GHE finAL, GHE GHE, GHE Infectious Diseases, GHE Nutrition, GHE NGOs, #5 GHE Maternal Health, GHE #4 CUlture, #3: Economy, Regulations
what must we think about before we set up tents
do we have the proper amount of space. can we set up more tends -how to effectively command placement of tents to eliminate unnecessary traffic
what is a recent potential problem for the eradication of guinea worm
dogs are now shown to transmit guinea worm. problem for eradication efforts
why don't we track MOE
don't know how don't know we need to don't want to show they aren't effective
guidelines for using mid upper arm circumference for anthropomorphic testing
don't use for prevalence studies use as treatment facility admission screening since it is good at testing for kwashiorkor and mortality risk raise cutoff to incrase sensitivity use secondary test like wt/length for confirmation
how to stop guinea worm
dracunculitis drag uhn koo litis fitlter water though a folded cloth clean water
what is in F-75 and F-100
dried skimmed milk, sugar, cereal flour, veggie oil, mineral/vitamin mix,and water to mix *give F-75 first and F-100 later
life cycle of Guinea worm aka Dracunculitis
drink containimated crustations w/water flea larvae released into GI larvae grow and penetrate intestinal wall into body cavity migrates down into legs where they grow into worms and mate fertilized female worms can be 3ft long and mvoe through connective tissue produce a blister/boil that has a terrible burning sensation when they come up through teh skin people put feet into water to help the burn9ing sensation but this causes the worm to release 100Ks of eggs into that water.
dengue hemorrhagic fever
happens when you are infected w/dengue 2-3x all dengue s/s Plus plasma leakage (what is left is too thick so shock) and low plt so bleed profusely
Advanced EmOC
has OR capabilities all Basic EmOC plus c-section & blood transfusion
NGOs in a humananitarian emergency
have a comparative advantage b/c has current oeprations in teh area preceding the emergency. specific interest in teh area
benefits of NGOs
have major global procurement capacilities for relief supplies, technical/assets, vehicles,
how do you prepare a pt for an eye exam if suspect River Blindness
have them keep their head down for 2 mintues to move the worms to the front of the eye for better viewing
problem of the initial stages of a eventual pandemic
imaging the future shape of a pandemic from the first waves ahead is exceedinly difficult
exceptions to sustainabiliyt and capacity buildign
immediate disaster rsopnse, access, end hgoal is just to gain influence, critical operative objectives, purely political -health diplomacy, persistent engagement -COING
3 things needed to decrease neonatal tetnus
immunization of moms hygenic birth practices proper cord care (b/c contact w/open cuts l. can enter via umbilical cord particular if dirt/other things are fubbed onto it)
when did the UN take notice of the far reaching impact of HIV/AIDS
in 2000, the UN Security Council recognized that, if unchecked, the HIV/AIDS pandemic culd threaten world stability
TB & HIV/AIDS
in 2015, TB supreassed AIDS as a cause of death not b/c AIDS less lethal and AIDS more so but 20M imostly in Africa were on HIV suppressing Rx
globalization
in 20th century heightened importance of NGOS which have since developed to emphasize humanitarian issues, development, and
problem of Pashtunwali
in Afghanistan culture doesn't recognize the legitimacy of central Afghan state and rejects modern state institutions like court, police/formal laws 0its social code provides ethnic governance based on idenity/clan/individual faithy/honor and a complex set of reciprocal obligations that combo hospitality, revenge exchange
when do cholera s/s emerge
in as little as a few hoursl but generally 203 days
integration of medical engagemnt into COIN operations by SPecial Ops
in coin warfare, popular indigenous support of a lgegit gov is the ultimate goal while the restoration of basic survices is critical to mission success
what must you realize in the age of budget cuts
in the age of budget cuts, you can't do everything you want
how did life on earth start
in the ocean then we crawled on land
cause of resistance to ABX in TB
inadaque # of people treated for inadequate period of time w/inadequate ABX *managemnet problem b/c needs 6months of rx so if you don't have consisten taccess/affordability/accessibility, problematic leadign to multidrug resistant
composite GBD indiucators
includes DALY
stage 2 on the Demographic Transition Model
income/food/nutrition improves. crude death rate drops birth rate remains high population explodes (LIC/MIC are here today)
best way to increase GDP (wealth)
increaing per worker productivity including health
mil to mil reasons for DOD GHE
increase expeditoaryu capability support peacekeeping counter CBRNE capability mil support to isaster support geographic combat commander
only real way to increase economic growth
increase the amoutn of work each person does (incfrease time spent working/increase per worker productivity) incfrease number wor workers increase prices of goods sold overseas tempoary deficcity spending
Options to increase GDP (wealth)
increase work each person does (hours or productivity per worker) increase number of workers increase price of goods overseas deficit spending (contributes to GDP but it is on credit)
consideration when you increase the number of workers including immigration in an attempt to boost GDP
increasing number of workers including immigration boosts GDP but not necessarily per capita GDP
emic
indider view
Social Contract Theory
individuals have agrteed to come together and cede some of their individual rights so others would cede theiree in exchange in things from the state (polical order, settling disputes, security....)
