, 1948, the UN general assembly adopted and proclaimed the Universal Declaration of Human Rights o This document was created to recognize the basic freedoms that all people should have o Theses freedoms, including the right to health, should be available to everyone regardless of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status Resiliency as an aspect of health   The health promotion movement of the 1980s was fostered by the WHO. This movement brought in a new understanding of health bcause it included the dynamic concept of resiliency  Resiliency is defined as “the extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities.”  Components of resiliency: o Involves social and personal resources strengthen one’s ability to cope with adversity Global health as a Discipline  Four factors: 1. Decision making based on data and evidence 2. A focus on populations rather than individuals 3. A goal of social justice and equity 4. An emphasis on prevention rather than curative care Public Health  The organized efforts of society to keep people healthy and prevent injury, illness, and premature death. It is a combination of programs, services, and policies that protect and promote the health of all citizens  Promotes the highest attainment of health for all people and deals with health from a population perspective. Public health ensures, that health is addressed early in life and that access to health resources are available as needed The role of public health  Public health aims to keep the population healthy through the following activities: o Health protection o Health promotion o Health and disease surveillance o Disease and injury prevention o Population health assessment Social determinants of health  Determinants can be thought of as the conditions in which people are born, grow, live, work, and age  Social conditions i.e. Gender, disability, housing, early life, income, education, race What makes Canadians sick?  50% your life  25% your health care  15% your biology   10% your environment Health Equity  The absence of avoidable or remediable health differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically Upstream and Downstream Prevention  Upstream prevention: interventions that aim to treat the cause of a health problem  Downstream prevention: interventions that focus on treating the health problem Gap Minder Findings  For all populations to become rich and healthy, Hans Rosling believes that we need: o Time o Trade o Peace o Green technology Health Advocacy Levels of health advocacy: 1. Individual 2. Community 3. Global/humanitarian Taking Root Video: the vision of Wangari Maathai  Discusses God (spirituality) in nature vs in a church (man-made structures)  Destruction of public land (environmental degradation)  Wangari Maathai o For more than 30 years, she has fought for the environment, human rights and democracy in Kenya o Founded the Green Belt Movement in 1977  Planting trees locally in Kenya  First community to build a tree nursery  In 1960, Wangari won a “Kennedy” scholarship and left Kenya for college in the US  Learned a lot while in the US about how to be a good citizen and how to be respected as an activist  Retuned to Kenya in 1966, and was soon married o In the late 1970’s, Wangari got divorced which was very expensive and she lost all her money  Was the first woman in East Africa to earn a Ph.D. o Wangari Maathai was elected to Parliament with 98% of the vote   People don’t understand the need of their own survival depends on the health of the ecosystem  Discusses settler colonialism by British in Kenya early 1900s o The British were very oppressive in order to use the resources in the country  Mau Mau Crisis o In 1952, the land Freedom Army (called Mau Mau by the British) fought colonial rule o It was the first armed liberation struggle against colonialism in Africa o Over 100,000 African Kenyans were killed o Fewer than 100 Europeans were killed  In 1992, President Moi was finally forced to accept multi-party elections for the first time in 26 years o Lots of protests lead to this o Tribal clashes over resources  Kenyans elected a coalition government advocating reforms GLPH 271 Week 2 Lecture (module 2) Measuring and Assessing Health Epidemiology: the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems  With respect to global health, epidemiological measurements and analysis help health professionals make informed decisions about how to best use resources to prevent disease and promote health How to calculate prevalence?  Prevalence of a disease tells us about the number of existing cases of a disease in a given population  Prevalence = # of cases/total population  Point prevalence: a measure of the proportion of the population that has the disease at a specific time  Period prevalence: the number of existing cases measured over a period of time and divided by the average population during that time How do we calculate incidence?  Incidence measures how quickly new cases of a disease arise in a population over a defined period of time. This is different from prevalence because it only considers new cases within the time period  Incidence is also a measure of risk. When population A has a higher incidence of a disease than population B, we can say that individuals in Population A have a higher risk of developing the disease than those in Population B   There are two measurements of incidence: o Cumulative incidence = proportion of the at risk population that develop the disease in a given time period  = # new of cases of a disease over a time period/total population at risk o Incidence density rate: uses person-year in the denominator as a way to face in time  = # of people who develop the disease/number of person-years at risk of disease Considering the at-risk population  Sometimes the at-risk population is constant. However, it is not safe to assume the at- risk population is constant when: o Incidence is high o There is a high death rate from other causes o People from the population can’t be monitored (e.g. emigrants) o There are a lot of births or immigrants increasing the at-risk population Crude mortality rates  Crude mortality rate is the count of all the deaths over a specified time period divided by the population at the mid-point of the time period in question. It is often reported per 100,000 people/year  There are two types of crude mortality rates: o All cause mortality rate: a measurement of all deaths in a population o Cause-specific mortality rate: a measurement of deaths in a population for a specific disease Specific mortality rates  Specific mortality rate is the