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Lecture 1.2 I Introduction to Global Health

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Title: Lecture 1.2 I Introduction to Global Health


1
Lecture 1.2IIntroduction to Global
HealthBecome part of the conversation.
  • Lori DiPrete Brown
  • Associate Director, Global Health Institute

2
Objectives
  • Provide an overview of teaching resources on
  • Definition of Global Health and GH Successes
  • Current GH Trends and Challenges
  • Global Health Timeline
  • The MDGs and the Post 2015 Agenda
  • How to Find and Use and Communicate GH
    Information
  • First Do No Harm

3
Why Should we Care about Global Health?
  • National Security
  • Trade economic productivity
  • Inequalities are unethical and unjust
  • States have humanitarian responsibilities to
    other states
  • Are we separate countries, or an interconnected
    world?
  • Global health, like global climate change, may
    soon become a matter so important to the worlds
    future that it demands international attention,
    and no state can escape the responsibility to
    act. -- Gostin

4
Have Global Health Efforts been Successful? Just
say YES!
  • Small pox eradication 1979
  • Vitamin A supplementation in Nepal prevents
    200,000 child deaths
  • Polio eliminated from western hemisphere 1991
  • Reduction of infant death due to diarrhea by 82
    from 1982 to 1987 in Egypt
  • Dramatic reduction in Guinea Worm reduced by 99
    in 20 countries
  • Fertility reduction in Bangladesh from 7 to 3
    children per woman
  • Overall improvements in IMR 126 to 56/1000, CMR
    197 to 82/1000, from 1960 to 2002.
  • Under 5 child mortality decreased by 60 from
    1990 thru 2010
  • Between 1990 and 2010, life expectancy increased
    by 12-15 years for men and women
  • Burden due to HIV and Malaria is falling

5
Successful Programs in Action
  • Bangladesh Rural Advancement Committee (BRAC)
  • http//www.youtube.com/watch?v5s0yVZlFdMU
  • Meningitis Vaccine for Africa
  • http//www.youtube.com/watch?vtZMiYTZpQUQ
  • For other success stories see RX for Survival
    Series http//www.pbs.org/wgbh/rxforsurvival/serie
    s/video/index.html

6
Is Global Health EngagementOptional or a Human
Rights Imperative?A Preferential Option for the
Poor
Although PIH is a secular organization not
affiliated with, motivated by, or espousing any
particular religious ideology, we find the
concept of a preferential option for the poor
to be a powerful moral imperative. The poor
includes but is not limited to those who are
economically deprived. The concept of a
preferential option for the poor challenges us
to be advocates for the voiceless and powerless
among us. Those who are in any way and for any
reason deprived, marginalized, or vulnerable have
a special moral claim on the community. As a
matter of both justice and charity, we must put
in place structures and systems to address and
meet their needs, so that they might participate
more fully in the common good and thereby
flourish more fully as human persons.
Partners in Health
.for all of us, when we are vulnerable to
harm?
7
What is Global Health?

Image Courtesy of lidc.org.uk
8
What is Global Health?
  • Health care, but not just health care
  • NOT just the absence of disease
  • NOT limited to sites outside the US
  • Linked to terms international health, global
    public health, public health, sustainable health
  • Draws on many disciplines
  • Grounded in social justice philosophy
  • Includes HEALTH IN ALL POLICIES multi-sector
    efforts to improve well-being that use prevention
    as prime intervention strategy
  • Linked to government, bilateral and multi-lateral
    cooperation, NGOs, civil society and the private
    sector.
  • Global Health is Public Health for the World!

