GLPH 271 Final Study Guide PDF

**Final Study Guide** **Q: Is the final exam cumulative?** A: No, it mostly covers content from modules 3-6, with some general overarching content from the course (ex. SDHs, health as a human right, health inequities, Taking Root, etc.) There will be no calculation questions from module 2. **Taki...

**Final Study Guide** **Q: Is the final exam cumulative?** A: No, it mostly covers content from modules 3-6, with some general overarching content from the course (ex. SDHs, health as a human right, health inequities, Taking Root, etc.) There will be no calculation questions from module 2. **Taking Root Discussion** - Grassroot movement - Movement bottom up - Not from government, from people or community - \- Community level -- Wangari established the Green Belt Movement (a grassroots organization) which - empowered women in rural Kenya to plant trees, combat deforestation, and generate income - \- The organization grew into an influential movement with a mission to mobilize community - consciousness for self-determination, justice, equity, reduction of poverty, and environmental - conservation, using trees as the entry point - global level with her protests and letters addressing the government for change - \- GBM was very bottom up -- started with one woman trying to work to improve the community - \- Built its way up to impacts others, the community, and the nation - \- Initially worked to improve the environment and quality of life of community members, and - reached its way up to the release of prisoners, governmental changes, and preventing the - destruction of parks - \- Starts with one person and grows to a national level- greenbelt movement **Taking Root Discussion** - Grassroot movement - Movement bottom up - Not from government, from people or community - \- Community level -- Wangari established the Green Belt Movement (a grassroots organization) which - empowered women in rural Kenya to plant trees, combat deforestation, and generate income - \- The organization grew into an influential movement with a mission to mobilize community - consciousness for self-determination, justice, equity, reduction of poverty, and environmental - conservation, using trees as the entry point - global level with her protests and letters addressing the government for change - \- GBM was very bottom up -- started with one woman trying to work to improve the community - \- Built its way up to impacts others, the community, and the nation - \- Initially worked to improve the environment and quality of life of community members, and - reached its way up to the release of prisoners, governmental changes, and preventing the - destruction of parks - \- Starts with one person and grows to a national level- greenbelt movement Modules 3-6 **Module 3: Global Burden of Disease** **Learning Outcomes** - **Describe how GBD measures total health loss from hundreds of disease and injuries (and their risk factors) and provide insights into the health status of different populations throughout the world** - **Discuss GBD in relation to three major categories** - **Communicable diseases and maternal, neonatal, and nutritional disorders** - **Non-communicable diseases, and** - **Injuries** - **Use the GBD Compare Tool to investigate how a disease pattern changes over time to compare trends of a disease by country, age, or gender** - **Discuss how data supports development goals** Section 1: Global Burden of Disease - Group 1: Communicable Diseases & Other Group 1 - Communicable, maternal, neonatal, perinatal, and nutritional disorders - These conditions occur largely in low-income populations due to inadequate access to healthcare, particularly in preventative care - 2 in 10 deaths - Group 2: Non-Communicable Diseases - (coronary artery disease, cancer, and mental illness) account for about 7 out of 10 deaths globally - 7 in 10 deaths - Group 3: Injuries - (car crashes, suicide, an war injuries) - 1 in 10 deaths - Racial and Ethnic differences in death rates - Men engage in a lot more unsafe behaviour and employment and less likely to be protected by someone else - Indigenous populations less likely to seek or receive poor medical treatment as a result of stigma and historical oppression - SDI (social demographic index) - Average Income - Fertility - Education - Disability Adjusted Life Years (DALY) - Measure of overall disease burden, which is 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) - Years Lived with Disability (YLD) - 0 is perfect, 1 is death A purple square with white text Description automatically generated - Years of Life Lost (YLL) - YLL = (\# of deaths) x (Life Expectancy -- Age of Death) - Section 2: Communicable Diseases - Intro - They spread from one person to another, from an animal, or even the environment, to a person - Can occur through airborne droplets or bodily fluids - Burden of Communicable Diseases - Account for 50% of total DALYs for Low SDI countries and less than 10% for high SDI countries - Big 3 - HIV - Tuberculosis - Malaria - Human Immunodeficiency Virus (HIV) - Infects white blood cells called helper T cells destroying them over time and eventually causing AIDS - HIV is spread from person to person via bodily fluids - Treated using antiretroviral therapy (ART), prolong life but doesn't cure - Indigenous peoples account for 5 of total pop in Canada but 20.1% of total HIV cases - Lack of health education services and denial of this crisis - Also substance use - 22x more at risk - Canadian Aboriginal Aids Network - NFP that ensures access to HIV and AIDS related services - Tuberculosis (TB) - Attacks the lungs - Airborne disease that is spread through air from person to person - Can be treated and cured with antibiotics as a means to prevent active TB from developing - Impact of TB in Indigenous communities - 40x as likely then non-indigenous Canadian pop - Lack of health promoting conditions - Overcrowded and poorly ventilated homes, food insecurity - Innuit Tuberculosis Elimination Framework - Enhance TB care and prevention programming - Reduce poverty, improve social determinants of health and create social equity - Empower and mobilize communities - Strengthen TB care and prevention capacity - Develop and implement inuit specific solutions - Ensure accountability for TB elimination - Malaria - After dormant period in liver, plasmodium enters the bloodstream and infects the red blood cells, often causing them to burst - Transmitted through mosquito bites - Malaria is