Global Health Midterm

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life expectancy

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-the average number of years a newborn baby could expect to live if current mortality trends were to continue for the rest of the newborn's life

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neonatal mortality rate

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-number of deaths to infants under 28 days of age in a given year per 1000 live births in that year

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maternal mortality ratio

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MMR; the number of women who die as a result of pregnancy and childbirth complications per 100,000 live births in a given year

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DALYS

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disability adjusted life year; a composite measure of premature deaths and losses due to illnesses and disabilities in a population

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population distribution

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-the patterns of settlement and dispersal of a population

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population pyramids

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-a bar chart, arranged vertically, that shows the distribution of a population by age and sex.
-By convention, the younger ages are at the bottom, with males on left and females on the right.

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demographic transitions

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-the shift from high fertility and high mortality to low fertility and low mortality

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epidemiologic transitions

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-a shift in the pattern of disease from largely communicable diseases to noncommunicable diseases
-most low income countries are in ongoing transition so they face large burdens of communicable/noncommunicable disease

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Communicable diseases

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-illnesses that are caused by a particular infectious agent and that spread directly or indirectly from people to people, from animals, from animals to people, or from people to animals

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Noncommunicable disease

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-illnesses that are not spread by an infectious agent

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Group 1

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-communicable disease; illness cause by a particular infectious agent that spread directly or indirectly from people to people, animals to people, or people to animals

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Group 2

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-noncommunicable disease; illness not spread by an infectious agent

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Group 3

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injuries and accidents; include road traffic injuries, falls, self-inflicted injuries, and violence, among other things

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Which is worse for your health: indoor or outdoor air pollution??

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-indoor air pollution!

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What is particulate matter?

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-soil, soot, dirt generated from local factories, etc.

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Health system

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-the combination of resources, organization, and management that culminate in the delivery of health services to the population

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Global health

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-health problems, issues, and concerns that transcend national boundaries and may best be addressed by cooperative actions

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Cost-effectiveness analysis

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-In health, a tool for comparing the relative cost of two or more investments with the amount of health that can be purchased with those investments

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bottlenecks

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-obstacles to health service delivery that can arise at all levels of a health system
-sound leadership, technical advancements, and global health partnerships can address fixing bottlenecks at a policy level

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barrier analysis

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-focuses on trying to understand barriers to the adoption of positive health behaviors so that more effective behavior change communication messages and support activities can be developed.

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What are 6 factors that influence health status?
SCEGEN

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1) education, 2) economics, 3) culture, 4) security, 5) genetic, 6) nutrition

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What are 3 Millenium Development Goals?

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1) achieve universal primary education, 2) reduce child mortality, and 3) improve maternal health

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Health

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-a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

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infant mortality rate

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-the number of deaths of infants under age 1 per 1000 live births in a given year

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Under 5 child mortality rate

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-the annual number of deaths in children under 5 years, expressed as a rate per 1000 live births, averaged over the previous 5 years

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HALEs

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-health adjusted life expectancy; a composite health indicator that measures the equivalent number of years in full health that a newborn can expect to live, based on current rates of ill health and mortality

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What are the 3 categories of health conditions used in the burden of disease?

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1) communicable-group 1, 2) noncommunicable-group 2, and 3) injuries and accidents-group 3

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Which of the following groups of countries: low income, middle income, or high income---have 3/5 leading causes of death attributable to Group 1 diseases?

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-Mostly low/low middle income have 3/5 leading causes of death attributable to Group 1 diseases.

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Name the indicator: ex-149 deaths per 1000 live births

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-under 5 child mortality

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Name the indicator: 1400 deaths per 100,000 live births

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-maternal mortality ratio (maternal is always 100,000)

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What 3 main things do children in all world regions die from?

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1) diarrheal disease
2) bronchitis
3) perinatal conditions

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Which region has a fourth health condition responsible for a large portion of child deaths? What is this health condition?

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-region: Sub-Saharan Africa
-condition: Malaria (obtained from mosquitoes)

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What is the leading cause of death in low and middle-income countries?

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-cardiovascular, heart disease!
(risk factors include: diabetes, obesity, stress, lack of exercise, family history)

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What is the leading cause of death in high-income countries?

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-cardiovascular disease!

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What does DALY stand for and which two components are included in the DALY formula?

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-Disability Adjusted Life Year; years lost due to illnesses and disabilities in a population. [DALYs and HALEs are composite measures]
1. years of life lost & 2. years lived with disability

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What do composites tell you about?

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-the quality of life

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What are 3 key health status indicators?

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1. Life expectancy at birth
2. Maternal mortality ratio
3. under 5 mortality rate

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morbidity

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-sickness or any departure, subjective or objective, from a psychological or physiological state of well-being

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mortality

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-death

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disability

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-temporary or longer-term reduction in a person's capacity to function

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prevalence

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-number of people suffering from a certain health condition over a specified time period

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incidence

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-the rate at which new cases of a disease occur in a population

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Vital Registration

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-birth and death certificates
-key to having quality data on a population
-many low/middle income countries lack this
-developing a system is progress towards addressing/understanding health problems

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What are 2 indicators that compare how far countries are from a state of good health? [measure burden of disease]

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1. HALE-summarizes expected # of years to be lived in what might be termed the equivalent of good health
2.DALY-unit for measuring the amount of health lost because of a particular disease or injury

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DALY

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-'health gap measure'
-indicates losses due to illness, disability, and premature death in a POPULATION
-gives better estimate of health of a population than the death rate
-accounts for health conditions like mental illness that rarely cause death

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Higher income countries have a greater burden of ________ disease; while lower income countries have a greater burden of ________ disease.

