1. FUNDAMENTALS OF
GLOBAL HEALTH
Fundamentals of global health
Course Introduction

2. COURSE COORDINATOR
Kerstin Klipstein-Grobusch, MSc, PhD
Associate Professor of Global Health, University Medical Center Utrecht, Utrecht
University, The Netherlands
Visiting Associate Professor, School of Public Health, University of the
Witwatersrand, Johannesburg, South Africa
k.klipstein-grobusch@umcutrecht.nl
www.globalhealth.eu
Fundamentals of global health
Course Introduction

3. Course Aim
• Introductory global health course
• Principles of global health, addressing
– global health governance, health-related development
strategies and health advocacy
– health indicators and burden of disease
– social determinants of health and health (in)equity
– epidemiologic transition & migration
– ethics in global health
– methodological approaches in global health research
Fundamentals of global health
Course Introduction

4. Course Format & Venue
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Lectures, exercises, readings, group work and assignments.
Self-study is an important aspect of this course.
Active participation is encouraged.
Course credits based on completion of
– compulsory assignments of learning units (50%)
– individual assignments (25%)
– final group work presentation (25%)
• Course credits: 1.5 ECTS
Fundamentals of global health
Course Introduction

5. Course Faculty
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Dr. Charles Agyemang, University of Amsterdam
Joyce Browne, Julius Center, University Medical Center Utrecht, Utrecht
Dr. Yme Berg, Royal Tropical Institute, Amsterdam
Prof. Dr. van Delden, Julius Center, University Medical Center Utrecht,
Utrecht
Dr. Ama de Graft-Aikins, University of Ghana, Ghana
Dr. Kerstin Klipstein-Grobusch, Julius Center, University Medical Center
Utrecht, Utrecht
Dr. Anne Poorta, Ministry of Foreign Affairs
Prof. Dr. Robert Pool, University of Amsterdam
Prof. Dr. Huub Schellekens, Utrecht University
Rineke van Dam, SUMAVI
Fundamentals of global health
Course Introduction

6. Course Program
The course consists of 13 Learning Units (LU), spread over three weeks:
• LU 1 – Introduction to global health
• LU 2 – Global health governance
• LU 3 – Health indicators and burden of disease
• LU 4 - Mixed methods approaches in global health research
• LU 5 – Social determinants of health
• LU6 – Health transition
• LU 7 – Migration and health
• LU 8 – Health equity
• LU 9 - Development strategies – sustainable development goals beyond
2015
Fundamentals of global health
Course Introduction

7. Course Program continued
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LU 10 - Time to work on presentation
LU 11 - Health advocacy
LU 12 - Sustainability and health
LU 13 - Ethics in global health research
LU14 - Group work presentation
Fundamentals of global health
Course Introduction

8. What is global health?
What are global health issues?
Fundamentals of global health
Course Introduction

9. Fundamentals of global health
Course Introduction

10. Global Context of Public Health
• Population: > 7 billion people worldwide, > 200 000
people added daily; in 8 countries > 30% of the
populations is under age 15
• Civil Society: Civil and foreign wars, > 43 million displaced
persons and refugees
• Poverty: 1.2 billion people live on less that US$1 per day;
2.8 billion live on less than US$2 per day; 1 in 6 are
chronically hungry
• Environment: Environmental changes such water
shortages, air pollution, increases in temperature
Fundamentals of global health
Course Introduction

11. The Challenge
• One billion of the more than 7 billion alive enjoy a long
and healthy life
• The challenge ahead is to find ways to help the other six
billion people to live longer and healthier lifes as well
Fundamentals of global health
Course Introduction

12. 2011 Basic Indicators by Level of Income
Population
(millons)
Average Per
Capita
Income ($)
Population
living on
< 2 US$
Life
Expectancy
(y)
Infant
Mortality/
1000 births
Least
Developed
Coutries
860
1220
77%
59
76
Less
Developed
Countries
(excl China)
4399
5000
56%
66
59
More
Developed
Countries
1241
32470
N/A
78
55
Population Reference Bureau, 2011 World Population Sheet
Fundamentals of global health
Course Introduction

