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Global health introduction

  2. Definition  What is global health?  Health problems, issues, and concerns that transcend national boundaries, which may be influenced by circumstances or experiences in other countries, and which are best addressed by cooperative actions and solutions (Institute Of Medicine, USA- 1997)
  3. Introduction  Reasons for interest in Global Health Moral duty  Public diplomacy  Investment in self-protection   Problems facing Global Health Past – Limited resources  Present – Uncoordinated efforts  wasted resources  Lack of stable leadership    ↑ turnover = ↑strategic uncertainty Key factors to future direction Expanded talent pool in developing world  Devise effective systems for disease prevention and treatment  Mend health infrastructure 
  4. Global Health Issues  Refers to any health issue that concerns many countries or is affected by transnational determinants such as: Climate change  Urbanisation  Malnutrition – under or over nutrition  Or solutions such as:  Polio eradication  Containment of avian influenza  Approaches to tobacco control
  5. Global Health  Prioritization of goals   Specific diseases vs. general health status Funding allocation   Disconnect with local needs   Dictated by foreign bodies Bureaucracy and corruption Change of focus  Maternal survival  Increased overall life expectancy
  6. 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.   International Health: Developed during past decades, came to be more concerned with     Data and evidence to support action, focus on populations, social justice and equity, emphasis on preventions vs cure. 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
  7. Disciplines involved in Global Health  Social sciences  Behavioural sciences  Law  Economics  History  Engineering  Biomedical sciences  Environmental sciences
  8. Communicable Diseases and Risk Factors  Infectious diseases are communicable But..  so are elements of western lifestyles:  Dietary changes  Lack of physical activity  Reliance on automobile transport  Smoking  Stress  Urbanisation
  9. 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
  10. 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
  12. Multi-sectoral Dimension of the Determinants of Health  Malnutrition –  more susceptible to disease and less likely to recover  Cooking with wood and coal –  lung  diseases Poor sanitation –  more  intestinal infections Poor life circumstances –  Prostitution  Advertising tobacco and alcohol –    STIs, HIV/AIDS addiction and related diseases Rapid growth in vehicular traffic often with untrained drivers on unsafe roads road traffic accidents
  13. 2. The Measurement of Health Status I  Cause of death  Obtained from death certification but limited because of incomplete coverage  Life expectancy at birth  The average number of years a new-borns baby could expect to live if current trends in mortality were to continue for the rest of the new-born's life  Maternal mortality rate  The number of women who die as a result of childbirth and pregnancy related complications per 100,000 live births in a given year
  14. The Measurement of Health Status II  Infant mortality rate  The number of deaths in infants under 1 year per 1,000 live births for a given year  Neonatal mortality rate  The number of deaths among infants under 28 days in a given year per 1,000 live births in that year  Child mortality rate  The probability that a new-born will die before reaching the age of five years, expressed as a number per 1,000 live births
  15. 3. Culture and Health  Culture:  The predominating attitudes and behaviour that characterise the functioning of a group or organisation Traditional health systems  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  Influence of culture of health  Diversity, marginalisation and vulnerability due to race, gender and ethnicity
  16. 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  Socioeconomic growth with increased car ownership  Based on a ‘business as usual’ assumption 
  17. High Fertility/High Mortality Source: US Census Bureau, Populatio n Report
  18. Declining Mortality/High Fertility Source: US Census Bureau, Populatio n Report
  19. Reduced Fertility/Reduced Mortality Source: US Census Bureau, Populatio n Report
  20. 5. Key Risk Factors for Various Health Conditions  Tobacco use –  related wide  Poor sanitation and access to clean water  to the top ten causes of mortality world related to high levels of diarrhoeal/water borne diseases Extra marital affairs –  HIV/AIDS,  sexually transmitted infections Malnutrition –  Under-nutrition (increased susceptibility to infectious diseases) and over-nutrition responsible for cardiovascular diseases, cancers, obesity etc.
  21. 6. The Organisation and Function of Health Systems  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:
  22. Changing in Health Inequality World Population arrange by income Distribution of Income 82.7% Richest 20% Second 20% 11.7% Third 20% 2.3% Fourth 20% 1.9% Poorest 20% Source: Walley J, Wright J, and Hubley J (2001) 1.4%
  23. Sustainable Infrastructure  Roles of developed world Establishment of independence  Policy and legislation  Reasonable exit strategies   Roles of the developing world Providing sufficient training  Provide incentives to remain  Shift focus to health and development   Sufficient resources to maintain implemented strategies Training and education  Healthcare infrastructure and initiatives  Economic responsibility  Funding scheme 
  24. The End  Thank you for your patience and time.

