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Introduction to Global Health as an overview

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Introduction to Global Health as an overview

  1. 1. Introduction to Global Health as an overview PRESENTED BY: NI’MAL BAROYA, M. PH. PUBLIC HEALTH FACULTY, UNIVERSITY OF JEMBER EAST JAVA INDONESIA ADAPTED FROM: MANY SOURCE 1. PROF. DR.SHARMEEN YASMEEN, CEO, PUBLIC HEALTH FOUNDATION OF BANGLADESH, HEAD OF THE DEPT. OF COMMUNITY MEDICINE, BANGLADESH MEDICAL COLLEGE, DHAKA 2. DR YOGA NATHAN, SENIOR LECTURER IN PUBLIC HEALTH, GEMS UL
  2. 2. Contents-  Definition of global health and global health issues  The differences between global and international health  Comparison of inequalities in health status  Global health agenda  Key concepts in relation to global health  Recognize the importance of information sharing in the area of global health
  3. 3. Why should we learn global health?  As of today, global health appears as newer concept  Health is becoming a global concern with the shifting paradigm of chronic diseases being a number one killer around the globe  Global Health is important for all professionals and young learners, those in health, engineering, chemistry, etc.  Professionals and students will be better equipped to face the challenges of their unique profession  Can explore better the priority areas for research
  4. 4. Definition of Global Health Health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions (Inst. of Medicine-USA: 1997)
  5. 5. Global Health Issues Non communicable diseases Emerging and remerging infections Climate change Urbanisation Malnutrition – under or over nutrition Nuclear war and bioterrorism etc
  6. 6. From individual to Global Health Global Health International Health Public Health • Health problems know no boundary • Health in the interconnected context, globalization, extends beyond problem on and capability of one country • Problem and/or concern beyond frontier • Focuses on solving health problem in developing countries • Health problem within national boundary • aims to promote health of the population through prevention and health promotion including sanitation Individual Health << Family Health << Community Health Source: J P Koplan et al. Towards a common definition of global health Lancet 2009; 373: 1993–95 4
  7. 7. Historical Development of Term  Public Health: Developed as a discipline in the mid 19th century in UK, Europe and US. Concerned more with national issues.  Data and evidence to support action, focus on populations, social justice and equity, emphasis on preventions vs cure.  International Health: Developed during past decades, came to be more concerned with  the diseases (e.g. tropical diseases) and  conditions (war, natural disasters) of middle and low income countries.  Tended to denote a one way flow of ‘good ideas’.  Global Health: More recent in its origin and emphasises a greater scope of health problems and solutions  that transcend national boundaries  requiring greater inter-disciplinary approach
  8. 8. It’s the Real Thing
  9. 9. Global health issues are closely related to numerous other fields of policy such as; Development, security, trade, economics, human rights, food, agriculture, research, employment, education, migration, environment climate protection, humanitarian aid.
  10. 10. Global health issues Vs. Global Impact Health Issue Global Perspective Cigarette smoking Tobacco is ranked as the second major cause of death in the world Tobacco is a multinational business with global marketing strategies. Illicit tobacco marketing is also important Obesity One billion adults worldwide are overweight; 300 million are clinically obese Food retailing and marketing is a multinational business STIs 340 million new cases of sexually transmitted infections occur world wide each year Increased travel and migration contribute to the spread of STIs; global action is required to coordinate containment efforts
  11. 11. Mental health Health Issues 450 million people worldwide are affected by mental illness at any one time Global Perspective Conflict and poverty are major contributors; these generally involve more than a single country and intervention strategies require multinational collaboration Alcohol 76.3 million people worldwide have alcohol use disorders Alcohol marketing and distribution is a global business; lessons can be learned from other countries Inequities Disparities in power and wealth directly influence health. inequities in societies are great, there are much greater disparities between countries.
  12. 12. Gaps in health status worldwide  Every second of every day, four women around the world give birth. And every minute, one of those women dies  In Sweden, the life-time risk of a woman dying during pregnancy and childbirth is 1 in 17, 400; in Afghanistan, it is 1 in 8.
