1
Q
Why is it important to communicate about global health issues as both an advocate and as a
scientist?
A
We must leverage the scientific findings and hard data to
demonstrate and prove the health inequities that exist. Once we are able to prove that these inequities
exist, the role of the scientist and advocate are still collaborative. Advocates and scientists can work
together to come up with implementable strategies and interventions to help eliminate these
inequities. After their implementation, scientists can test the success of these interventions.
2
Q
Advocate and scienctisit : 1
A
- state your conclusions first, then support them. (advocate)
- Build your case gradually before presenting
conclusions. (science)
3
Q
advocate vs science : 2
A
- Limit the number of messages (advocate)
- Several points can be made in single research
paper (science)
4
Q
advocate vs science : 3
A
- Too many facts and figures overwhelm the
audience (advocate) - upporting evidence is vital. (science)
5
Q
advocate vs science : 4
A
- A: Extensive qualifications can overwhelm the
audience. - s: extensive qualifications can be necessary for
scholarly credibility
6
Q
advocate vs science : 5
A
- A: echnical jargon can confuse people.
- S: Technical jargon can add greater clarity and precision.
7
Q
advocate vs science : 6
A
- A: Simplification is preferable.
- S: Detailed explanations are useful.
8
Q
advocate vs science : 7
A
- A: Quick, but accurate, preparation and action are
often necessary to take advantage of
opportunities. - S: hastily prepared presentations can be
discredited.
9
Q
advocate vs science : 8
A
A: Present a passionate and compelling argument
based on facts.
S: Be objective and unbiased.
10
Q
The gap in global health can be described as
A
as the health inequities that exist between wealthy and
impoverished populations
11
Q
Populations with the lowest income have
A
high levels of illness and
premature mortality.
12
Q
what is the relation/pattern seen in the total deaths and income related
A
the low-income countries have more deaths associated with each disease.
13
Q
What is the trend you see in life expectancy rates between different countries?
A
people who live in high income countries tend to have greater life expectancy and lower levels of illness, whereas people who live in low income countries tend to have higher levels of illness and premature mortality. As of 2018, the average life expectancy for the world is 73. For high income
countries life expectancy is 81 years, middle income countries 72 years, and low income countries only
63 years.
14
Q
why does the gap in health exists
A
social determinants of health as they allow them to deal with illness
15
Q
individual impacts of social determinants of health
A
- 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
16
Q
what is the social gradient
A
individual living in poverty have worse health compared to wealthy people
17
Q
where does the social gradient occur
A
globally and between and within countries
18
Q
poverty can affect health by
A
direct or indirect methods
19
Q
why does living in poverty affect health
A
challenging for
individuals to buy healthy foods, or attain clean and safe living conditions, stressors (mental burden of financial stress, and the feeling of lacking support)
20
Q
what plays a crucial role in the perpetuation of social gradient
A
work environment
21
Q
having a job and and income doesn’t just mean
A
good health outcomes
22
Q
in a study about social gradient what did it look at
A
those who are employed can be further broken down into various “social classes” based on education level and occupational position (management versus front-line)
23
Q
results of the social gradient study
A
Of these
individuals, the lowest income earners tend to work more labour intensive jobs that contribute to poor
health, and this is often attributed to the role and contribution of various physical and psychosocial
working conditions
24
Q
social gradient graph and income/work environment; lower social classes
A
tend to work in fields and hold jobs that
are more dangerous (i.e. more prone to injuries), more physically demanding, and have inflexible work
hours
25
he poverty trap is the mechanism that explains
how individuals who are in poverty are trapped in
poverty unless an external force intervenes by providing them with a significant amount of money and
resources
26
the actions of people living in poverty
become self-reinforcing mechanisms that will keep
them in poverty
27
example of the poverty trap
, if an individual working a low-paying job increases their working hours to make money for essential needs, they are more likely to get sick and have less time to improve their
skills for a better job.
28
Gross Domestic Product (G D P). division
is divided by a country’s population to
get the G D P per capita.
