1
Q
Communicable Diseases
A
- spread from person-to-person
- 30% of DALYs
- maternal, perinatal, nutrition
- occur largely in poor populations
ex: HIV, TB, Malaria
2
Q
Non-Communicable Diseases
A
- CANNOT spread from person-to-person
- 60% of DALYs
- not a high rate in poor countries
ex: coronary heart disease, cancer, mental illness
3
Q
Injuries
A
- largest difference betwwen sexes
- 1 in 8 make deaths
- 1 in 14 female deaths
ex: car crashes, suicide, war injuries
4
Q
DALY
A
Disability Adjusted Life Years
- overall disease burden
- cumulative number of years lost due to ill-health, disability, early death
5
Q
YLL
A
Years of Life Lost
- age of death
(life expectancy - average age of death)
- more weighting on early mortality (larger impact on the individual and society)
# of deaths X age of death (life expectancy - average age of death)
6
Q
YLD
A
Years Lived with Disability
- disability + mortality
- weighting factor from 0 (perfect health) to 1 (death)
- number of years a condition effects quality of life
# of prevalent cases X disability weightinh factor
7
Q
HIV
A
- infects WBC helper T-cells
- destroying of helpter T-cell results in AIDS
- leading infectious disease
(killed 39 million, 3.2 million children)
8
Q
HIV treatment
A
- antiretroviral therapy (ART)
- does not cure
9
Q
Tuberculosis (TB)
A
- infects 1/3 of population
- only 5-10% infected develop active TB infection
10
Q
TB treatment
A
- antibiotics
- potential for drug resistance (made worse with non-compliance medication)
11
Q
Malaria
A
- caused by the parasite, Plasmodium falciparum
- spread to humans by mosquitoes
- more prevalent then HIV, but not as deadly
- primarily occurs in Africa
12
Q
Malaria Treatment
A
- anti malarial drugs
- insectide treated mosquitoe nets/sprays
13
Q
Iron Deficiency
A
- most common nutritional disorder
- impairs development in children
- decreases work productivity in adults
14
Q
Protein - Energy Malnutrition (PEM)
A
- severe calorie or protein deficiency
- starvation
- more severe effects on children due to their lower protein intake
- less common but more severe then iron deficiency
6 million death/year
15
Q
Maternal Conditions
A
- Impact on Children
- poor care/nutrition of the mother
- motherless children are less likely ot get an education - Economic Reasons
- 70% of those in absolute poverty are women
- maternal health interventions = cost effective
- women are more likely to spend their income on their family
- better maternal health will strengthen the entire healthcare system
3. Social Justice women have unequal access to: - employment - education - finances - basic health care
16
Q
Neonatal Health - Interventions
A
- Pre natal visits
- Skilled birth attendents
- Emergency care
- Post natal care
17
Q
Neonatal - mortality
A
- pre term birth (36%)
- birth weight (28%)
- birth trauma (23%)
40% of child deaths
18
Q
Cardiovascular Disease (CVD)
A
- leading cause of morbidity and mortality
19
Q
CVD - conditions
A
- coronary (ischemic) heart disease
- cerebrovascular disease (stroke)
- hypertension (high BP)
- heart failure
- rheumatic heart disease
20
Q
CVD - risk factors
A
- high BP
- high cholesterol
- diabetes
- tobacco use
- unhealthy diet
- physical inactivity
- obesity
21
Q
CVD & Global Health
A
- 80% of deaths are in low/middle income countries
- mostly occurs in mid life
- affects socioeconomci status of person/family/countries
Low SES = more risk factors, higher morbidity/mortality
22
Q
CVD - interventions
A
- Access to Medications
- widely available
- expensive medication
- research is in progress to improve medication access for primary/secondary prevention
23
Q
Cancer and GBD
A
1 in 3 people will develop cancer
1 in 9 people are at risk for developing cancer again
2 in 9 people are at risk of developing a second type of cancer
70% of cancer deaths occur in low/mid income countries
30% of cancers could be prevented by reducing risk factors
1/3 of cancers could be prevented with early detection
24
Q
Global Cancer Prevention
A
- Educate - to increase avoidance of risk factors
- Vaccinate - against HPV, HBV
- Control - occupational hazards
- Reduce - exposure to sunlight
25
Suicide - prevention
1. reduce Stigma/Misinformation
2. reduce access to Suicide Means
3. responsible Media Reporting
4. Alcohol policies/reduce Harmful Use
5. Follow up care - for people who attemtped suicide
26
MDGs
1. stop Poverty/Hunger
2. Universal Primary Education
3. Gender Equality/Empower women
4. reduce Child Mortality
5. improve Maternal Health
6. combat against HIv/AIDS, Malaria, other diseases
7. environmental sustainability
8. global Partnerhip for Development
27
MDGs & SDH
1. Gender Inequality
- work discrimination
- no private/public decision making
- more women in poverty
2. Big Income Gaps - rich/poor
2X stunted
4X out of school
2X U5 mortality
28
SDGs
1. no Poverty
2. no Hunger
3. Good Health
4. Quality Education
5. Gender Equality
6. Clean Water, Sanitation
7. Clean Energy
8. Good Jobs, Economic Growth
9. Innovation, Infrastructure
10. Reduced Inequalitites
11. Sustainable Cities, Communities
12. Responsible Consumption
13. Protect the Planet
14. Life below Water
15. Life on Land
16. Peace, Justice
17. Partnerships for Goals
29
Closing the Gap - in One Generation
1. Improve Daily Living Conditions
2. Address Inequalities - power, money, resources
3. Measure, Understand the Problem, Assess Impact to Action
30
Improve Daily Living Conditons