  13. 13. Gaps in health status worldwide  Today, there is a 36-year gap in life expectancy between countries. A child born in Malawi can expect to live for only 47 years while a child born in Japan could live for as long as 83 years.  In Chad, every fifth child dies before they reach the age of 5, while in the WHO European Region, the under-five mortality rate is 13 out of 1000.  There is no biological or genetic reason for these alarming differences in health and life opportunity.
  14. 14. Gaps in health status within country  There are significant gaps in health outcomes within countries, too – rooted in differences in social status, income, ethnicity, gender, disability or sexual orientation.  For example in the United States, infants born to African- American women are 1.5 to 3 times more likely to die than infants born to women of other races/ethnicities. American men of all ages and race/ethnicities are approximately four times more likely to die by suicide than females.
  15. 15. Key Facts-Inequality in health service  Worldwide, about 150 million people a year face catastrophic health-care costs because of direct payments such as user fees, while 100 million are driven below the poverty line.  Even if they could pay, access to doctors would be a challenge.  Low-income countries have ten times fewer physicians than high-income countries. Nigeria and Myanmar have about 4 physicians per 10 000, while Norway and Switzerland have 40 per 10 000.
  16. 16. Cause of death Death in Millions Percent of Death Coronary heart disease 7.20 12.2 Stroke and other cerebrovascular diseases 5.71 9.7 Lower respiratory infections 4.18 7.1 Chronic obstructive pulmonary disease 3.02 5.1 Diarrheal diseases 2.16 3.7 HIV/AIDS 2.04 3.5 Tuberculosis 1.46 2.5 Trachea, bronchus, lung cancers 1.32 2.3 Road traffic accidents 1.27 2.2 Prematurity and low birth weight 1.18 2.0 10 leading causes of death around the world (WHO)
  17. 17. Source: W.H.O. Statistics Source: WHO statistics 2008
  18. 18. Global Governance The term “global governance” refers to the interaction of all mechanisms and forms of international cooperation to solve global issues in the context of globalization.
  19. 19. Global and National Health Agenda HFA: 1981 to 2000 AD: 12 global indicators MDGs: 2000 to 2015: 8 goals, 18 targets and 48 indicators SDGs: 2016 to 2030 : 17 goals and 169 targets and UN Statistical Commission will finalize around 300 indicators by March 2016
  20. 20. Global Goals – all SDGs
  21. 21. Health in post-2015 development goals 17 goals & 169 targets Target Description 3.1 Reduce global MMR to <70 per 100,000 live births 3.2 End preventable newborn & U5 deaths, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births & U5 mortality to at least as low as 25 per 1,000 live births 3.3 End AIDS, tuberculosis, malaria & neglected tropical diseases epidemics & combat hepatitis, water-borne diseases & other communicable diseases 3.4 Reduce by 1/3rd premature NCD mortality through prevention & treatment & promote mental health & well-being 3.5 Strengthen prevention & treatment of substance abuse, including narcotic drug abuse & harmful use of alcohol 3.6 Halve the number of global deaths & injuries from road traffic accidents 3.7 Ensure universal access to sexual & reproductive health-care services, including for FP, information & education, & the integration of RH health into national strategies & programs 3.8 Achieve UHC, including financial risk protection, access to quality essential health-care services & access to safe, effective, quality & affordable essential medicines & vaccines for all 3.9 Substantially reduce number of deaths & illnesses from hazardous chemicals & air, water & soil pollution & contamination Ensure health lives & promote well-being for all at all ages
  22. 22. Linkage between National and Global movements Examples  Framework Convention on Tobacco Control (FCTC)  Health for All  Global Fund  MDGs  NCDs  IHR  Alcohol: Global Strategy, National Strategy,  SDGs  UHC etc 6