9
Global Health Scope, Trends and Challenges

Image Courtesy of lidc.org.uk
10
The Scope of Global Health
  • Environmental Health
  • National Disasters, War and Complex Emergencies
  • Global Population Dynamics
  • Meeting the health needs of special populations
  • Difference is not disease!
  • Communicable Disease
  • Non-Communicable Disease
  • Nutrition and Food Systems
  • Unintentional Injuries and Violence
  • Disability
  • Mental Health

11
Factors that Affect Health
WHO Determinants of Health
12
Current Global Health Trends
  • Growing population
  • Aging population manifesting in shifts in disease
    burden to NCDs
  • Urbanization
  • Changing patterns of consumption with economic
    development
  • Global spread of tobacco
  • Diets high in sugar, fat, salt
  • Physical inactivity

13
Some Current Global Health Challenges
  • In 2011, 6.9 million (down from 11 million in
    1990) children under 5 die from preventable
    diseases
  • 222 million women do not have access to family
    planning and reproductive health services
  • 13 million people die yearly from preventable
    infectious disease (half due to HIV/AIDS)
  • 1.2 billion people do not have access to clean
    water
  • Over 300 million adults are obese raising risk
    for chronic disease
  • 17 neglected tropical diseases affect 1 billion
    people worldwide.
  • Nearly 1 billion males and 250 million females
    smoke
  • 76.3 million struggle with alcohol use disorders,
    185 million use other drugs

14
Global Health Timeline

15
Global Health A Timeline
  • Ancient Civilizations -- herbal knowledge,
  • rituals, bone-setting, obstetric practices,
  • sanitation measures
  • 542--Plague of Justinian extends from Asia to
    Ireland
  • 1346--Black Death kills 25 million in Europe
    alone
  • 1348--First Quarantine in Venice
  • 500-1500-- Middle Ages smallpox, diphtheria,
    measles, influenza, tuberculosis, rabies,
    scabies, leprosy
  • 1100s--First Hospitals in Europe

16
  • 1400s--Colonial Era Begins and diseases spread
  • Influenza, measles, typhus, smallpox, Cholera,
    syphilis, dysentery, malaria, sleeping sickness
  • 1552--Codex Badianus Compendium of medicinal
    herbs from Latin America (Aztecs), and interest
    in other ancient traditions
  • 1600sJesuits learn indigenous nmalaria cure
  • in South America Cinchona Bark Quinine
  • 1700--Enlightenment brings urban sanitation
  • and water systems to European cities.
  • Paris, then others.

17
1796 -- Edward Jenner safe vaccine for Small Pox
1803 -- Charles IV commissions the
Balmis-Salvany Smallpox Expedition.
It is the first public health vaccination
campaign in South America
  • THEN http//www.paho.org/English/DPI/Number11_
    article6.htm
  • NOW http//www.youtube.com/watch?vtZMiYTZpQUQ

18
  • http//www.rainforesteducation.com/terrors/yellowf
    ever/yf.htm
  • 1851 First International Sanitary Conference
    (international cooperation regarding quarantine
    to prevent cholera and other problems)
  • 1905 Yellow Fever and Malaria control Panama
    (William Crawford Gorgas)

19
  • 1880-1910 medical discoveries, vaccines, health
    education
  • 1910-1945 global health infrastructure begins
    to develop (schools, foundations, agencies)
  • 1960s and 1970s immunization, disease specific
    programs
  • 1978 Alma Ata Declaration Health for All, 134
    countries sign

20
  • 1979 SMALL POX ERADICATION
  • 1980 -- Ken Horne, the first AIDS case in the
    United States is reported to the Center for
    Disease Control.
  • 2000 UN Millennium Declaration
  • 2004 PEPFAR and others launch global HIV/AIDS
    treatment initiative
  • http//www.youtube.com/watch?vl16YH6xCN4cwide1

21
  • 2012 UN High Level Mtg on Non-Communicable
    Diseases
  • January 2014 Polio eradication in India.
  • Continued challenges in Nigeria,
  • Pakistan and Afghanistan. Last
  • case may be seen in 2014.