29
GDP why is it used
as a comparative measure of economy and standard of
living between countries
30
Gross Domestic Product (G D P)
product is an annual monetary measure of all the goods and services produced by a country (domestic)
31
to over come inequities in the SDHs
many of these health inequities and unequal health
outcomes can be eliminated
32
the mediate the effect of SDHs the WHO...
created the Commission on Social Determinants of Health
33
The call to
action was published
in a report entitled closing the gap in a generation
34
What are some examples of gaps in global health?
- life expectancy
- pregnancy risks
- gaps also exist within countries
35
What are the social determinants of health? Why are these important?
- born, live, grow, work,
and age.
- impact the health of individuals, and by extension,
populations.
36
How should we broaden our understanding of health?
health should be viewed as socially so changes could be made to social and economic conditions that will have good / betters impacts on health
37
the WHO is goal
close the global health gaps in one generation
38
three ways global health gap can be closed
- improve daily living conditions
- address inequalities in Power, Money, and recourses
39
Improve Daily Living Conditions
Improve the conditions in which people work and live, and implement a universal social protection
policy to protect all individuals from insecure employment.
40
improve daily living conditions also includes improving what
circumstances in which
children are born, and put an emphasis on equal childhood development and education between boys
and girls to promote lifelong health.
41
e five areas that can be addressed to improve living conditions:
* Equity from the Start
* Healthy Places, Healthy People
* Fair employment and healthy work
* Social protection throughout life
* Universal health care
42
Address Inequalities in Power, Money, and Resources
fix the he inequalities that occur in the division of resources and power across the public and private sectors through effective health policy methods
43
Measure and Understand the Problem and Assess the Impact of Action
Increase global health research through using effective measurement of health and SDoH, and evaluate the impact that policies have on health.
44
what was the first recommendation in the closing the gap in generation report
improve daily living conditions
45
three main dimension of housing
- physical dimension
- social dimension
- spatial dimension
46
Physical Dimension of housing
should meet all of an individual’s basic survival needs.
47
examples of physical dimension of housing
having clean water and sanitation, electricity, plumbing, heating, proper ventilation, and a safe
infrastructure.
48
what and why is physical dimesion important
poor housing increases rates of communicable disease, injuries, violanece, and health probelms
49
Social Dimension
involves aspects such as affordability and home ownership, which
contribute to a person’s sense of belonging and control over their home.
50
what is central to social dimension and why
domestic environment
personal sense of safety and stability and lack of overcrowding lead to the health and well-being of a household.
51
Spatial Dimension
housing refers to the location of a house in relation to other things in its
environment.
52
spatial dimension includes:
the distance to schools, healthcare services, recreation areas, and grocery
stores.
- waste location
- environmental contaminants
53
Indigenous reserves and living conditions
poor
- long term drinking water advisories
54
may 2025 and long term drinking water advisories
37 active ones in 35 communities
55
Neskantage first nation - drinking water
has been under long term drinking water advisory for 30 years
56
what is important for healthy childhood development
adequate living conditions
57
healthy development of the brain allows for
progression of linguistic, cognitive, and psychosocial development
58
At least 200 million children globally are not
achieving their full development potential due to poor living conditions in early life
59
To close the gap in health inequities in the population, it is vital to understand
how those early
childhood development years are critical to the health of an individual, and further set the stage for
health outcomes of the population.
60
equity from means
every child is given the same
opportunities and access to services .
Including education, food and nutrition, health care, so they grow up in safe and healthy environments.
61
what is the equity for the start
- comprehensive upstream approach to the protection and promotion of the well-being of children
which prevents larger inequalities in population health
62
The Jamaican Study was a
longitudinal study that looked into the relationship between ensuring the
healthy development of children, both physical and psychosocial, and a child’s later development in
life.
63
what did the Jamaica study do
It was done over a 24-month period. What they did was they took children who were stunted, and they had four different groups.
-One of the groups was
supplemented with high nutrition, and another group was stimulated psychosocially, and then the fourth group was both stimulated psychosocially and also had the nutrition
64
what did the study highlight
early childhood
development is a really key time to be able to make a huge impact on the social determinants of health as
well as on the health of an individual in the future and on closing that gap in global health.
65
Adverse working conditions tend to
be clustered in lower-status occupations
66
working conditions and adverse conditions associated with
poor physical and psychosocial health and stress, which has been shown to increase risk of coronary
heart disease (C H D) by 50%.