curable using anti-malarial drugs - Taking malaria drugs is easier than using a bed net - Difficult to use - Causes of Communicable Diseases - HIV - Children in Africa - Tuberculosis - People in India - Malaria - Sub-saharan Africa A close-up of a chart Description automatically generated \- Communicable disease present a significant burden for countries with a LOW SDI (Over 50% of total DALYs) but less than 10% for countries with a HIZGH SDI - Nutritional Conditions - Account for 2% of total DALYs - Protein energy malnutrition - PEM is a form of severe calorie or protein deficiency (starvation) - Large impact on children - Less common but more severe than iron deficiency - Iodine deficiency - Dietary iron deficiency - Vitamin A deficiency - Maternal Conditions - Maternal hemorrhage - Maternal sepsis - Maternal hypertensive disorder - Obstructed labour and uterine rupture - Maternal abortion miscarriage - Ectopic pregnancy - Indirect maternal deaths - Late maternal deaths - Maternal deaths aggravated by HIV - Impacts of Maternal Conditions and Maternal Health - Impact of Children - 70% those who live in absolute poverty are women - Women are more likely to spend what they make on their family - Maternal deaths are rooted in women's powerlessness and their unequal access to: - Employment - Finances - Education - Basic health care - Economic Reasons - Poor care and or nutrition of the mother leads to - Poor health or child - Low birth weights - Motherless children are - Less likely to get education - More likely to die - Social injustice - Empowering women leads to more equal access of power and resources and leads to positive change - Neonatal Health - First 28 days of life - Causes of neonatal death - Infections (leading to sepsis) 36% - Pre-term 28% - Birth trauma 23% - Interventions - Prenatal visits - Skilled birth attendants - Emergency care - Postnatal care - Indigenous Communities resilience during COVID-19 - Had experience form TB Section 3: Non-Communicable Diseases - Diseases that cannot be spread from one person to another - Cardiovascular Disease (CVD) -- still prevalent in higher income countries but 80% of CVD deaths occur in low and middle income countries due to larger populations. - Gone from a minor disease to number one cause of death globally - Coronary Heart Disease - Cerebrovascular Heart Disease - Peripheral Arterial Disease - Congenital Heart Disease - Rheumatic Heart Disease - CVD Risk Factors and Interventions - Access to Medication - Public health research is in progress to improve access to CVD drugs for primary and secondary intervention - Very expensive - Education & Accessibility - Other barriers include geographic location; - Unaffordability, and lack of programming that make it increasingly difficult to live a healthy and active lifestyle - Introduction to Cancer - Umbrella term for the collection of disease where the body's cell begins dividing uncontrollably without cell death, which eventually can begin to spread to other parts of the body - Most common - Lung - Breast - Colorectal - Prostate - Skin - Stomach cancer - Cancer and GBD - Cancer is ranked 2^nd^ in global deaths, YLL\< and DALYs - In low SDI countries, population growth is the major contributor to the increase to the total cancer incidence. In low-middle SDI countries aging and changes in incidence rates contribute equally. In high-middle and high SDI countries, increased incidence is mainly driven by population aging. - Global Cancer Prevention Strategies - Tabacco - Obesity - Alcohol - Infections - Carcinogens - Radiation - Mental Illness Section 4: Injuries - Death or disability due to the direct or indirect result of a physical force, immersion, or exposure, including accidental, interpersonal, or self-inflicted forces as well as war, conflict, violence, and natural disasters - Injuries by Geographic Areas - DALY rate for road injuries is 9.7 times higher in boys living in central sub-Saharan Africa compared with high-income Asia Pacific - Suicide - 800,000 people per year die from suicide - Canada's Indigenous Suicide Crisis - 3x death rate of non-indigenous Canadians - Intergenerational trauma - Transmission Models for Intergenerational Trauma - Sociocultural Model - Explains intergenerational trauma through parenting styles and exposure to environmental factors that may impact child's development - Psychological Model - Childs brain can be impacted if during the early years of development they are subjected to harsh conditions - Physiological Model - Biological factors and predisposed genetic factors - Learning disabilities - Suicide Rates - Inuit: 9x - First nations: 3x - Metis: 2x higher - Resiliency Factors within Indigenous Communities - Protective factors - High community knowledge of the indigenous language - Secure indigenous titles to traditional lands - Self-governance leading to control over essential services (such as health care, education, police, fire department) - School attendance - Sustainable employment - Easy access to social support and tailored mental health services - Ending the Stigma of Suicide - Language - Respect - Advocate - Suicide Prevention - Follow-up - Stigma - Access - Policy - Media Section 5: Millennium Development Goals and Sustainable Development Goals - Millennium 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 - Successes - Decline in global poverty - Increased primary school net enrolment - Decline in under-five mortality - Decline in maternal mortality - An increase in the number of girls attending school globally and eliminationof the gender disparity - Challenges - Persistence of gender inequality - Gaps in wealth - Conflict - Climate change impacts for people in poverty - Poverty - MDGs and the Social Determinants of Health - Gender Inequality - Income Gap - 3 pillars - Social Progress - Economic Growth - Environmental Protection - Compare the MDGs to SDGs - SDGs are applicable to all countries - Covers broader spectrum of issues - Place more emphasis on partnerships between gvernments, private sectors, civil society, and individuals - Sustainability as a focus - SDGs aim to improve GBD - Sustainable development goals: - No poverty - Zero hunger - Good health and well being - Quality education - Gender equality - Clean water and sanitation - Affordable and clean energy - Decent work and economic growth - Industry, innovation, and infrastructure - Reduced inequality - Sustainable cities and communities - Responsible consumption and production - Climate action - Life below water - Life on land - Peace, justice, and strong institutions - Partnerships for the goals **Module 4: Closing the Gap in Health** Learning Outcomes - Understand what the global gap in health is and why it needs to be addressed - Identify examples of gaps in global health and gaps in health in your own community (home or school) - Recognize that health inequities arise because of inequities in the determinants of health - Research a **top-down (policy)** or **bottom-up (grassroots)** approach to political empowerment that addresses a health-related problem Section 1: The Gap in Global Health and Social Determinants of Health - Communicating About Global Health - To demonstrate global health status and show that health inequities exist, scientific data is used as evidence - Advocacy involves communicating scientific data to inform awareness - The Gap in Global Health  Life Expectancy Across the Globe - A gap in global health is the large difference in life expectancy at birth in 2018: - Lowest was 53 - Highest was 85 - Social Determinants of health - **Unemployment and job Security** - **Gender** - **Indigenous Status** - **Disability** - **Housing** - **Early Life** - **Income and Income Distribution** - **Education** - **Race** - **Employment and Working Conditions** - **Social Exclusion** - **Food Insecurity** - **Social Safety Net** - **Health Services** - Social Gradient - Individuals living in extreme poverty have worse health compared to those who are wealthy - Lower social classes tend to working in fields and hold jobs that are more dangerous - The Poverty Trap - Money isn't used to make future money as there's nothing to fall back on (trapped in poverty unless an external force intervenes by providing them with a significant amount of money and resources) Section 2: The Closing the Gap Report - SDH are the social conditions of where people are born, live, grow, work, and age - Goals of Closing the Gap in a Generation - Improve Daily Living Conditions - Equity from the start - Healthy places, healthy people - Fair employment and healthy work - Social protection throughout life - Universal health care - Address Inequalities in Power, Money, and Resources - Measure and Understand the Problem and Assess the Impact of Action Section 3: Closing the Gap by Improving Living Conditions - Goal 1: Improve Daily Living Conditions - Equity from the start - Healthy places, healthy people - Fair employment and healthy work - Social protection throughout life - Universal health care - Housing and Home Environment - Physical Dimension - Social Dimension - Spatial Dimension - Living Conditions on Indigenous Reserves - Long-term drinking water advisories - Early Childhood Development & Health - Adequate living conditions are particularly important to ensure early childhood development - A comprehensive upstream approach to the protection and promotion of the well-being of children prevents larger inequalities in population health - The Jamaican Study - Shows how important development of children are - Employment and Working Conditions - Adverse working conditions tend to be clustered in lower-status occupations - Job security is a SDH - Unemployment can have a profound negative effect on physical and mental health through financial insecurity, material deprivation, lack of opportunity - Migrant Work and Early Childhood Health & Development - 3 million children can be found unsupervised on construction sites across india - Urbanizing and Health - Crowding - Violence & Injuries - Diseases - Pollution& Climate Change - Gentrification - Government and Social Policies - Social Protection Across the Lifecourse - Only 29% of the world's population have a form of social security to protect them against emergencies such as illness, disability, or loss of income and work - Universal Healthcare - Key global aspiration is universal healthcare coverage for all individuals - Racial Inequality in Healthcare - There are inequities for visible minorities - ABC Project - Followed children from a disadvantaged area of NC for 35 years Section 4: Closing the Gap by Addressing Inequalities - Goal 2: Addressing Inequities - The need to tackle inequalities in power, money, and resources - Optimal Healthcare Systems - Local Action - Primary Level of Care - Equitable System - Prevention, Health Promotion, and Intervention - Health Inequity in the Canadian Indigenous Population - Individuals living In remote, indigenous communities in Canada have less access to quality healthcare - Nursing Stations - Access to Medical Transportation - Challenges to Increasing Medical Transportation - Actions to Enhance Health Equity in Indigenous Populations - In 2015, the Truth and Reconciliation Commission (TRC) of Canada compiled a report that highlighted calls to action to the government to close inequality and inequity gaps - Some included - Recognizing the indigenous health care rights enshrined in international and national law - Establishing a dialogue with Indigenous peoples to identify and eliminate health care inequities - Acknowledging, respecting, and addressing the distinct health needs of metis, inuit, and off reserve first nations peoples - Providing sustainable funding for existing and new Aboriginal healing centres to address residential school harms - In collaboration with indigenous healers and elders, recognizing as medically legitimate the value of traditional healing practices - Hiring and retaining indigenous health care professionals, as well as ensuring that all staff have cultural competency training - Intersectoral Action for Health (ISA) - Aligning health polices across a number of government departments to promote health equity (Health, trade, education, industry) - 3 main aspects of Market Responsibility - Social goods should be governed by the public sector - Legislation should promote gender equality - Promote political empowerment - Social Goods Governed by the Public Sector - Putting water back into the public hands - Paris - Gender Equity - Women tending to have less power, resources, entitlements, and social value than men - Education opportunities are not the same - Empowering Women - Legislation that enforces equity and equality - Making discrimination on the basis of gender illegal - Investing in formal and vocational education for girls - Guaranteeing pay equity - Increasing investment in female sexual and reproductive health - Gender Inequality in Healthcare - Girls in most areas in South Asia are falling behind