why prioritise?
- finite health services
- .opportunity costs for each prioritisation
- ethical and evidence based judgement required
- difficult to compare health outcomes
- individual vs. population needs.
aims of GBD?
- to use a systematic approach in summarising the burden of disease and disability at a population level using population health principles and the best available evidence, for health research and health service prioritisation and to identify disadvantaged groups to target health interventions.
- to take into account death and non-fatal outcomes/disability.
reasons for GBD
- incomplete data from different countries
- data focused on mortality and did not take into account disability (which is hard to measure)
- lobby groups give a disproportionate view on the important health issues.
- hard to compare strategies and conditions without the same approach.
underlying determinants of health?
WHO the right to health reading
- safe drinking water & adequate sanitation
- safe food/nutrition
- adequate nutrition and environment
- healthy working and environmental conditions
- health related information and education
- gender equality
key aspects of the right to health
WHO the right to health reading
- inclusive
- contains freedom
- contains entitlements
- health services provided without discrimination
- all services/goods/facilities must be acceptable, available, accessible and of good quality
gains of DALY approach?
- revealed the hidden burden of mental health burden/injury as a major public health problem
- recognised ncd’s as a major problem for LMIC’s - not just a rich country problem
challenges of DALY approach?
- disability is viewed as a burden
- disability weights are considered the same as the disease burden, not taking into account setting/social position/physical or social environment
Medical model of disability
- disability is an individual problem and they need to be cured. justifies their exclusion from society
- disabled = defined by their illness
- disabled = dependent
- control = health professional’s
- individual choice is limited
social model of disability
- problem for society
- caused by policies, practices, attitudes, environment
- resolved by removing barriers
epidemiological transition
characteristic shift from perinatal/CD’s –> NCD’s as the common burden of disease/disability as we shift from low–> high income
risk transition
shift from RF’s for CD’s/PND’s –> RF’s for NCD’s. as we shift from Lower–> higher income countries
double burden of disease
common risks of PN/CD’s coexist with risks of NCD’s
NCD Truths
80%+ of NCD's are in LMIC's preventable double burden requires double response, not CD's first then NCD's ~50% in 30-69 yo's concentrated among poor
feminisation of the HIV epidemic
the increasing proportions of new HIV infections are among women, primarily via heterosexual transmission
leading cause of death for women of reproductive age?
AIDS-related illness
HIV prevention and control
safer sex: - media - education - condoms safer products - needle exchange - prevent against needle stick injuries - screening of blood products improved access - testing and counselling - antenatal screening - treatment, support, counselling for HIV+ people - treatment of infections, family planning
challenges for the future of HIV
global resources fall short of the needs
need to combat stigma and discrimination
need to address social determinants of health and human rights
obesogenic environments
the sum of influences that the surroundings/opportunities/conditions of life have on promoting obesity in individuals or populations
consequences of obesity
metabolic diseases
mechanical disorders
psychological problems
social consequences
causes of obesity pandemic
food system
political and economic drivers
other changes - e.g. sedentary lifestyle
local environments that shape obesity
economic - income and income disparity physical - food and PA socio-cultural - food, PA, body size policy - regulations of market
policy inertia
food industry opposition
- direct opposition (court), self-regulatory pledges/codes
government reluctance to regulate or tax
- conflicts of interest, unwilling to battle food industry, belief in education and market solutions
lack of public demand
- more supporting of policy actions, not translated into pressure for change
right to health instruments
- universal declaration of human rights
- international covenant on economic, social and cultural rights
3, other international rights conventions - indigenous rights (ToW, UN Dec of Rights of Ind. peoples)
- NZ Legislation and policies (human rights, NZPublic health and disabilities act, code of patient rights)
respect (R2H)
no discrimination