67
examples of adverse working conditions
physically or psychologically demanding job,
low job autonomy, inflexible working hours, and an effort-reward imbalance.
68
job security is a
SDoH
69
Unemployment can have a profound
negative effect on
physical and mental health through financial insecurity, material deprivation, a lack of opportunities for personal development, and increased stress
70
e Closing the Gap in a Generation report ; second goal of "improving living conditions" is
"Healthy Places Healthy People
71
Healthy Places Healthy People involves
improving the larger built-in environment where people live, which has a large impact on
physical and mental health
72
W H O’s Healthy Cities program,
long-term international development
initiative that aims to create an environment that supports health and a good quality of life.
73
With a growth of urbanization, people living in cities usually have
better access to opportunities and
healthcare
74
_____ is an important driver in reshaping population health problems
urbanization
75
city life leads to
sedentary lifestyles, pollution, and crowded living conditions,
which can negatively impact population health.
76
urbanization and what has reshaped population health problems
- crowding
- violence and injuries
- diseases
- pollution and climate change
- gentrification
77
Crowding :
With an increase in urbanization comes an increase in population density
78
if stores and
access to services does not keep up with this increased population demand, then
the increased
population must compete for the limited daily resources
79
resources people might have to compete for
grocery stores,
healthcare services, community centres,
80
in order to keep up with crowding/demand of people ubran centers
get more
investment, while rural communities, including many Indigenous communities, end up suffering from
underinvestment and lack of access to essential services.
81
crowding : With limited space
the cost of housing increases, which can then lead to crowding
at the family level
82
Violence & Injuries ; urbanization
- increase in disparities in the standards
of living amongst citizens, which may lead to conflicts over resources
- urban cities tend to have
areas with higher crime rates, which create insecurity for much of the population.
-
83
Often women,
migrants, and refugees ; Violence & Injuries
bear the brunt of this lack of security, with significant impacts on their
livelihoods, health, and access to basic services
84
Higher levels of violence & lack of security have what
economic and social impacts on the entire population
85
Diseases
eased risk of the spread of
communicable diseases due to a large population living in a close proximity.
86
diseases: urbanization accounts for significant changes in
dietary patterns and physical activity levels, which
increase the risk of obesity in children, and increase both injuries and non-communicable diseases in
the urban-poor.
87
walking and cities
increased access to services or fast food and if there is sidewalks and safe neighouboods good then
88
Pollution & Climate Change who is more vulnerable
living in low
SDI countries which have poor health infrastructure, people living on small islands, and those living in
mega cities, mountain ranges, or the polar regions
89
Urbanization has lead to
o increases in greenhouse gas emissions, which is the main cause of climate change
90
. Climate
change and effects
major health issue as it impacts air and water quality, sanitation, sufficient food
production, and secure shelter,
91
the climage impact is
disproportional
92
The W H O
reported that climate change is expected to
cause approximately 250 000 additional deaths per year
between 2030 and 2050, with the main causes of death being heat exposure in elderly individuals,
childhood malnutrition, diarrhoea, and malaria.
93
Gentrification is
process through which low-value neighborhoods experience an influx of affluent
residents and business, transforming the neighborhoods to high-value areas
94
Gentrification tends to
occur once the other impacts of urbanization have happened.
95
Gentrification effects
drives up rent and
property values, leading to the forced displacement of low-income individuals, and changes in the
racial and ethnic composition of a neighborhood
96
What are some of the ways in which developing countries experience worse environmental
conditions, and how do these impact health?
* Lack of policy (or implementation of policy) to control pollutants, including those in foods
(pesticides, etc)
* Lack of social security/insurance helping those living in poverty to be able to afford to live in
decent areas/housing conditions
* Crowded living
* Lack of universal healthcare and health promotion interventions
(Dr. Carpenter’s response)
97
The Closing the Gap in a Generation report identified two areas of improvement that lie within the policy level of global and population health, what are they?
1. Social Protection Across the Lifecourse
2. Universal Healthcare
98
what does 1. Social Protection Across the Lifecourse
2. Universal Healthcare focus on
broader, structural forces that play a significant role in determining the
health of the population
99
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.