nutritionally - NA gender inequality is observable in the LGBTIQ population - Political Empowerment - Freedom to participate in political decision-making - Top Down - When the state works to guarantee a complete set of rights (policy) - Bottom up - Founded by self-organization of disadvantaged groups (Grassroots) - Female Genital Mutilation - Entrenched in many of the tribes of Tanzania - Addressing Inequities Through policy - Social goods being governed by the public sector - Legislation that promotes gender equality - Promoting political empowerment, especially for disadvantaged populations - Goal 3: Measuring and Monitoring Health - To design effective, targeted interventions - Barriers and Enablers - Barriers - Understood as obstacles that could harm the feasibility of a policy or intervention - Covil unrest - Governmental policies or agendas - Physical barriers - Cultural barriers - Enablers - Relate to factors or resources that can be leveraged to increase the feasibility or effectiveness of a policy or intervention - The willingness of a community to accept a policy or participate in an intervention - Governmental programs that make additional resources available for addressing the health issue **Module 5: Health Promotion and Disease Prevention** **Learning Outcomes** - **Discuss an existing health intervention and describe its level of prevention (primordial, primary, secondary, and tertiary)** - **Understand that effective health promotion strategies address social determinants of health** - **Discuss an existing health promotion program and describe its level of promotion (individual, peer, or group, population-based)** Section 1: An Overview of Disease Prevention - A Shift Towards Disease Prevention - As the percentage of deaths from non-communicable diseases increase this is important, non-communicable diseases account for approx. 70% of deaths globally - The River Story - Upstream and downstream prevention - Disease Prevention - Aims to minimize the incidence or effects of disease - There are 4 stages of prevention - Stage 1 - Primordial prevention - Aims to prevent the development of risk factors of diseases by targeting the underlying environmental and social conditions that might promote them - Stage 2 - Primary prevention - Identification and modification of risk factors (risk reduction) to prevent onset of disease - Stage 3 - Secondary prevention - Early detection and treatment of disease before symptoms appear - Stage 4 - Tertiary prevention - Treatment of disease to stop its progression and control its negative consequences - Stages of Prevention - No Disease - Primordial prevention - Targets the underlying health determinants by modifying social policies - Promoting a healthy lifestyle - Primary prevention - Targets susceptible individuals and attempts to prevent disease development - vaccinations - Asymptomatic Disease - Secondary prevention - Involves early detection and treatment of disease - Regular mammograms to detect and treat breast cancer - Clinical Course - Tertiary Prevention - When a disease has developed and is in its clinical phase, help reduce the impact of disease on the patients function, survival, and quality of life Section 2: Health Promotion - Health Promotion - Primordial prevention is often considered synonymous with health promotion; however, by definition, that is not entirely accurate - Health promotion is more individual base - Primordial prevention is more policy based (whole population) - Identification Risk - Identification of individuals susceptible to a risk factor and intervening to reduce the development of that risk is one effective approach to health promotion - Reduced Average Risk - Through legislative and or public policy changes, reduce the risk level for whole population - The Ottawa Charter of Health Promotion - The charter called for several important actions to facilitate health promotion - Build healthy public policy - Create supportive environments - Strengthen community actions - Develop personal skills - Reorient health services - Health promotion and the social determinants of health - Environmental Factors - Occupation - Housing/living conditions - School or work environment - Social factors - Education - Family - Social economic status (SES) - War/conflict - Culture - Race/racism - Other factors - Internal/external factors that affect health - Healthy/unhealthy behaviours - Availability of quality health services - The Need for Behaviour Change - The behaviours we choose to engage in also happen to be the most easily modifiable SDH, as the remaining ones we are either born into, or they are beyond our immediate control - Challenging because there is often a disconnect between knowledge and behaviour - Barriers to Changing Health Behaviours - Intrapersonal - Knowledge, skills, motivation, SES - Interpersonal - Social relationships, with friends, family, peers, partners, and coworkers - Community/Institution - Social and physical environments and settings individuals engage with family - Schools - Workplaces - Neighbourhoods - Public Policy - Broad structural factors such as local, state, and federal policies, that may either enable or hinder and individual's ability to take control over their health - The Health Belief Model - Modifying Factors - Age - Gender - Ethnicity - Personality - SES - Knowledge - Individual Belief's - Perceived seriousness - Perceived susceptibility - Perceived benefits vs. perceived barriers - Perceived threat - Self-efficacy - Action - Likelihood of engaging in health behaviour - Cues to action A diagram of a belief model Description automatically generated - The Transtheoretical model of Health Behaviour Change - Outlines the process of intentional behaviour change - Precontemplation - Individuals are unaware of the need to change - Contemplation - This is the "getting ready" stage - Procrastinators - Preparation - Have motivation and a plan of action - Action - Individuals actively trying to modify their lifestyle and want to succeed - Maintenance - Sustained their behaviour change for at least six months - Relapse - Have abandoned the idea of changing due to difficulty in maintaining their new behaviour - Health Promotion - Individual Level - One-on-one interactions - Labour intensive and costly - Peer or Group - Small groups, or communities - Population Based - Legislation, regulation, and policy - Social marketing - Neocolonialism - Using economic influences to influence another population - Combining Traditional