mortality rate for a sub-group of a population. Sub-groups may be defined by age, sex, race or other demographic factors  This calculation is very similar to crude mortality rate and includes the following changes: o In the numerator, only deaths of individuals in the sub-group are included  o In the denominator, only the total number of individuals that meet sub-group criteria are included Relative risk  The number of times more likely that one group of people will become ill compared toanother group. Risk is simply the cumulative incidence of being exposed to an illness Global Burden of Disease Disability adjusted life year (DALY)  Is a measure of overall disease burden, expressed as the cumulative number of years lost dude to ill-health, disability or early death  Allows direct comparison of burden across diseases  Summing burden across disease  Permit comparing treated and untreated diseases  Compare different disease interventions  Standardized quantitative measure burden of disease  Includes mortality (life years lost due to the disease) with morbidity (disability adjustment)  Compliments another standardized measurement of QALYs (quality adjustment life year)  DALY quantifies disease burdens o You want a lower number  Programs try to avert DALYs  Have become the accepted way to quantify global disease burden  Can compare disease burden to age, gender, type of disease, country and region  Can use DALYs to quantify and comparing different intervention programs GLPH 271 Week 5 Lecture (module 3) Global Burden of Disease The WHO uses the DALY to represent the GBD in three areas of health: 1. Communicable diseases and maternal, neonatal, and nutritional disorders a. Represent 3 out of every 10 deaths that occur globally b. These conditions occur largely in poorer populations due to inadequate access to healthcare, particularly preventative care, and include such conditions like HIV, tuberculous, malaria c. Although the global rate of death is estimated at 30%, the rate is still greater than 50% in many of the poorest countries 2. Non-communicable diseases a. Among both men and women, most deaths are due to non-communicable conditions such as cardiovascular disease and cancer, and they account for about 6 out of 10 deaths globally  b. Even though, as you can imagine, many of the poorest countries do not have a rate this high, it is important to note that the rate of NCDs is increasing even in poor countries 3. Injuries a. Encompass injuries, such as suicide, war injuries, road accidents, and homicides b. This category represents the largest difference between the sexes with injuries accounting for almost 1 in 8 male deaths and 1 in 14 female deaths GBD definition:  Is a measure of total health loss from hundreds of diseases and injuries (and their risk factors) that provides insight into the health status of different populations throughout the world Disability Adjusted Life Years (DALY)  Measure of overall disease burden, expressed as the cumulative number of years lost due to ill-health, disability or early death  DALY = YLD (years lived with disability) + YLL (years of life lost) o YLD  Incorporates disability and mortality into a single measure of burden  Multiplies the number of years a person has a condition that affects their quality of life by a set weighting factor unique to the disease o YLL  It takes into account age of death by subtracting life expectancy by the average age of death  It places more weight on illnesses that result in early mortality because dying young has a bigger impact on both the individual and society at large Communicable Diseases  Maternal, neonatal, and nutritional disorders (e.g. tuberculosis, HIV, malaria)  Typically occurs through airborne droplets or bodily fluids containing a virus, bacterium, or parasite. Nutritional, maternal and neonatal conditions are often grouped with communicable diseases in the study of GBD  These diseases present a significant burden for poorer countries (over 50% of total DALYs) but less than 10% for developed countries The big three communicable diseases 1. HIV a. The world’s leading infectious disease and has killed over 39 million people to date, including about 3.2 million children b. GBD for this disease is increasing in developing countries and decreasing in developed countries, and it is a leading cause of death in Africa 2. Tuberculosis  a. Is a bacterium that infects one third of the world’s population. However only 5- 10% of those infected will develop an active TB infection – the percentage is much higher when co-infected with HIV b. GBD for this disease is decreasing in both developing and developed countries, with more than half of all cases found in South-East Asia and Western Pacific Regions. It caused 4.77% of deaths in southeast asia in 2013 3. Malaria a. Transmitted between humans by mosquitos b. More prevalent but less deadly that HIV, with 200 million cases and over 500,000 deaths in 2013, primarily in Africa c. Is curable using anti-malarial drugs and preventable using insecticide-treated mosquito nets and indoor sprays d. GBD for this disease is extremely small in developed countries and decreasing in developing countries. But the DALY is still as high as 17% in countries such as Gambia Causes Nutritional Conditions 1. Iron deficiency 2. Protein energy malnutrition Maternal conditions  Refers to the health of women during pregnancy, labour, and breastfeeding o Impact on children  Leads to decreased stability in the home, poor health/death of child, low birth weights o Economic resons  70% those who live in absolute poverty are women  Maternal health interventions are among the most cost effective in health o Social justice  Maternal deaths are rooted in women’s powerlessness and their unequal access to:  Employment   Finances  Education  Basic health care Non-Communicable diseases  Cannot be spread from one person to another  Cardiovascular disease (CVD) o Management: access to medication, education  Cancer o Quickly becoming one of the largest burdens of disease o Three drivers causing cancer cases to increase globally:  Population is growing  Population is ageing  Cancer rates are increasing over time  Mental illness o Structure of the action plan:  To strengthen effective leadership and governance for mental health  To provide comprehensive, integrated and responsive mental health and social care services in community-based settings  To implement strategies for promotion and prevention in mental health  To strengthen information systems, evidence and research for mental health Injuries  Top causes of death due to injury were road