13. Impact of disease on economic growth
• Reduced years of healthy life expectancy and productivity
due to chronic illness or early death
• Direct and indirect medical costs
• Reduction in returns to business and society, political
stability
Fundamentals of global health
Course Introduction

14. Relation between life expectancy
and economic growth
• Each 10 percent increase in life expectancy at birth,
holding all other factors constant, is associated with a
rise in economic growth of around 0.3 – 0.4% per year
WHO Macroeconomic Report 2011
Fundamentals of global health
Course Introduction

15. Global burden of disease
Fundamentals of global health
Course Introduction

16. Fundamentals of global health
Course Introduction
Juliuscenter.nl

17. Fundamentals of global health
Course Introduction

18. Global expenditure on health, 2010
as a percentage of GDP
Fundamentals of global health
Course Introduction
WHO, 2011

19. Fundamentals of global health
Course Introduction
WHO, The Global Burden of Disease – 2004 Update

20. Fundamentals of global health
Course Introduction
WHO, The Global Burden of Disease – 2004 Update

21. Leading Causes of Mortality and Burden of
Disease World, 2004
Mortality
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
DALYs
%
Ischaemic heart disease
Cerebrovascular disease
Lower respiratory infections
COPD
Diarrhoeal diseases
HIV/AIDS
Tuberculosis
Trachea, bronchus, lung cancers 2.3
Road traffic accidents
Prematurity, low birth weight 2.0
12.2
9.7
7.1
5.1
3.7
3.5
2.5
2.2
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
%
Lower respiratory infections
Diarrhoeal diseases
Depression
Ischaemic heart disease
HIV/AIDS
Cerebrovascular disease
Prematurity, low birth weight 2.9
Birth asphyxia, birth trauma
Road traffic accidents
Neonatal infections and other
6.2
4.8
4.3
4.1
3.8
3.1
2.7
2.7
2.7
Fundamentals of global health
Course Introduction
WHO, The Global Burden of Disease – 2004 Update

22. Public Health Agendas
• The unfinished agenda: Infectious Diseases
• The upcoming epidemic: Chronic Diseases
• The unnecessary epidemic: Injuries, violence and
environmental threats
• Disparities in health
• Health systems
Fundamentals of global health
Course Introduction

23. Global burden of infectious*
disease
• 9 519 000 of total global deaths (16.2%)
• 19.8% of global DALY’s
• 4 849 000 = deaths in Africa
• 2 674 000 = deaths in Asia in LMIC
Infectious/parasitic disease, WHO 2004
Fundamentals of global health
Course Introduction

24. Infectious diseases – the unfinished agenda
• HIV/AIDS
– 33.4 million HIV+
people
worldwide
– 22.4 million in
Africa
– 2 million deaths
Fundamentals of global health
Course Introduction
MDG Report 201,0, WHO

25. Infectious diseases – the unfinished
agenda
• TB
– Prevalence worldwide 11 million cases
– In 2008: 9.4 million new cases diagnosed
– 1.8 million deaths in 2008, 50% in HIV+
– Emerging drug resistance
• Malaria
– Worldwide 243 million cases
– 863000 deaths of which 89% in Africa
– Emerging drug resistance
• Respiratory and Diarrheal Diseases
• Emerging Infections
Fundamentals of global health
Course Introduction
MDG Report 2010, WHO

26. The coming epidemic of chronic
disease: the demographic
transition
Fundamentals of global health
Course Introduction
IBRD, World Bank 2000

27. Proportion of population aged 60 years and older:
world and developmental regions 1950-2050
Fundamentals of global health
Course Introduction
UN, World Population Aging, 2009

28. Population change (2005 equals 100)
Population change
250
Least developed
200
Less
developed
150
100
More developed
50
1950
60
70
80
90
2000
10
20
30
40
2050
Years
(Adapted from “World Population Prospects: The 2004 Revision”, Population Newsletter, UN Population Division, June, 2005
Fundamentals of global health
http://www.un.org/esa/population/publications/popnews/Newsltr_No_79.pdf)
Course Introduction
Juliuscenter.nl