Unintended consequences of GHE
-Trinidad & Tobago thought the hospital ship visit was patronizing -Mercy post Hurricane Katrina led local docs to threaten to leave b/c took their patients who would give them Medicare reimbursemebt
results of negative GDP
-affects the Development Web greatly -Great depresson -great recession of 2008 -health can deteriorate greatly during periods of low GDP especially for marginalized populations
impact of Myanmar replacing its junta government with a reformist more democratic government in 2011
-as a direct result of hte change, CHina pulled out its foreign direct investment in the country which reduced aggregate demand . **$12B ($3B per yr from 2008-2011) decreased to $400M per year -reduction in Chinese in estmentg in Myanmar could hurt myanmar's economy in unexpected ways. greater foreign investment on needed myanmar party on the nation's under eloped and inadequate infracture that is acting as obstacle to industralization
suffix of rx that are antiparasitics/helmiths
-azole
Problems of per-capita GDP
-doesn't account for inequality within a country -does not account for artificality in aggregate demand -doesn't consider the sustainability of resources used to produce that income -ignores the damage done to the enviornment in pursuit of increased production
best ways to increase per worker productivity
-educate the workforce to improve skills -better tools/labs/factories -\foreign investiment increases capital stock -invest in infrastructure like roads/bridges -trade agreements for comparative advantage -improve health of workforce
efforts to vaccinate against smallpox in US
1926: a group of health officials visited Georgetown, Deleware to vaccinate the people. a retired army LT and City councilman led an armed mob out successful to prevent the vaccination attempt
2B world population
1927 (123 years after the world hit 1B)
humanitarian programs used as a ruse
CIA used a vaccination program to gather intelligence and conduct asssassinations how we got Bin Laden " Vaccination Ruse use in Bin laden to get DNA from family at his comound
COCOM
COmbatant COmmand DOD has 11 each with a geographic or functional mission african, centra, cyver, european, ind0-pacific, northern, southern, space, special ops, strategic, transportation
what did a sitting VP say about tobocco
VP Dan Quayle said "tobocco expodrts should be expanded aggressively b/c american are smoking less" said when he was a sitting VP
today's smallpox vaccination
Vaccinia: not cowpox or smallpox
how does the CDC resond to cholera outbreaks
WASH - water, sanitation, hygeine
secretariat of GOARN
WHO
what certifies that a country is eradiated frmo an infectious disease
WHO
what is the ultimate body that certifies a country/world eradicated from infecious diseases
WHO *for a disease to be considered eradicated, every ountry msut be certified even if transmission never took place there
what organizations are working on the Global Polio Eradication Initiative
WHO UNICEF Rotary INternational CDC
what happened to International Health Regulations in 1951
WHO established in 1948 Intermediate REgime started difference was that treaties were replaced w/ WHO regulations. opt out rather than opt in
result of 2003 SARS
WHO member states adopted the revised 2005 Internal Health REgulaatiosn after almsot a decade of debate on teh most appropirate tiechnical and legal framework for confonting wmwerging/reemerging diseases
GHE budget per person per year as recommended by WHO
WHO recomments $35-50 per person per year from lifesaving services *64 WHO members fail to meet this minimum threshold **30 states are only able to spend $20 per person per year
what does WHO say about failing the project to eradicate polio
WHO says "the risk fo failure to finish global polio eradication constitutes a pragmatic emergency of global proportions for public health. failure would not only lead to major resurgence of the disease w/thoughds of kids crippled for life or killed per year but would also be seen as the most expensive public health failure in history. it would have a disasterous effect on overall global immunizations. efforts and primary healthcare by seriously undermining their credibility with donors and stakeholders
human rights are an evolutionary adaptation
adoptation facilitates and catalizes development lack of human rights hinders . at some points in hx, deliberately violating human rights b/c believes it promotes deve.lopment
