Lecture 2 - Part 1

Question 1

Why is measurement is critical for global health? (1-5)

Answer 1

1. To understand disease trends and set priorities
2. To assess progress towards targets
3. To evaluate the Effectiveness of interventions
4. To better plan interventions/programs
5. To monitor and evaluate health systems and services

Question 2

Why is measurement is critical for global health? (6-9)

Answer 2

6. To provide feedback to improve performance
7. To advocate for resources and investments
8. To measure impact of donor aid
9. For granting agencies to evaluate their investments and strategies

Question 3

What are the 4 steps to creating literature/relevant global health data?

Answer 3

1. Discovery research [basic sciences/observational sciences]
2. Development research [validation through RCTs or observational studies demonstrating efficacy and then effectiveness]
3. Delivery/Implementation research [transitioning to scale]
4. Monitoring and Evaluation of Impact [health systems, behaviors, coverage, outcomes (morbidity, mortality)]

Note: Flow goes in both directions

Question 4

What is a concern about data from RCTs?

Answer 4

RCTs don’t tell us anything about the real world, they’re controlled, small population. Studies can be impacted by the Hawthorne effect.

RCT functions more as ‘proof of concept’

Question 5

What are some disadvantages of data collected through national demographic surveys?

Answer 5

1. they are large and don’t focus on any specific issue
2. published by the government, so if I government doesn’t want to look bad or something they may omit it from the survey

Question 6

What are the impacts of an intervention?

Answer 6

Impact is not the same as effectiveness, impact is looking at the effect of the intervention on:

1. Health outcomes
2. Health systems
3. Sustainability
4. Environment
5. Gender

Question 7

What are some challenges to measuring the impact of an intervention? (6)

Answer 7

1. Data are often unreliable or irrelevant
2. Insufficient planning and funding for measurement (many projects never quantify impact)
3. Denial: do we really want to know the truth?
4. Advocacy, sometimes, is more impactful than measurement and evidence (e.g. advocacy promoting breast cancer screening vs evidence)
5. No guarantee that Evidence will change what we do or lead to policies to support it
6. Politics (self interest) will almost always TRUMP science

Question 8

What are 3 key health indicators?

Answer 8

1. Morbidity
2. Mortality
3. Disability

Question 9

What is Morbidity?

Answer 9

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

Question 10

What is Disability?

Answer 10

temporary or long-term reduction in a person’s capacity to function

Question 11

What is Prevalence?

Answer 11

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

Question 12

What is Incidence

Answer 12

• the rate (#s/time) at which new

cases of a disease occur in a population

Question 13

What is a ratio?

Answer 13

Ratios: numerator is not derived from
denominator
(# maternal dealth/100,000 live births)

Question 14

What are 5 key health status indicators?

Answer 14

1. Maternal mortality ratio
2. Neonatal mortality rate
3. Infant mortality rate
4. Under-five mortality
5. Life expectancy

Question 15

What is Health-Adjusted Life Expectancy (HALE) ?

Answer 15

A health-expectancy measure

Summarizes expected number of years to be lived in what might be termed the equivalence of good health

To calculate the HALE: the years of ill health are weighted according to severity and subtracted from the overall life expectancy

Question 16

What is Disability-Adjusted Life Years (DALYs)?

Answer 16

The sum of years lost due to premature death (YLLs) and years lived with disability (YLDs). DALYs are also defined as years of healthy life lost

Indicates losses due to illness, disability and premature death in a population, accounting for health conditions like mental illness that rarely cause death

Disabilities are weighted

Question 17

What is the Global Burden of Diseases, Injuries, and Risk Factors Study?

Answer 17

over1,000 people from over 100 countries put together all the world’s data on more than 1,000 different clinical outcomes

• It describes mortality and morbidity from major diseases, injuries and risk factors to health at global, national and regional levels

Question 18

What has happened to DALY rates from all causes since 1990s

Answer 18

Dalys improving over time: the biggest impact is due to survival of children under 5

Question 19

According to DALY, a year lost under 5 is worth more or less than a year lost in early 20s? Why?

Answer 19

the ‘value’ of a year lost under 5 is less than that of someone in their early 20s
This is because of all the resources put into young adults and their potential for productivity in the coming years

Question 20

What are the 3 types of conditions?

What are the trends in these 3 types?

Answer 20

1. Communicable, maternal, neonatal, and nutritional diseases
2. Non-Communicable diseases
3. Injuries

Over time, decrease in communicable but no change in injuries. Non-communicable now represents a greater part of the ration in comparison to the two other ones

Question 21

What are the 2 biggest causes of death within Communicable diseases?

Answer 21

pneumonia and diarrhea

Question 22

What are the 5 diseases with the highest burden? *****

Answer 22

1. Cardiovascular
2. Diarrhea and other infectious diseases
3. Cancers
4. Other non-communicable
5. Neonatal disorders

Question 23

Where have the highest burden for non-communicable diseases?

Answer 23

Mongolia, Afghanistan, Russia, and Eastern Europe

Question 24

Who is at highest risk for road traffic injuries?

Answer 24

pedestrians

Question 25

What is The Epidemiologic Transition

Answer 25

It is a shift in the burden of disease that almost all low income countries are going through Shift from burden of disease dominated by communicable disease to burden of disease dominated by noncommunicable disease Communicable still high, but Rising NCD burden due to change in lifestyles and increasingly attributed to pollution & climate change Progressive declines in mortality as epidemics become less frequent Finally, further declines in mortality, increases in life expectancy, and the predominance of noncommunicable diseases

Question 26

What determines the pace of the Epidemiologic Transition?

Answer 26

Sociodemographic status explains more than 50% of the variance between countries and over time for Group 1 causes ( diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases). BUT explained less than 10% of the variance in DALY rates for group 2 and 3 causes (cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence). * note: specific causes are there as examples, do not memorize

Question 27

What are the top risk factors for death globally?

Answer 27

1. Poor diet 2. high systolic blood pressure 3. Smoking

Question 28

What is the the top risk factors for death in children under 5 globally?

Answer 28

1. undernutrition

Question 29

What are the 5 groups of social determinants of health?

Answer 29

1. Neighbourhood and built environment 2. Social and community Context 3. Economic Stability 4. Education 5. Health and Health care

Question 30

Which social determinant did the prof say is most important for continuing to reduce mortality in women and children?

Answer 30

Education

Question 31

Give an example of a social determinant of health related to Economic Stability

Answer 31

Availability of resources to meet daily needs (e.g., safe housing and local food markets)

Question 32

Give an example of a social determinant of health related to Education

Answer 32

Quality of education and job training

Question 33

Give an example of a social determinant of health related to Social and Community Context (2)

Answer 33

Social norms and attitudes (e.g., discrimination, racism, and distrust of government) Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)

Question 34

Give an example of a social determinant of health related to Neighbourhood and built environment

Answer 34

Transportation options