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noncommunicable-high income
communicable-low income

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What are some leading causes of death among adults in low/middle-income countries

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-HIV/AIDs, TB

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What are some truths of people living in low/middle income countries?

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1. rural people will be less healthy
2. disadvantaged ethnic minorities will be less healthy
3. women suffer from weak social positions
4. poor people less healthy
5. undeducated people less healthy

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Risk factor

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-an aspect or personal behavior style that is known to be associated with health-related conditions considered important to prevent
i.e. high bp, high cholesterol, smoking, malnutrition, unprotected sex

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Population Growth

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-majority occurs in low/middle income countries
-put pressure on environment
-creates need for more infrastructure and services

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Population Aging

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-population of world is aging
-creates implications for buden of disease becuz ppl live longer with morbidities & disabilities
-healthcare financing affected

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Urbanization

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-majority of world's population lives in urban areas for the 1st time
-enormous pressure on urban infrastructure like water and sanitation

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Demographic Transition

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-shift from pattern of high fertility and high mortality to low fertility and low mortality
-mortality declines due to better hygiene and nutrition
-population grows due to younger share of pop. increasing
-fertility declines

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Economic Development

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-economy of low income countries need to grow in order to invest in health
-impact of economic development will depend on countries investing in areas that improve health: i.e. water, sanitation, and education

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Rights-Based Approach

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-assess health policies, programs, and practices in terms of impact on human rights
-analyze and address the health impacts resulting from violations of human rights when considering ways to improve population health
-prioritize the fulfillment of human rights

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Declaration of Helsinki

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-developed ethical principles to guide physicians conducting biomedical research on humans
-principles apply equally to nonphysicians

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Belmont Report

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-US National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research
-identified basic ethical principles
-developed guidelines for research

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Health system--what parts?

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-agencies that plan, fund, and regulate health care
-$$ that finances health care
-those who provide preventive health services
-those who provide clinical services

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What are some of the goals and functions of a health system?

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Goals: good health, fairness of $$ contribution, responsiveness to expectations of population
Functions: provide health services, raise $$ spent on health, pay for health services

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How are Health Services Organized?

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-who owns health facilities
-manner in which insurance is operated
-manner in which insurance schemes are financed

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How are different income countries' health services organized?

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low-income: fragmented health systems that include both public and private providers
middle-income: organized around a national insurance scheme
high-income: usually have a national health insurance system

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What are the levels of care?

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1. primary-first point of contact
2. secondary-provided by specialist physicians and general hospital
3. tertiary-array of specialist physicians and specialized hospitals

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Declaration of Alma-Ata

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-speaks of health as a human right
-outlines content of primary health care as care that is essential and socially acceptable
-'primary health care' as a movement and central tenet of global health

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What are public sector roles?

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-stewardship of system
-raising and allocation of $$
-establishing approaches to health insurance

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What are private, for-profit sector roles?

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-provision of services (i.e. nonlicensed 'medical practitioners')
-operation of health clinics, hospitals, services, labs
-can partner w/public sector or work under contract to public sector

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What are NGO, private not-for-profit sector roles?

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-community based efforts to promote better health
-carry out health services
-can partner with public sector or work under contract with public sector

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What are some key health sector issues?

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1. stewardship-problems of governance in many low and middle income countries; poorly built facilities & corruption
2. human resources issues-poorest countries don't have enough healthcare personnel to operate a system effectively; lack of incentives to perform jobs properly
3. quality of care-health services should be safe, effective, timely, efficient, patient-centered, and equitable
4. financing-all systems have to ration services in some way; lack of resources
5. access and equity-access to health care services and equal treatment difficult to come by

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What is the importance of culture to health?

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-related to health BEHAVIORS
-important determinant of people's perceptions of illness
-affects usage of health services
-different cultures have different health practices

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society

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-a group of people that occupy a specific locality and share the same cultural traditions

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Folk Illness

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-cultural interpretations of physical states that people perceive to be illness, but that do not have a physiologic cause
-efforts to improve health need to consider these beliefs

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Health Providers

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-depend on location
-local practitioners of indigenous medicine, traditional birth attendants, herbalists, priests
-western medicine: community health workers, nurses, doctors

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What are leading causes of death in low/middle income countries?

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-ischemic heart disease, cerebrovascular disease, HIV, pneumonia, malaria,TB, diarrhea

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Ecological Perspective

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-health related behaviors are affected by, and affect, multiple levels of influence
-behavior both influences and is influenced by the social environments in which it occurs

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Beliefs

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-peoples health behavior depend on their perception of: severity of illness, likelihood of getting ill, preventive behaviors
self-efficacy: whether or not ppl feel that they could carry out the behavior

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Improving Health Behaviors

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-stages of change model
-change is a process and different people are at different stages of the process

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Diffusion of Innovations Model

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-communication promotes social change
-diffusion is process by which innovations are communicated over time among members of different groups

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Conditional Cash Transfers

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-a government agency provides an economic incentive for families who engage in a certain healthy behavior

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Social assessment

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-process for assessing the social impacts of planned interventions or events or and for developing strategies for the ongoing monitoring and management of those impacts