Hinweis der Redaktion

  1. As defined by the WHO, Global Health is “ the health of populations in a global context and transcends the perspectives and concerns of individual nations”Addressing diseases of poverty (the developing world) has become a central topic in foreign policy among many nations. But why the interest? Stopping the spread of diseases such as HIV and malaria can be viewed as a moral duty [expand]It could also be viewed as a strategy in public diplomacy [expand]Finally, given that national boarders do not stop the propagation of disease, interest in global health can be viewed as an investment in self-protectionThe field of Global Health faces a multitude of challenges. In the past, limited resources greatly restricted the ability to provide aide to populations in need. Now, a significant influx of public and private funding has reversed this issue, and created a new one. Uncoordinated efforts between various bodies are resulting in significant waste of available resources. Global Health has also seen rapid turn-over in a multitude of high profile leadership positions within their community. These periods of transition contribute to instability and uncertainty as to major strategic endpoints. Going forward, key areas of development will dictate the future of Global Health….
  2. There has been an extraordinary increase in public and private giving directed at public health in recent years, however it has tended to be directed towards high profile diseases such as HIV/Aids, malaria and TB rather than overall public health of populations. Of course there is no arguement that these are worthy causes to invest in, it is the narrow channelling of aid and resources that have left other major global health concerns overlooked. For example the global focus on HIV/AIDs offers little benefits to Islamic states such as Afghanistan, Egypt, Iraq and Pakistan where the disease is not prevalent, however these nations have some of the highest maternal mortality rates in the world.In fact the 3 top killers in most poor countries is Maternal death around childbirth, pediatric respirational and intestinal infections leading to death from pulmonary failure/uncontrolled diarahea. Still in many poor countries, governments recieve substantial funding to support ARV distribution for pregnant women to stop the spread of HIV to their babies, but have no fiancial capital to support basic maternal and infant health programmes.Which leads me to another large issue of funding allocation. Aid unforuntely is still often dictated by foreign bodies with many strings attached. Efforts can often be lacking in co-ordination, oversight and guidance and most importantly not in touch with local needs. There are often few if any provisions that allow the local communities to indicate what they want, and dictate which intiatives they need or adopt local innovations.A further detractor from addressing the general needs of the community is the bereaucracy and corruption that is all too rampant. For eg In Ghana as much as 80% of donor funds have been syphoned away. This will remain to be a huge hinderence to improving global health unless it is firmly addressed by all involved.An entire change of focus on improving Global Health is also needed. Assessing the sucess of initiatives based on short term targets such as no of people recieving drugs is not good enough. We need to evaluate on long term goals, encompassing overall public health of populations and the focus should be shifted from targeting specific diseases. Instead concentating on achieving two basic goals-Maternal Survival and Increased Overall Life Expentency. Why? Because these are important markers for overall health. Pregnant women survive where safe,clean well staffed facilities are available with sterile equipment and antiobiotics. While Life expectancy is a good indicator of child survival and essential public health services. Children survive when there is safe water to drink,good immuzination practices carried out and where food is nutritional and available. Defeating AIDS. TB and Malaria are best understood not simply as tasks in themselves, but as essential components of these two larger goals. On this basis it may well take 2-3 generations to improve Global Health but we all must realise that it is not enough to invest in the present, we must invest in the future.
  3. While a great many health initiatives have been established all over the world, very few have been implemented with a viable plan for exit strategy. Over the course of a program, local governments can become dependent on foreign aid in order to maintain standard of care. This is because most funding is focused on aid deliverables themselves, and not on the establishment of viable infrastructure for the continued dispensation of service after foreign bodies withdraw.Foreign bodies must recognize that local governments must retain both their financial and decision-making independence if programs are to succeed after aid has been withdrawn. Policy and legislation must be enacted to protect these vulnerable populations from exploitation by enterprise.In planning a reasonable exit strategy, consideration must also be given to the resources demanded by the program, in relation to the availability of local resources. This, as well as whether or not the current rate of production can reasonably be maintained over time are crucial planning points. If the demand on local resources is too great, they can quickly become depleted, and the program is doomed to fail.It falls to the local governments to ensure that adequate spending has been allocated to both the development of basic health care building blocks, as well as local supporting industry. Health care centres require trained staff, so adequate education and training programs must be in place. As well, retention of qualified professionals will depend on appropriate incentives, such as availability of medical supplies and equipment or job security/ safety.Finally, local infrastructure needs to be strong enough to sustain the changes brought about by the program. Health care infrastructure is required to co-ordinate and carry out these programs effectively. Business infrastructure is needed to produce and supply, or at least procure, the products demanded by the programs. Therefore, it is essential that the local economy is stimulated in such a way that it can support the costs of the program, and do that in a sustainable way. This establishment of sustainable infrastructure will be key to ensuring these worthwhile programs continue to run, and benefit local communities long after the foreign bodies have left. So the question becomes…