  23. 23. Key Concepts in Relation to Global Health 1. The determinants of health 2. The measurement of health status 3. The importance of culture to health 4. The global burden of disease 5. The key risk factors for various health problems 6. The organisation and function of health systems
  24. 24. 1. Determinants of Health  Genetic make up  Age  Gender  Lifestyle choices  Community influences  Income status  Geographical location  Culture  Environmental factors  Work conditions  Education  Access to health services Source: Dahlgren G. and Whitehead M. 1991
  25. 25. Determinants of Health PLUS MORE GENERAL FACTORS SUCH AS:  POLITICAL STABILITY  CIVIL RIGHTS  ENVIRONMENTAL DEGRADATION  POPULATION GROWTH/PRESSURE  URBANISATION  DEVELOPMENT OF COUNTRY OF RESIDENCE
  26. 26. 2. The Measurement of Health Status  Cause specific death rate  Life expectancy at birth  Maternal mortality rate  Infant mortality rate  Neonatal mortality rate  Child mortality rate
  27. 27. 3. Culture and Health  Culture:  The predominating attitudes and behaviour that characterise the functioning of a group or organisation  Beliefs about health  e.g. epilepsy – a disorder of neuronal depolarisation vs a form of possession/bad omen sent by the ancestors  Psychoses – ancestral problems requiring the assistance of traditional healer/spiritualist  Diversity, marginalisation and vulnerability due to race, gender and ethnicity
  28. 28. 4. The global burden of disease  Predicted changes in burden of disease from communicable to non-communicable between 2004 and 2030  Reductions in malaria, diarrhoeal diseases, TB and HIV/AIDS  Increase in cardiovascular deaths, COPD, road traffic accidents and diabetes mellitus  Ageing populations in middle and low income countries
  29. 29. Trends in Global Deaths 2002-30 Source: World Health Statistics 2007
  30. 30. 5. Key Risk Factors for Various Health Conditions  Tobacco use –  related to the top ten causes of mortality world wide  Poor sanitation and access to clean water-  related to high levels of diarrhoeal/water borne diseases  Low condom use –  HIV/AIDS, sexually transmitted infections  Malnutrition –  Under-nutrition (increased susceptibility to infectious diseases) and over-nutrition responsible for cardiovascular diseases, cancers, obesity etc.
  31. 31. 6. The Organisation and Function of Health Systems and UHC  A health system  comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health (WHO)  Most national health systems consist:  public, private,  traditional and informal sectors:
  32. 32. Global Health Players - More complex and not only UN  UN: UNGA, WHO, UNICEF, UNFPA, UNAIDs, etc  WB and regional banks, and IMF, WTO  Bilateral donors: USAID, DFID, AFD, NORAD, SIDA, CIDA, IDRC, JICA, EC and G8  Foundations: BMGF, RF, Ford, CMB, etc.  NGOs: MSF, Oxfam, Clinton foundation, etc  Global Health Partnerships: GAVI, GF, RBM, Stop TB, PMNCH, HMN, GHWA, CORDs, etc. 10
  33. 33. 4 11
  34. 34. Digital divide: gap between haves and have nots One of the biggest global health challenges is access to information Potential Solution: WWW and Mobile Global Health
  35. 35. The importance of knowledge, learning, innovation, and IT “The most fundamental resource in modern economy is knowledge and, accordingly, the most important process is learning” Lundvall, Bengt-Åke (1992) National Systems of Innovation. Towards a Theory of Innovation and Interactive Learning. Pinter, London and New York, pp. 342
  36. 36. GloCal Health (Global to Local) Your Patient and Where you live
  37. 37. Global Health References  Skolnik R. Essentials of Global Health. Jones & Bartlett Publishers, Sudbury MA 2008. Chapter 1  Ed. Robert Beaglehole, 2003. Global Public Health: A new era. Chapter 1  Megan Landon. 2006. Environment, Health and Sustainable Development  Bonder, B. Martin L. Miracle A. Culture in Clinical Care  Koplan J et al, 2009. Towards a common definition of global health The Lancet, Volume 373, Issue 9679, Pages 1993-1995

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