29%
100
WHO thoughts on social protection policy
it is needed
101
why is a universal comprehensive social protection policy needed
because
greater social security has been associated with better population health
102
why would implementing a universal social protection policy be good for
improving health in poor countries as most of the population
works in the informal sector or domestically.
103
barriers that may be faced in trying to implement social security
globally. Dr. Carpenter’s response
- Limited institutional infrastructure and financial capacity in low income countries
- political ideologies and economic policies that favour economic growth and
prosperity over the well-being of the population
104
In 2016, 22.3% of Canadian citizens
self-identified as a visible minority
105
visible minorities in Canada experience
healthcare
inequities, which can be attributed to a lack of minority healthcare workers, meaning the current
Canadian healthcare system lacks the ability to deliver culturally sensitive care.
106
culturally sensitive care that could be lacking
language, cultural,
and spiritual differences between physicians and patients
107
The A B C project was a
longitudinal study that followed children from a disadvantaged area of North
Carolina for 35 year
108
the ABC project included
d both a control group, and a treatment group which received
an enriched preschool experience and access to healthcare in early childhood
109
second major recommendation of the Closing the Gap in a Generation report
the need
to tackle inequalities in power, money, and resources.
110
the report
suggests the need to develop policies that promote equity because
inequity in daily living conditions is
shaped by deeper social structures, including governmental policies and institutions
111
need for equitable health policies because
optimal healthcare systems are characterized by an equitable system that does not rely on
an individual's ability to pay for health care
112
four main pillars that healthcare systems should be built on to have better outcomes
1. Local Action
2. Primary Level of Care
3. Equitable System
4. Prevention, Health Promotion, and Intervention
113
Local Action
Appropriate local action across the range of social determinants
114
primary Level of Care
Emphasis on the primary level of care with adequate referral to higher levels.
115
euitable System
An equitable system not relying on ability to pay.
116
Prevention, Health Promotion, and Intervention
Preventions and health promotions valued just as highly as curative interventions.
117
even though the Canadian healthcare system is built on four pillars of optimal healthcare system not
every individual in Canada has equal access to health services or have equal equality of services
118
2015 Spring Reports of the Auditor General of Canada, Report 4 summarized Access to Health
Services for Remote First Nations Communities in Manitoba and Ontario.
- nursing stations
- medical transportation
- support allocation and comparable access
119
many Indigenous communities, nursing
stations are not
adequately staffed
120
ccording to Report 4 (2015) ; nursing stations
only one in 45 nurses
working in First Nations communities have completed all five of Health Canada’s mandatory training
courses
121
it is required that nursing facilities
undergo an inspection every five years; however, Report 4 found
that out of eight stations in First Nations communities, only five were inspected within the designated
time period.
122
Nursing stations that are non-compliant with health and safety requirements or building
codes can put
patients and staff at risk and may limit access to health services.
123
Although
medical transportation benefits exist, according to Report 4
Indigenous individuals who are not
registered in the Indian Registration System can be denied the medical transportation benefit.
In
communities, some only have approximately half the children registered.
124
, Report 4 identified that there
was no transparency from Health Canada ; medical transportation
Health Canada did not analyze the denied requests for
medical transportation benefits to explain the reasons for denial. Further, Health Canada also failed to
maintain sufficient documentation to demonstrate that medical transportation benefits were
administered.
125
when improving and increasing medical transportation, the focus is on
improving ways that
patients are taken from their communities to larger center's
but intervention hardly consider or look at the challenges faced by medical professionals traveling to these rural and remote locations
126
The report showed that Health Canada did not take into account the
health needs of remote First
Nations communities when allocating its support
127
specific and measurable criteria when comparing First Nations communication other remote communities
Health Canada did not establish it in terms of access to clinical and client care services
128
Report 4 highlighted a lack of
effectiveness in the established committees towards developing
workable solutions to the interjurisdictional challenges that negatively affect First Nations individuals’
access to health services.
129
Accommodating the unique needs of each rural and remote community,
is complicated and challenging task but it is achievable
130
two initiatives helping to increase access to healthcare in remote communities.
- telehealth
- Northern Ontario School of Medicine (N O S M)
131
Telehealth
allow for long-distance
patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote
admissions
132
e Northern Ontario School of Medicine (N O S M)
a medical school in Ontario, created through a
partnership between Laurentian University and Lakehead University
133
N O S M is mandated to
educate doctors and to contribute to care in Northern Ontario's urban, rural, and remote communities.