22
The MDGs and the Post 2015 Agenda

Image Courtesy of lidc.org.uk
23
Alma Ata, 1978, 134 countries
24
Millennium Development Goals 2000By the year
2015, all 191 UN member nations have pledged to
meet these goals
  • Eradicate extreme poverty and hunger
  • Achieve universal primary education
  • Promote gender equality and empower women
  • Reduce child mortality
  • Improve maternal health
  • Combat malaria, AIDS and other diseases
  • Ensure environmental sustainability
  • Develop a global partnership for development

Images Courtesy ofpnowb.org (top),
cities-localgovernments.org (bottom)
25
Were the MDGs Good for Health?
  • Raised profile of GH and mobilized assistance
  • Considerable progress in low and middle income
    countries
  • MDGs contributed to fragmentation of
    interventions
  • Further progress will require the reduction of
    inequality, discrimination and human rights
    violations.

26
A Post-2015 Agenda Focused on Health and
Well-being
27
Other Post 2015 ThemesAll Relate to Health
  • Population
  • Education
  • Food and Nutrition Security
  • Environmental Sustainability
  • Water
  • Energy
  • Disasters, Conflict and Fragility
  • Economic Growth and Employment
  • Inequalities
  • Governance

28
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30
Information Sources

31
Useful Links
  • BBC News Country Profiles http//news.bbc.co.uk/2
    /hi/country_profiles/default.stm
  • The World Health Organization (WHO) Country
    Reports, see http//www.who.int/countries/en/
  • World Bank Country Profileshttp//web.worldbank.or
    g/WBSITE/EXTERNAL/COUNTRIES/0,,pagePK180619theSi
    tePK136917,00.html
  • CIA World Factbook at https//www.cia.gov/library/
    publications/the-world-factbook/
  • 2010 GBD Country Summaries http//www.healthmetri
    csandevaluation.org/gbd/country-profiles
  • Food and Agriculture Organization (FAO),
    http//www.fao.org/countryprofiles/selectcountry/e
    n/
  • Set up TWITTER or other News Aggregator and
    follow as a class

32
The Global Burden of Disease Studies

Image Courtesy of lidc.org.uk
33
GBD 2010 Global Burden of Disease, Injuries and
Risk Factors
  • Published in Lancet, December 2012
  • Builds on World Band and WHO studies for 1990,
    1999-2002 and 2004
  • 7 partners WHO, Inst of Health Metrics, 5
    universities
  • 235 causes of death (from 107), 67 (from 10) risk
    factors, 21 regions, 20 age groups, sex,
    morbidity and mortality, DALYs
  • Universal access to findings at
  • http//www.thelancet.com/themed/global-burden-of-d
    isease

34
The way it was.
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37
Ranked Causesof Diseases and Risk
FactorsInteractive Visual Tools to Access GBD
Data
  • http//www.healthmetricsandevaluation.org/gbd/visu
    alizations/gbd-2010-change-leading-causes-and-risk
    s-between-1990-and-2010

38
Patterns and Distributionby Broad
CausesInteractive Visual Tools to Access GBD
Data
  • http//www.healthmetricsandevaluation.org/gbd/visu
    alizations/gbd-2010-patterns-broad-cause-group

39
Heat Map ComparisonsInteractive Visual Tools to
Access GBD Data
  • http//www.healthmetricsandevaluation.org/gbd/visu
    alizations/gbd-2010-leading-causes-and-risks-regio
    n-heat-map

40
Using GPH Information EffectivelyThe River of
Mythshttps//www.youtube.com/watch?vOwII-dwh-bk
Population Growth and Climate Changehttps//www.y
outube.com/watch?vSxbprYyjyyU Will Saving Poor
Children Lead to Overpopulation?https//www.youtu
be.com/watch?vBkSO9pOVpRM