and Western Medicine - BC Cancer Prince George Centre for the North - Aboriginal Care Coordinator - Aids in fostering trusting dynamic and helps facilitate treatment from and indigenous perspective - Healing garden - Created healing garden with Indigenous plants from the north, known for their healing properties - Amplifying Indigenous Voices in health Promotion - Protective Factors - Self-government - Land control - Control over cultural activities - Prevention - Community based approaches - Gatekeeper training - Peer support groups - Spirituality - Using indigenous concepts of well-being and spiritual practices: pow-wows, sweetgrass ceremonies, and sweat lodges - Suicide Prevention (Indigenous) - Successful programs - Community and family connectedness, community empowerment, cultural affinity - Community healers utilizing spiritual practices, dances, and ceremonies - Unsuccessful Programs - Westernized suicide programs have failed, resulted in higher suicide rates - Health Promotion in Practice - Increase Frequency of healthy behaviours - OMAMA app - Eliminating unhealthy behaviours - Unsmoke - Indigenous Considerations - First Nations, burning tabacco - Metis - Medical plant - Social use - Innuit - Do not use it - Becoming Tabaco-Wise - Sacred Smoke Program - Western medicine nicotine replacement therapies and traditional Anishinaabe medicines - Elders - Coping strategies Section 3: Primary, Secondary, and Tertiary Prevention - Primary - The identification and modification of risk factors for disease - Prevent occurrences of diseases - There is no disease present but the individual is susceptible to the disease due to risk factors - Quitting smoking - Secondary - The early detection and treatment of diseases - Stop the progression of the disease, or to either cure, prevent complications and death, or to stop or limit spread - Subclinical or early clinical, pathological changes but not signs or symptoms - Regularly scheduled mammograms to detect and manage breast cancer - Tertiary - The treatment and rehabilitation of the person with the disease - To limit disability, prevent relapse, and restore function - Signs and symptoms of the disease - Early rehab - Primary prevention of HPV related cancers - Without vaccination, its estimated that 75% of sexually active Canadians will have HPV infections in their life - Secondary Prevention of Cervical Cancer - Put vinegar on cervix to test for cervical cancer - Testing for precancerous or unsymptomed cancer - Tertiary Prevention of Parkinson's Disease - Rehab opportunities - Primordial Prevention - Sanitation - Primary Prevention - Tooth brushing - Secondary Prevention - Blood sugar testing - Tertiary prevention - Stroke rehabilitation Section 4: Developing an Intervention - Health Interventions - The target (the entity on which the action is carried out) - The action (a deed done by an actor to a target) - The means (the processes and methods by which the action is carried out) - Population health interventions are policies, programs, and resource distribution approaches that impact a number of people by changing the underlying conditions of risk and reducing health inequities - Types of health interventions - Epidemiology and surveillance - Outreach - Social marketing - Screening - Health teaching - Policy development - Developing an Intervention - Step 1: identify and assess the level of the problem - Step 2: develop a solution to the problem - Step 3: describe the action plan for the intervention - Step 4: Assess the Potential Impact - Is there a quaternary prevention - Opioid crisis - Overprescription - The Importance of Consultation and Participation - White saviour complex - White person acts to help non-white people in a self-serving context - Fight Malaria or Starve - Forced to make the choice - Unintended consequences: - Use of nets for fishing practices and an increase in food - Destruction of natural ecosystems by contamination - Some people choose not to use the nets because they believe the nets are poisoned and will cause impotence - Ways to prevent them included - Addressing starvation first - Conduct a needs assessment - Work with community leaders **Module 6: Healthcare Systems** **Learning Outcomes** - **Understand the role universal health coverage (UHC) plays in establishing health as a human right by promoting equitable health outcomes** - **Describe the strengths of a top-ranked healthcare system** Section 1: Universal Health Coverage and Healthcare - Universal Health Coverage - The third SDG aims to promote the well-being and ensure healthy living for all individuals at all ages, meaning that UHC is a key component of the SDGs - Evaluating Global Prevalence of UHC - Have to meet two criteria - Passed Legislation - Legislation explicitly stating that the entire population is covered under a specific health plan - Essential Service Coverage - Amount of coverage based on 4 components - Reproductive, maternal, newborn, and child health - Infectious disease - Non-communicable diseases - Service capacity and access - 2017 Canada scored 89 - Funding Health Coverage - Social Insurance - State Coverage - Private Health Insurance - Employer Based Insurance - Healthcare Models - The Beveridge Model - The Bismarck Model - The National Health Insurance Model - The Out-of-Pocket Model - Access and Quality of Health Services - Access to Health Services - Cost - proximity - Quality of Health Services - Timely - Examples of Three Different UUHC Systems - Single-Payer Coverage (UK) - Comprehensive care with NO copays at point of service - All residents - Government finances health care with taxes - Regulated Private Coverage (Netherlands) - Government-defined health benefits - Everyone is required to have insurance - People pay premiums for regulated private health coverage - Mixed Public-Private (France) - Wide range of services with some cost sharing: private insurance fills gaps - All residents - Government finances non-profit funds that pay providers - Requirements for UHC - Healthcare System - Finances - Access - Health Workers - A Simple Health System Model - Structure - Provision - Health Outcomes  - 4 Characteristics of a well-functioning healthcare system - 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 - Well Functioning Healthcare Systems Response to Needs - Defending - Providing - Protecting - Improving - Participating - First Nations health authority - FNHA Funding Structure: 3 Blocks - Protection - Benefits - Support - Decision making that