our role in GHE
advisde the community on things theyve identified that they wnat to accomplish so we help them remove obstacles and facilitare what they want and how they want their country to develop
Neglected Tropical Diseses
affect LIC developing only not profitable market to incentivize research to develop cures/treatmetns lack of political will to fix the problem
MM rate
affected by the fertility level of the population
how does cholera affect people
affects everyone different. some have mild, some more severe
what was the USA doing at the same time of the Nuremberg Trials
after WW2, at the exact time the germans were being tried at Nuremberg, US doctors were intentionally infecting 1500 Guatamalan soldiers, prosittutes, mental patients, and priosoners with syphilis/STD for experienments
intermediate regime of INternational Health REgulations
after then 100yrs of hte classical period (failed) 1951-1994 global treateies new global treatties under HWO rapidly i new opt in/oput otu
nominal GDP
assessment of economic production in an economy but includes the current price of goods/services in its calculation **market value of goods/servies produced in an economy unadjusted for inflatijon
Age-weighing of DALY
attempt to make more representative more represent how people themselves view the disease. Elderly person death much less of a tragedy b/c not contributing to community & young can't contribute to the community either. so childhood/middle age contributes more to a community so their loss is greater. Loss of one healthy life at 22yo is greater b/c the age-weighing application to the DALY was greater but super old did not have an impact and would cause 1/2 of a daly
principles of cultural compliance
attempt to understand emic. engage w/host nation cultural leaders, design all programs accordingly
what does low/middle/high income country mean
average standard of living in the country per capita GDP
important point to remember when you want to do a GHE project in a low income country
avoid starting a GHE project in a low income country b/c you sense that they need this/that b/c you think they need that and tyhen after you leave, you wonder why they wern't willing to keep it going -we need to have a concept of their GDP and what they are willing to do -may need an endowment to ensure continuation -often, even in the military, we don't look back even after when we are done with a GHE project -consider what the country can reasonably susting
military can never be considered a humanitarian ser i e
b/ it cannot be impartial, independent, neutral. so don't pretentd to be something we're not. so when leaders say we do humanitarian work, they aren't always technically correct. GHE is doing disaster relief DOD operatiosn support huma itarian operations but our actions in and fo themselves dont' met the core principles so DOD/USAID provides humanitarian assistance but we do FOREIGN HUMANITARIAN ASSISTANCE
why is knowing the total fertility rate of a region important?
b/c high total fertility rates means that woman are becoming pregnant more frequently so at a greater risk for maternal death
why do we use the term global health today
b/c international health is patrionizing us versus them does not take into account how health needs over there affect us here
why is the definition of "live birth" important?
b/c not all countries apply the definition in the same way. variable application -USA probably isn't #30s in infant mortality...
real reason maternal deaths are decreasinhg
b/c of development. women's rights, access to , targeting quality interventions to vulnerable populations
why is the calculation of MMR imperfect
b/c of the diffiuclties of collecting certain types of data
why is guinea worm considered a disease of poverty
b/c of the disability is causes for weeks. also it comes out during planting/harvest season
why is the number of pregnant women not included in the calculation of MMR maternal mortality ratio
b/c that is diffiuclt to calculate in the developing world
why didn't debt spiraling happen in the USA during the 2008 recession
b/c the rest of the world believed so strongly in the US that interest rates didn't increase despite massi ve borrowing **developING countries don't have that luxury
why didn't people love Ben Franklin's lightening rod?