mage Courtesy of lidc.org.uk
41
Disparities within Countries

Image Courtesy of lidc.org.uk
42
Chart 3-4. Life expectancy at birth is five years
lowerfor blacks compared with whites.
Life expectancy in years of life remaining, 2003
Note Based on 1990 post-censal estimates of the
United States resident population. Source
National Center for Health Statistics. Health,
United States, 2006 With Chartbook on Trends in
the Health of Americans. 2006.
43
Chart 3-5. Infant mortality rates are more than
two timeshigher for blacks than for whites,
despite a slight declinefor all groups in the
past eight years.
Deaths per 1,000 live births by
maternalrace/ethnicity, 1995 and 2003
AI/AN American Indian/Alaska Native. Note
Infant is defined as a child under one year of
age. Source T. J. Matthews and M. F. MacDorman,
Infant Mortality Statistics from the 2003
PeriodLinked Birth/Infant Death Data Set,
National Vital Statistics Reports, May 3, 2006
54(16)129.
44
Chart 3-12. Minority women have lower rates of
breast cancer, but black women are more likelyto
die from the disease.
Incidence
Mortality
New cases per 100,000 female population, 2003
Deaths per 100,000 female population, 20002003
AI/AN American Indian/Alaska Native. Note Data
are age adjusted. Source National Center for
Health Statistics. Health, United States, 2006
With Chartbook on Trends in the Health of
Americans. 2006.
45
Chart 3-14. Black men are 50 percent more
likelyto have prostate cancer than whites but
are more than twice as likely to die from it.
Incidence
Mortality
Deaths per 100,000 male population, 20002003
New cases per 100,000 male population, 2003
AI/AN American Indian/Alaska Native. Note Data
are age adjusted. Source National Center for
Health Statistics. Health, United States, 2006
With Chartbook on Trends in the Health of
Americans. 2006.
46
Chart 3-19. Blacks are three times more likelyto
die from asthma than whites.
Number of asthma deaths per 100,000 people, 2003
AI/AN American Indian/Alaska Native. Note Data
are age adjusted to the 2000 United States
standard population. Source L. Akinbami, Asthma
Prevalence, Health Care Use and Mortality United
States, 200305. National Center for Health
Statistics.
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50
First Do No Harm.http//vimeo.com/22008886 Do
Students do Too Much Too Soon?http//chronicle.co
m/article/Overseas-Health-Programs-Let/142777/

Image Courtesy of lidc.org.uk
51
Selected References
  • Birn, Ane-Emanuelle, and Yogan Pillay, and
    Timothly Holtz. Chater 2, the historical Origins
    of Modern International Health, in Textbook of
    international Health Global Health In a Dynamic
    World, Oxford University Press, 2009.
  • Beaglehole R and Bonita R, What is global health?
    Global Health Action, 2010,3, 5142.
  • Fried LP, Bentley ME, Brekens P, Burke DC, Frenk
    JJ, et.al. Global health is public health. Lancet
    2009 375,536-537.
  • Gostin, L. Why Should Rich Countries Care about
    the Worlds least healthy People? JAMA, July 4,
    2007Vol 298, No. 1
  • Koplan J,  Bond C, Merson M et. Al.  Towards a
    common definition of global health.  Lancet 2009
    3731993-1995.
  • Fineberg H, and Hunter, D. A Global View of
    Heath, NEJM, January, 2013
  • Levine R, Case Studies in Global Health Millions
    Saved. Jones and Bartlett 2007.
  • Lindstrand et al. Global Health, Narayana Press,
    Denmark, 1007.
  • United Nations Millenium Declaration, 2000.  Read
    primary text posted at learn at UW and explore
    Millennium Development Goals indicators and
    progress at www.developmentgoals.org.
  • Alma Ata Declaration, 1978.  http//www.who.int/hp
    r/NPH/docs/declaration_almaata.pdf
  • GBD 2010, The Lancet, December 2012.
  • Rx for Survival. http//www.pbs.org/wgbh/rxforsurv
    ival/
  • Health in the Post 2015 Agenda. Report of the
    Global Thematic Consultation on Health. April
    2013. Pages 7-15 and 21-50.
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