is shared between the federal and provincial governments, and Indigenous leadership - Key Improvements with Indigenous Self-Governance - Participation - Training - Access - Time Section 2: Healthcare Systems in High-Resource Countries - Healthcare in Canada - All citizens qualify for health coverage - Funding is draen from provincial and federal budgets - Tax-funded model - How Historical Events Shaped Healthcare in Canada - Urbanization - World War I - The Great Depression - World War II - The Struggle for UHC in Saskatchewan - Doctors would be "slaves" - UHC in Canada - Canada achives UHC as it provides 90% of its population with healthcare coverage - Five Main Principles of the Canada Health Act - Accessibility - Portability - Universality - Public Administration - Comprehensiveness - Structure of Healthcare In Canada - Tax-funded public insurance system - Services beyond medically necessary must be paid for out of pocket by individuals or through private insurance plans - Approx. 70% of healthcare costs in Canada were funded publicly by the government - 30% out of pocket - Approx 49% of healthcare costs In the US were funded publically - 51% private - Access to healthcare in Canada - Covered Health Services - Doctor visits - In-patient hospital care - Emergency room visits - Most essential surgeries - Psychiatrist's visits - Public psychologists visists - Public physiotherapy - Not Covered Health Services - Private psychologist - Dental care - Eye care - Prescription drugs - Cosmetic surgery - Canada has a Provincially Funded Healthcare System - Ontario: OHIP - Funding Indigenous Peoples Health Care - Non-Insured Health Benefits - Funding Canadian Armed Forces Health Care - Covered by national defense act - The Interim Federal Health program (IFHP) - provides temporary and limited coverage of health care benefits for people under pressing circumstances - Myths of Canada's Healthcare System - "Canada has the longest wait times for common surgeries among OECD nations" - "Doctors are leaving Canada to practice in other countries at an increasing rate" - Frances Comprehensive Healthcare System - Provides dental and transportation - What is Stopping Canadians from Seeking Care for Mental Health Issues - Hard to monitor data - Canada's Two-Tiered System of Mental Health - Only spends 5% of total health spending on mental health - Australia's Mental Health Coverage - State and territory governments fund and deliver public sector mental health - A lot more services are funded by government than Canada - Access to Primary healthcare in Canada - Canada has a low practicing doctor per capita ratio - Canadians experience long wait times for primary care - Access to Primary Care in Germany - PHI and SHI models - Canada's Aging Population and Home Care - Lack of home care - The Affordable Care Cast - The USA's movement towards UHC - Pros and Cons of the Affordable Care Act - Pros - Slows the rise of care costs - Covers 10 essential benefits - Coverage for pre-existing conditions - Children can stay on theirs parent's health insurance plans - Cons - Raised the income tax rate - The ACA taxed those who didn't purchase insurance - People chose to pay fine over coverage - Medicare and Medicaid in the USA - Summary of Healthcare in Canada - Strengths - Provides access to medically necessary healthcare services through taxation - Provides relatively high-quality healthcare - The healthcare system is fiscally conservative - Weaknesses - Inequitable access to healthcare services not deemed medically necessary - Limited eligibility for home care - Does not provide comprehensive services that promote holistic health (mental health) - Low doctor to population ratio results in overuse of emergency room care - Inequalities in rates of diseases for indigenous populations - Does not cover prescription \*know how France, Germany, Australia, and USAs healthcare system compares to Canada France Benefits - Lower copay fees + provides way more services (dental, transportation) Germany Benefits - Decrease primary care wait times, low doctor to patient ratio Australia - Ways to improve mental health support Section 3: Healthcare Systems in Low-Resource Countries - Healthcare Systems in Low-Resource Countries A chart with colored bars Description automatically generated with medium confidence - Healthcare Funding as a Major Obstacle in Low-Resource Countries - Health needs of high resource countries - Need care for chronic or lifestyle based disease - Cardiovascular and type II diabetes - Low Resource Countries - Poor living conditions - Inability to access healthcare - Health illiteracy - Malnutrition - Geographic Accessibility as an Obstacle - Lack of infrastructure and communication in remote areas - Lack of indigenous practitioners - Retaining Talent as an Obstacle - Brain drain - High proportion of high-skilled workers leave low income countries - Healthcare in Cuba - Successful low-resource healthcare system - Cuban Medical Model - Insurance should cover all medical fees - Health providers should understand and live in the community they serve - Focusing on the community is more effective than focusing on the individual - The Cuban Healthcare System - Key Factors of Success - Integration of Public Health (huge emphasis on prevention) - Doctor Patient Ratio - Community Health Networks (brought doctors to communities) - Central Government Support - Weaknesses of the Cuban Healthcare System - Drug and Equipment Shortage - Lack of Freedom for Doctors and patients - South-South Cooperation - Model of successful programs in one low-resource country to model in another one - Healthcare In Gambia - South-South Cooperation between Cuba and Gambia - Apply the Cuban Model in Gambia - Obstacles to Applying a Cuban Model - Nothing for doctors to do in the areas - Doctors - Lack of willingness from doctors to make sacrifices to meet the needs of the community, loss of talent to urban centres and private clinics - Government - Lack of government support for universal access to public health care - However private care is unaffordable to most people in poor countries - What can we learn from Cuban model - How community based medicine can provide effective primary care and prevention - Despite lack of resources, one small country has been able to change the face of healthcare and health education - They have managed to enable change in infrastructure and training of medical doctors, to allow for the development of sustainable community-based public health in multiple places worldwide - Cuban Example - Grassroots method of prioritizing preventative care and health promotion **Important Concepts** **Q: Is the final exam cumulative?