b/c they thought the strikes were causing beuildign fires were selected by god for burning. churches often the tallest buildign 9ni teh town
why does vitamin A cause night blindness
b/c vitmain A is a critical component of rhodopsin which is in the retina that helps w/night vision
babies protection if mom is vaccinated w/tetnus
baby gets several months of coverate
when would you suspect neonatal tetnus
baby has an arch back, spasms, respiratory arrest/asphyxiation
characteristics of cholera
bacterial infection profuse water diarrhea "rice water stool" & dehydration hypovolemic shock
positive deviance
based on the observation that in every community there are certain individuals/groups whose uncommon behaviors & strategies enables them to find better solutions to problems than their peers while having access tot he same resources and facing similiar or worse challenges. an approach that is asset based, problem-solving, and community-driven approach that enabvles the community tio discover these succcessful behaviors and strategies and develop a plan of action to promote their adaption by all involved
UN CLuster System
basic conept - disaster reponders are divided into 11 differnet functional gruops (clusters) each led by a differnt org (WHO -health...) created b/c it was found in the 90s that responses wans't coordinated (camp management, recovery, edu, protection, nutr, logistics,, water/sanitation/hygeine, communication) each cluster is under a lead UN org NGO's fall under the clusters
how do we divide historical population policy
before and after 1994
when are you contagious from measles
before and after the rash appears Koplik spots are an early warning sign
important thing to remember about teaching soldiers cultural competence
behavioral guideliens do not assist soldiers in de eloping the cirtiical thinking skills needed to understand how culture might inflence an operation *too focused on ettiquete detracts from the mission
what does someone w/kwashiorkor look like
belly protuding, blondish hair. eats but low protein foods like sugar. flag sign in hair shows time of low protein like tree rings
how do you get guinea worm
crippling and very painful parasite when you drink water contaiminated w/water fleas that have the parasitic worm. the worm can grow to 3ft in you and emerge 10-14 months later
CBR
crude birth rate
other cultures aren't better or worse than ours. they are just different
cucltural relativism
persistnent engagement
describes the importance of showign face over and over against -term first used by General Mattis during his lectures on counterinsurgency =
sustainability
design programs so their impact endures beyond the end of the project
India's national shame
despite GDP growth, the Prime Minister of INdia was the one who said malnutritoin was the country's national shame -despite the Indian national school lunch progrtam
a factors that affects something else
determinent
growth of developed versy developing countries
developED coutries grow at 1-3% per years. developing grow at faster rates b/c have the potential to grow faster due to more potential to adapt best practices/techniques that have already been adopted in developed countries
how to eradicate tania solium aka neurocystircoisis
development
development cannot effectively take place...
development cannot effectively take place w/o the security that armed force provides and security can't occur until the locals view promise tfo develoopment as an alternative to war
how is deveopment an imperative
development is a strategic, economic, and moral imperative
Bush's 2002 National Security Strategy
development, diplomacy, defense. includign all of the world's poor than expanding circle of devleopment and opportiunioty is a moreal imperative and one of the top priorities of US international policey
combat cholera
development. sanitation. bacteria spread via fecal oral route probably not a good candidate to eradicate b;c multiple animal reservoirs
Double Burden of Disease
develping world is now experiencing both type 1 and type 2
rx for ascaris lumbercoides
deworming rx but need it every 6 months ultimate solution is development - clean water, soap, fertilizer not night soil night soil -poop overnight is used as fertilizer
main s/s of enteric infections
diarrhea, anemia, bowel obstruction
treatment for malnutrition
differnet for moderate versuse severe
why is it accurate calculation of MMR easy
difficult except in countries w/good data collection so MMR is not suitedable for short-term projections aimed at improproving maternal healtg in countries with poor data keeping
Pros/cons of capacity building beyond the end of the project
direct medical care does not build capacity Direct care- immediate benefit, photo op, minimal plan time, mission can be as short as you want, can push whatever resources you have, persistent engagtement Cons= doesn't build capacity of the nation to provide for itself, little/no long term benefit, little/ no evidence that MEDRETE actually achieves strategical objectives, increases hostility to USG/military, can delegitimize the HN government by showing they cannot provide for their own people
the selectivity principle
directs US assistance to invest scare resources to the US based on 3 principles: humanitarian need, foreign policy interests of the US, commitment of a country/leadersip to reform
principle "resutls'
directs resources to achieve clearly defined, measurable, and strategically focused objectives
DART
disaster assistance response teams
gateway drug into global health
disaster medicine is a gateway drug to global helath. hear about a disaster. leads into learning more about global helath
mil to civ realsons for GHE
disaster prepare/response disease surveillance/prevetion helath releated engineering projects like water/sanitation/vector control clinic construction/equipping
disaster response as a gateway drug
disaster response is a "gateway drug" to Global health b/c disasters draw a lot of attention oto health disparities and that's how many are hooked
Dahlem Workshop
discussed the possibility of public health interventions in dealing w/infectious disease *control, elimination of disease, elimination of infectiouns, eradication, extinction
disease pre 1851
diseases spread from country to country and countreis took individual action to limit exposure like quarantine at sea (but quarantine at sea was cocordinated and they didn't know best ractices so the time varied
ecomoci impact of HIV/AIDS
dissuades outsider investment since few companies are interested in buildign oerpations in a region where labor productive/costs are so dramatically affected by death and disease
GHE
dister relief medcaps embedded training teams SME exchanges
justified legitimacy of kings
divine rights of kings. divine rights are from god. that's why kinds are so close to the church
International Bank for Reconstruction and Development
division of the World Bank -lends to somewhat poor countries on a 12-15 year terms w/reasonable interest rates the reasonable interest rates are usually 1 point above what the Bank is able to borrow for itself
best way to achieve our miltiary objectives r/t GHE
do GHE the right way consider the 9 PRincioples of by Nastyios
INDEPENDENT
do not take sides in hostility e en in a political sense or engage in controversies of a political, racial, religious, or ideological nature
Q's to ask about NGOs
do they really help alleviate poverty do the locals think they help fulfil aims wasteful overstate too many
important if you implement a GHE project in a coutnry that is beyond the country's GDP to sustain
you may need an endowment to ensure continuation -can do something beyond the country's budget but you will need to find the money to sustain
nutritional deficiency that can cause diaper rash
zinc deficiency is a leading cause of diaper rash in develping countries
goal of USAID
it is a developmental agency not a global health agency but global health is a big part of what it does. leading role in development work but also is the parent organization of OFDA -office of foreign disaster assistance
problem of the oral polio vacicne
it is a live virus. 1 in 2 million causes does cause actual paralysis in teh pt and their household. -some outbreaks have happened this way
Is GHE (US military) humanitarian?