injuries, self-harm, falls, and interpersonal violence  Suicide o Occur in high income countries, but low and middle income countries bear the brunt of the numbers o Part of injuries category, but very closely tied to mental illness Millennium Development goals and sustainable development goals 1. Eradicate extreme poverty and hunger  2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat hiv/aids, malaria and other diseases 7. Ensure environmental sustainability 8. A global partnership for development GLPH 271 Week 7 Lecture (module 4) Closing the Gap in Health The gap in global health  The gap in global health can be described as the health inequities that exist between the richest and the poorest populations  That is, the poorest of the poor have high levels of illness and premature mortality Social determinants of health  The gap in global health exists because of social determinants, or the circumstances in which people grow, live, work, and age, and the accessibility to healthcare allowing them to deal with illness  The gap is shaped by political, social, and economic forces Closing the Gap Report  Goals to accomplish: o Improve daily living conditions o Address inequalities in power, money and resources o Measure and understand the problem and assess the impact of action Closing the gap by improving living conditions Improving living conditions  Five main areas needed to be addressed to improve daily living conditions: o Fair work and healthy employment  Safe work environments o Social security throughout life  o Healthy homes  Sanitation o Early childhood health and development o Universal healthcare Closing the gap by addressing inequities Optimal health systems  Appropriate local action across the range of social determinants  Preventions and health promotions valued just as highly as curative interventions  Emphasis on the primary level of care with adequate referral to higher levels  An equitable system not relying on ability to pay Gender equity  Legislation that enforces equity and equality  Make discrimination on the basis of gender illegal  Invest in formal and vocational education for girls  Guarantee pay equity  Increase investment in female sexual and reproductive health Political empowerment  Represents the ability of individuals to contribute to and be included in political procedures  Inequity in who participates in political decision-making, with those who are most disadvantaged having the least amount of political power  Way to increase the political empowerment of disadvantaged people: o Top-down approaches  Which the state works to guarantee a complete set of rights for all citizens and fair distribution of resources across society o Bottom-up (grassroots)  Founded by self-organization of disadvantaged groups GLPH 271 Week 9 Lecture (module 5) Health promotion & disease prevention Four stages of disease prevention: 1. Primordial a. Health promotion to prevent the development of risk factors b. Targets underlying health determinants by modifying social policies to improve the health of a population 2. Primary a. Identification and modification of risk factors (risk reduction) to prevent onset of disease  b. Target causes and risk factors for specific diseases (more personal) 3. Secondary a. Early detection and treatment of disease before symptoms appear b. Involves early detection and treatment of disease 4. Tertiary a. Treatment of disease to stop its progression and control its negative consequences b. Help soften the impact of a clinical phase of a disease on the patient’s function, survival and quality of life Health promotion:  There are two main approaches to health promotion: o Identify individuals at high risk and intervene to reduce their risk o Reduce average risk level for the whole population  Social determinants of health are targeted through: o Environmental factors o Social influences o Other internal & external factors that affect health The Ottawa charter of health promotion  The charter called for the following actions to facilitate health promotion: o Build healthy public policy o Create supportive environments o Strengthen community actions o Develop personal skills o Reorient health services Barriers to changing health behaviours 1. Risk perception is flawed 2. Inconvenience 3. Not pleasurable 4. Not fashionable 5. Too expensive 6. Perception of no control over the risk factor The transtheoretical model of health promotion 1. Pre-contemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance 6. Relapse Levels of health promotion 1. Individual 2. Peer or group 3. Population based Primary, Secondary, and Tertiary Prevention Overlap in stages of prevention strategies GLPH 271 Week 11 Lecture (module 6) Healthcare systems Universal healthcare coverage and health care systems  Universal health coverage (UHC) is a key component of SDG goals o SDG #3: ensure healthy lives and promote well-being for all at all ages   All people who need quality, essential health services to receive them without enduring financial hardship Global prevalence of UHC 1. Healthcare legislation explicitly stated that the entire population was covered under a specified health plan 2. The country’s population had access to skilled attendance at birth and healthcare insurance coverage is greater than 90% a. Out of 194 countries, only 58 countries met these two criteria Main methods to finance healthcare insurance 1. Social health insurance a. Employers and employees pay contributions towards health services 2. State coverage a. Provided and financed by the government through tax payments 3. Private health insurance a. Individuals purchase private healthcare insurance to cover the cost of healthcare services 4. Employer-based insurance a. Insurance is purchased by employers for their employees and financed through employer or joint employer-employee contributions Requirements for UHC 1. A high quality healthcare system 2. Finances to support healthcare services 3. Access to essential medicines and technologies 4. A well-trained healthcare workforce Model of a health system Well-functioning healthcare systems are characterized by the WHO as having:  A robust financing mechanism  A well-trained and adequately paid workforce  Reliable information on which to base decisions and policies  Well maintained facilities and logistics to deliver quality medicines and technologies UHC in Canada  1. Public administration 2. Comprehensiveness 3. Universality 4. Portability 5. Accessibility Health services not covered by Medicare  Private psychologist’s visits  Dental care  Eye care  Prescription drugs Summary of healthcare in Canada