** A: No, it mostly covers content from modules 3-6, with some general overarching content from the course (ex. SDHs, health as a human right, health inequities, Taking Root, etc.) There will be no calculation questions from module 2. **Taking Root Discussion** - Grassroot movement - Movement bottom up - Not from government, from people or community - \- Community level -- Wangari established the Green Belt Movement (a grassroots organization) which - empowered women in rural Kenya to plant trees, combat deforestation, and generate income - \- The organization grew into an influential movement with a mission to mobilize community - consciousness for self-determination, justice, equity, reduction of poverty, and environmental - conservation, using trees as the entry point - global level with her protests and letters addressing the government for change - \- GBM was very bottom up -- started with one woman trying to work to improve the community - \- Built its way up to impacts others, the community, and the nation - \- Initially worked to improve the environment and quality of life of community members, and - reached its way up to the release of prisoners, governmental changes, and preventing the - destruction of parks - \- Starts with one person and grows to a national level- greenbelt movement **Module 3: Global Burden of Disease** - Non-Communicable Diseases (2/10) - Big 3 - HIV - Destroys white blood cells and eventually leading to AIDS - Chronic - Indigenous Canadians have disproportionate percentage - Canadian Aboriginal Aids Network (CAAN) - advocacy - Tuberculosis (TB) - Attacks lungs - Cured with antibiotics - Causes - Overcrowding - Poorly ventilated homes - Lack of food security - Diabetes (comorbidities) - Malaria - Enters blood stream and infects red blood cells - Curable using anti-malarial drugs  - Communicable Diseases (7/10) - Cardiovascular Disease (CVD) - \#1 cause of death - Risk Factors - High blood pressure - High cholesterol - Diabetes - Tobacco use - Unhealty diet - Physical inactivity - Obesity - Cancer - \#2 cause if death - Risk Factors - Tobacco - Obesity - Alcohol - Infections - Carcinogens - Radiation - Mental Illness - Injuries (1/10) - Very different by geographic region and gender and age - Suicide - Indigenous suicide crisis - Transmission Models for Intergenerational Trauma - Sociocultural Model - Parenting style and environmental exposure - Children are influenced by the home environment they are raised - Psychological Model - Childs brain development can be impacted during early years of development when subjected to harsh conditions - Conitive delays - Physiological Model - Biological factors and predisposed genetic factors - High levels of stress - Protective Factors for Indigenous Youth - High community knowledge of indigenous language - Secure indigenous titles to traditional lands - Self-governance, leading to control over essential services (health care, education, police, fire department) - School attendance - Sustainable employment - Easy access to social support and tailored mental health services - Ending the stigma of suicide - Language - Respect - Advocate - DALY - YLD + YLL - GBD Compare Tool - Other group 1 conditions - Nutritional - Maternal - Neonatal - Millennium Development Goals (MDGs) - 8 goals - 2000-2015 - Successes - Decline in global poverty - Primary school enrollment - Decline in under 5 mortality - Challenges - Gender inequality - Rich poor gap - Climate change impacts on low SES - Sustainable Development Goals (SDGs) - SDGs are applicable to all countries - Covers broader spectrum of issues - Place more emphasis on partnerships between gvernments, private sectors, civil society, and individuals - Sustainability as a focus - SDGs aim to improve GBD - gender equality **Module 4: Closing the Gap** - The Gap in Global Health A table with numbers and text Description automatically generated - Social Determinants of Health - What do they mean? - They are the social conditions of where people are born, live, grow, work, and age - They impact the health of individuals and by extension, populations - Unemployment and Job Security - Gender - Indigenous Status - Disability - Housing - Early Life - Income and Income Distribution - Education - Race - Employment and Working Conditions - Social Exclusion - Food Insecurity - Social Safety Net - Health Services - Social Gradient - People living in poverty have worse health - People in lower social classes tend to work in fields and hold dangerous jobs - Poverty Trap - Goals of Closing the Gap in a Generation - Improve Daily Living Conditions - Equity from the start - Healthy places healthy people - Fair employment and decent work - Social protection across the lifecourse - Universal healthcare - Housing and Home Environment - Physical Dimension - Social Dimension - Spatial Dimension (proximity) - Address Inequalities in Power, Money, and Resources - Optimal healthcare system - Local action - Primary level of care - Equitable System - Prevention, Health Promotion, and Intervention - Health Inequity in the Canadian Indigenous Population - Nursing Stations - Medical Transportation - Support Allocation & Comparable Access - Truth and Reconciliation Commission (TRC) of Canada - Made report highlighting calls to access to close these gaps - Intersectoral Action for Health (ISA) - Health - Trade - Industry - Education - Market Responsibility - Social goods should be governed by public sector - Legislation should promote gender equality - Promote political empowerment - Measure and Understand the Problem and Assess the Impact of Action - Putting recommendation into practice - Jamaican Study - Looked into relationship between ensuring the healthy development of children, both physical and psychosocial, and a child's later development in life - Control - Supplemented - Stimulated - Supplemented and stimulated - Urbanization and Health - Crowding - Violence & Injuries - Diseases - Pollution & Climate Change - Gentrification - The ABC Project - Disadvantaged children of NC **Module 5: Health Promotion and Disease Prevention** - A shift Towards Disease Prevention - Disease Prevention - Stage 1: Primordial Prevention - Aims to prevent the development of risk factors of diseases by targeting the underlying environmental and social conditions that might