134
all medical student at NOSM
complete various placements in Aboriginal or Métis communities throughout the
four-year program
135
the Truth and Reconciliation Commission (T R C) of Canada regarding Indigenous healthcare recommendations
- recongizing the Indigenous health care rights
- establsihing a dialogue
- Acknowledging, respecting, and addressing the distinct health needs of Indigenous peoples
- Providing sustainable funding for existing and new Aboriginal healing centres (harm from res schools)
- In collaboration with Indigenous healers and elders
- Hiring and retaining Indigenous health care professionals
- all staff have
cultural competency training.
136
Equitable health
can be determined by a number of government and economic factors including
finance, education,
housing, employment, transportation, and health
137
to address healthy inequities government should
policies across departments align in their goal to produce health equity.
138
intersectoral action for health (I S A) is what
Aligning health policies across a number of government departments to promote health equity
139
intersectoral action for health (I S A) implies the inclusion of
several sectors and health sector
140
I S A is crucial because
most of the decisions that impact the health of a population are more than the
health sector
141
about the health sectors and address health outcomes (SDoH)
- has to work with other government sectors of government and society
142
who has playd an important role in (ISA)
Canada
- public health agency of Canada working with WHO to establish effective intersectoral approaches
143
Equitable Health Outcomes
* Education
* Health
* Trade
* Industry
144
Industry, or the market, can
impact health
145
The market can
n bring health benefits
146
how can market bring health benefits
- through new technolgoies
- goods and services
147
what else can marketing do
adversely affect the social determinants of health
148
how can marketing affect the SDoH
through economic inequalities, resource depletion, environmental pollution,
unhealthy working conditions, and the circulation of dangerous goods.
149
what are the 3 main aspects of market responsibility
1. Social goods should be governed by the public sector.
2. Legislation should promote gender equality.
3. Promote political empowerment.
150
Commercialization of education, healthcare, and other basic human and societal needs produces
health inequity
151
because commercialized education, healthcare, basic human and societal need they must be
governed by the public sector
152
gender inequities
- in all societies
- women tending to have less power, resources, entitliements, and social value than men
- less income than men
- reduce education for women and girls
153
Empowerment of women and reducing gender inequities is
essential to reducing health inequity
154
what ways can empowering women occur at
changes made to policy that affect societal structures
155
examples of empowerment
* 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
156
Political empowerment represents
he ability of individuals to contribute to and be included in political
processes.
157
importantance/ idea of political empowerment
Having the freedom to participate in political decision-making is important for citizens
because it gives them autonomy, provides an opportunity to voice their needs and interests, and
allows them to challenge unfair, graded distribution of social resources.
158
who has the least amount of politiical power and what does this represent
disadvantaged individuals' and inequity
159
what does inequity in political power result in
unfair distribution of
societal power and resources, which contributes to health inequity
160
Two main methods for political empowerment
- top down approach
- bottom up
approach
161
Top Down
Top-down approaches are when the state works to guarantee a complete set of rights for all citizens,
and a fair distribution of resources across society.
162
Bottom Up
Bottom-up, or grassroots approaches are founded by self-organization of disadvantaged groups.
163
top down approach promote
a bottom up approach
164
Health policies are aimed at
reducing health inequities
165
types of policies that help eliminate health inequities.
1. Social goods being governed by the public sector.
2. Legislation that promotes gender equity.
3. Promoting political empowerment, especially for disadvantaged populations
166
the third recommendation of closing the gap in the generation report
the need
to continuously measure health problems and solutions to design effective, targeted interventions
167
Barriers (obstacles)
Barriers are understood as obstacles
that could harm the feasibility of a policy
or intervention.
168
examples of barriers
Civil unrest
* Governmental policies or agendas
* Cultural barriers (e.g. mistrust of
Western medicine)
169
Enablers (supports)
relate to factors or resources
that can be leveraged to increase the
feasibility or effectiveness of a policy or
intervention.
* Physical barriers (e.g. lack of
infrastructure
170
example of enablers
- 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
GLPH 271
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Decks in class (5)
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