29. The coming epidemic of chronic disease
The epidemiologic transition
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Obesity and Diabetes
Cardiovascular Disease and Stroke
Cancer
Neuro-psychatric disease and dementias
Fundamentals of global health
Course Introduction

30. Obesity Trends* Among U.S. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Fundamentals of global health
Course Introduction

31. Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Fundamentals of global health
Course Introduction

32. Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Fundamentals of global health
Course Introduction

33. Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Fundamentals of global health
Course Introduction
≥20

34. Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
Fundamentals of global health
Course Introduction
25%–29%
≥30%

35. Obesity Trends* Among U.S. Adults
BRFSS, 2010
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
Fundamentals of global health
Course Introduction
25%–29%
≥30%

36. Type 2 diabetes: The coming co-epidemic
• 366 million cases in 2011 (8.3% prevalence)
• 4.6 million deaths in 2011
• 465 US$ health care expenditure
• 566 million cases expected in 2030
Fundamentals of global health
Course Introduction

37. Fundamentals of global health
Course Introduction

38. Global impact of cardiovascular
disease
• Non-communicable disease contribute 60 % of deaths and
43 % of the global burden of disease. Already 79% of
these NCDs are occurring in developing countries.
• By 2020 these will account for 73% deaths and 60% of the
disease burden.
• Half of the deaths are attributable to cardiovascular
diseases.
• There are more CVD deaths in India or China than in all
developed countries added together.
Fundamentals of global health
Course Introduction
Juliuscenter.nl

39. Cancer burden in developed
and developing countries - Men
Fundamentals of global health
Course Introduction

40. Cancer burden in developed
and developing countries - Women
Fundamentals of global health
Course Introduction

41. What are the main reasons for
increasing rates of NCD’s
globally?
Fundamentals of global health
Course Introduction

42. Increase in NCD risk factors
The major modifiable risk factors for cardiovascular disease are
known, and their impact is similar in most regions of the world
• Tobacco Smoking
• Unhealthy diet
• Physical inactivity
• Alcohol consumption
Fundamentals of global health
Course Introduction

43. What are the main distal drivers
of a changing risk factor profile?
Underlying socioeconomic, cultural,
political and environmental determinants
• Globalization
• Urbanization
• Poverty
Fundamentals of global health
Course Introduction

44. Global burden of mental illness
DALY’s 13.1%; Deaths 2.1% (mental Illness)
Fundamentals of global health
Course Introduction
WHO, 2001

45. Community-based treatment of
depression, psychosis and epilepsy
• Depression, bipolar disorder and schizophrenia represent
13% of the global disease burden
– Approx. 20% can be treated by drugs in primary care
settings
– Costs per year of life saved is affordable in all middleincome and some low-income countries
Fundamentals of global health
Course Introduction

46. The unnecessary epidemic: Injuries
• Most rapidly rising
burden in
developing
countries
• > 3000 killed/d
• > 130 000
injured/d
WHO, Global Status Report on Road Safety, 2009
Fundamentals of global health
Course Introduction

47. Global health disparities
Life expectancy
• Malawi 47 years
• Afghanistan 48 years
• Sierra Leone 49 years
• Switzerland 82 year
• Singapore 82 years
• Japan 83 years
World Health Statistics 2012
Fundamentals of global health
Course Introduction

48. Health systems
• High priority of Developing Country Ministers of Health
– Workforce
• Capacity: training, technical
and managerial
• ‘Brain drain’
– Institutions – linkages/partnerships
– Sustainable drug acquisition and
delivery
– Financing and resource allocation
– Equitable distribution of services
– Need for ‘Implementation Research’ and Up-Scaling
Fundamentals of global health
Course Introduction

49. The Challenge
• The challenge of global health is to find ways to help the
other six billion people to live longer, healthier lives.
Fundamentals of global health
Course Introduction

50. Further Readings
• Koplan JP et al. Towards a common definition of global health.
Lancet 2009; 373:1993-5.
• Beaglehole R & Bonita R: What is global health?
• Global Health Action 2010 – DOI:10.3402/gha.v310.5142
Fundamentals of global health
Course Introduction