1. Fair work, Health employment
2. Social Security thorugout Life
3. Healthy Homes
4. Early childhood Health/Development
5. Universal Health care
31
Working Conditions - healthy
- financial security
- social status
- personal development
- social relations
- self-esteem
- protection from physical and psychosocial illness
32
Working conditions - adverse
- poor physical and psychosocial health
- stress
- increase risk of CHD 50%
33
Job Security - effects
- induce poverty
- material deprevation
- incresed stress
34
Early Childhood Health & Development
- first 8 years = critical for developmental changes and to reach full potenital
35
Optimal Healthcare Systems
1. Local Action - across Social Determinants
2. Health Promotion&Prevention - valued as high as medicine
3. Primary Level health care - with referral to higher levels
4. Equitable System - no worry for ability to pay
36
Intersectional Action for Health (ISA)
1. align health policies across government departments
2. promote health equity
3. include several factors - with health secotr
4. public policies - to address health outcomes
37
Market Responsibility
1. Social Goods - governed by the public sector
2. Enforce Legislation - promote gener equity
3. Promote - political empowerment
38
Gender Equity
pervades in all societies
women have less:
- power
- resources
- entitlements
- social value
- income
- education
- employmeny
39
Empowerment - political decision making
1. give them autonomy
2. opportunity - to voice needs and interests
3. challenge - unfair distribution of social resources
40
Reduce Health Inequity
1. Top-Down approach
- state gurantees set of rights and fair distribution of resources
2. Bottom-Up approach
- grassroots
- founded by self-organization of a disadvantaged group
41
Barriers
- civil unrest
- government policies/agendas
- physcial barriers
- cultural barriers
42
Enablers
1. Willingness of Communities
- to accept policies
- participate in intervention
2. Governmental Programs
- make resources available for addressing health issues
43
Social Demographic Index (SDI)
```
High = incease in Non-Communicable diseases
Low = increase in Communicable diseases
```
44
High SDI - increasing
- lower respiratory infections
- colon/rectum cancer
- lung cancer
- most NCD
45
High SDI - decreasing
- IHD
- stroke
- stomach cancer
- breast cancer
- injuries
46
Low SDI - increasing
- diabetes
- prostate cancer
- breast cancer
- pancreatic cancer
- Ebola
47
Low SDI - decreasing
- most diseases
48
Mental Illness
- NCD
7.4% DB
5th leading DALY
183. 9 million DALY
8. 6 million YLL
175. 3 million YLD
highest pop: age 10-29
1990 - 2010: 37.6%
49
Mental Health - WHO Action Plan
- value mental health
- protection, promotion
- full human rights
- health, social care
- promote recovery
- participate in society
- free from stigmatization, discrimination
50
Mental Health - Objectives
1. stronger Leadership/Governance
2. Mental Health/Social Care services - community based
3. Promtion/Prevention strategies
4. improve Evidence/Research
51
Mental Health - Approaches
1. Universal Health coverage
2. Human rights
3. Evidence based approach
4. Life course approach
5. Multi sectional approach
6. Empowerment - of people with mental disorders
52
MDG - challenges
1. Gender Equity - persists
2. Gaps - rich/poor, rural/urban
3. Climate Change - environmental degradation
4. Conflicts - threaten human development
5. Poor People - live in poverty, no access to basic services
53
3 Pillars of SD
1. Social Progress
2. Economic Growth
3. Environmental Protection
54
Gaps - examples
1. Lesotho born girl - life expectancy 42 years less then Japan girl
2. Women giving birth - death
Sweden: low risk (1 : 17 400)
Afghanistan: high risk (1 : 8)
3. Scotland life expectancy (adjacent)
area 1: 54 years
area 2: 82 years
55
WHO - environmental health report
Low Income Countries
- 13 million deaths can be improved with healthier environment
- lack of blood transfusions/blood banks
(125 000 women die from bleeding during birth)
- lack of clean water, sanitation (diarrheal)
- solid fuels indoor (respiratory infections)
High Income Countries
- air pollution
- stress (neurological disorders)
- could prevent 1/6 of DB
56
ABC Project
- early childhood intervention (30 years ago)
1. enriched preschool
2. access to healthcare
- disadvantaged children in North Carolina neighbourhood
control group
- 1 in 4 males had metabolic syndrom (obesity, hypertension)
treatment group
- 0% had metabolic syndrome
57
Mobile Creches Program
India
- unsupervised children on construction sites
founder: Meera Mahadevan (1969)
- daycare at construction sites
- safe, nurturing, stimulating environment
- promotes health development
- increases worker productivty
- employment opportunities to work with children
enriched children = future economic gain
58
Universal Health Care Policy
1. Populaton:
Who is covered?
2. Quality of Services:
Which services are coverd?
3. Direct Costs:
Portion of costs covered?
59
Remunicipaliztion: Putting water into the public
- with private sector, water bill increased 88%
- infrastructure produces work and jobs for low income workers
- water provided to low income homes, famrs (reducing chemicals)
1. water to privateization is reversible
2. transfer to public sector, with little disruption
3. committed to work force, improves water services
GLPH 271
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