promote them - sanitation - Stage 2: Primary Prevention - Identification and modification of risk factors (risk reduction) to prevent onset of disease - HPV Vaccination - Stage 3: Secondary Prevention - Early detection and treatment of disease before symptoms appear - Cervical cancer screening project - Stage 4: Tertiary Prevention - Treatment of disease to stop its progression and control consequences - Parkinsons rehab - The Ottawa Charter of Health Promotion - Build healthy public policy - Create supportive environments - Strengthen community actions - Develop personal skills - Re-orient health services - The Need for Behavior Change - Most easily modifiable SDH - The Health Belief Model  - The Transtheoretical Model A diagram of a process Description automatically generated - Health promotion - Individual - Peer or Group - Population based - Need for Indigenous Voices in Health Promotion Strategies - Combining traditional and western medicine - Prince George Centre - Aboriginal Care Coordinator - Healing Garden - Types of Public Health Interventions - Epidemiology and Surveillance - Outreach - Social Marketing - Screening - Health Teaching - Policy Development - Developing an Intervention - Step 1: Identify and Assess the Level of the Problem - Step 2: Develop a Solution to the Problem - Step 3: Describe the Action Plan for the Intervention - Step 4: Assess the Potential Impact - Quaternary Prevention - Action taken to identify risks of overmedicalization - Importance of Consultation and Participation - Ernesto Sirolli - Zambia - Hippos - White saviour complex - Fight Malaria or Starve **Module 6: Healthcare Systems** - Universal Health Coverage (UHC) - 3^rd^ SDG aims to promote well-being and ensure healthy living - Two Criteria - Passed Legislation - Essential Service Coverage - Funding Health Coverage - Social Insurance - State Coverage - Private Health Insurance - Employer Based Insurance - Healthcare Models - The Beveridge Model - The Bismarck Model - The National Health Insurance Model - The Out-of-Pocket Model - Three Different UHC Systems - Single-Payer Coverage (UK) - Regulated Private Coverage (Netherlands) - Mixed Public-Private (France)  - A Simple Health System Model - According to Who, a well-functioning healthcare system responds toa. Populations needs in multiple ways: - Participating - Improving - Protecting - Providing - Defending - Potential barriers to a well-functioning healthcare system: - Some of the potential barriers - Disproportionate focus on specialist curative care - Fragmentation of competing programs, projects, and institutions - Pervasive commercialization of healthcare delivery - Insufficient resources, including finances - First Nations Health Authority: BC - Self-governance - FNHA Funding Structure - Support - Benefits - Protection - Key Improvements with Indigenous Self-Governance - Participation - Training - Access - Time **Section 2:** - Healthcare in Canada - Tax-funded model - Low doctor-to-patient ratio - Long wait times for primary care - Historical Events Shaped Healthcare in Canada - Urbanization - World War I - The Great Depression - World War II - Struggle in Saskatchewan - 1962 - Canada health Act - Public Administration - Comprehensiveness - Universality - Portability - Accessibility - Access to Healthcare in Canada - Covered - Doctor visits - Hospital care - Emergency room visits - Most essential surgeries - Not covered - Dental - Eye - Mental health - Funding Indigenous Peoples Health Care - Non-Insured Health Benefits to fill gaps - NIHBP Inclusion Criteria - Funding Canadian Armed Forced Health Care - National Defense - Myths - Canada has the longest wait times for common surgeries - Doctors are leaving Canada to practice in other countries - France - Dental - Mental health - Transportation - Very low copay (out of pocket) - 50 euro cap - Canada's Two-Tiered System of Mental Health - Expensive - Australia - Good mental health funding - A lot more mental health services are government funded - Both countries (Canada and Australia), have two-tier public-private model for mental health, but in Australia, the publicly covered services are much more extensive and comprehensive - Germany - Great access to primary care - High doctor-patient ratio - More doctors = less wait time - Home and Community Care in Canada - Population getting older - As canada's population grows, there is an increasing need for more home care. - USA - 50/50 private public split - Lots of people with low SEC who don't have health insurance making healthcare really expensive - Summary of healthcare in Canada - Strengths - Provides access to medically necessary healthcare eservices through taxation - Provides relatively high-quality healthcare - The healthcare system is fiscally conservative - Weaknesses - Inequitable access to healthcare services not deemed medically necessary. - Limited eligibility for homecare - Does not provide comprehensive services that promote holistic health - Low doctor to population ratio results in the overuse of emergency room care - Inequalities in rates of diseases and poor health outcomes in indigenous populations - Does not cover prescription drugs **Section 3:** - Healthcare Systems in Low-Resource Countries A graph of a number of diseases Description automatically generated with medium confidence - Needs of high resource - Care for chronic diseases - Needs for low resource - Poor living conditions - Inability to access healthcare - Health illiteracy - Malnutrition - Retaining Talent as an Obstacle - Brain drain -- skilled workers leaving their countries for better opportunities. - Healthcare in Cuba - Successful low-resource provision - Based on 3 principles - Insurance should cover all medical fees - Health providers should understand and live in the community they serve - Focusing on the community is more effective than focusing on the individual - Key Success Factors in Cuban Model - Integration of Public Health - prevention - Doctor-Patient Ratio - Community Health Networks - Central Government Support - Weaknesses - Drug and equipment storage - Lack of freedom for doctors and patients - South-South Cooperation - Using a successful model in one low-resource country to model in another low-resource country - Gambia - Obstacles of Applying Cuban Model - Doctor - Lack of willingness from doctors to make sacrifices to meet the needs of the community, includes loss of talent to urban centres and private clinics - Government - Lack of government support for a UHC