it is diffiuclt to claim the US military is a humanaritaian organization c we aren't impartial. we do have an agenda. our bottom line is security
Is health a right?
it is essentaial part of right to life cannnot be negotiated away as part of any societal contract must supers ecde culture when the two are in conflict must supewrscede developmental concerns must superscede any notion of state superiority right to health to the highest attainable standards
what is needed to close the loop on any diasese
it is hard to close the loop on any disease w/o cooperation from many different facets of soceity
5 misconceptiosn about neutrality per the Red Cross
it is naieve neutrality is a smokescreen passivity neutrality and just war neutrality an guil
why don't we need to send SME
it is often not an exchange of knowledge that individuals needs -the people are often capable practitionsers- instead, they have limited organizational capabiliyt, poor incentives, longstanding organization based on hierarchy and compliance, or government ministries based on patrongage
what shoudl yuo do before you ask a group of people to adopt a new habit
it is wise to ascertain the existing habits,, how these habits are linked to each other, what functions they have, and what they mean to those who practice them
buildign partnership/building partnership capacity
it's about buildign the capabilities of our partners and allies to rewspond to variosu contingencies areound the world so we don't hav eto
major s/s of River Blindness
itchy rash eye disease/vision loss nodules under the skin
s/s of river blindness
itchyrash nodules under skin eye diease to blindness
HIV antiretroviral therapy
jdoens't cure but highly suppresses viral replication within a person's body
how did Dengue spread around the world
jumped to humans 100-800yrs ago minor restrited geographically intil middle 20th centruy when cargo spread it 1st document in 1950s during PHillipean/Thialan edpidemics Caribbean/Latin America in 1981
we aren't always good at evaluationg results and someotimes take it personally b/c we "mean well"
just because results didn't come back with glowing reviews doesn't mean the people didn't do their best
relationship between money and ideas
just because you have the money doesn't mean it is a good idea
Bitot's spots
keritinization (hardening in the eye) if low in vitamin A
kidnapping by Boko Haram
kidnapped over 1K inlcuding 276 schoolgirls in CHibok, Nigeria. most freed but 100 had whereabouts uniknown
selective breeding in ancient Greece
kill babies if not strong. avoid pairing the weak and pair the best candidates together. even supported in ARistotle's writings
what does food calories really mean
kilocalories
cause of the disease on the first epidsode of HOuse
kindergarten teacher ate undercooked pork got Taenia Solium (tan ee ah sol ee um) a tapeworm. seizures were form that aka neurocystircerosis neuro sis ah cer coisis
Red Cross in teh 1940s
knew about the HOlicast
protein defiency
kwashiorkor
training traditional birth attendents
lack of evidence to show observable differences in maternal death. not supported benefit. many single interventions are available but none decfrease rate of maternal mortality in a population
India's national school luch program
largest in the world "Right to Food" campaign was supported by their courts -recognized the right to food but malnutrition is still a problem.
highest risk for HIV
male gay sexually active, IV rx users, prisobners/closed settinhs, transgender, sex workers
overarching umbrella of nutritional problems
malnourishment
cognition and malnutrtion
malnutrition can cause irreversible cognitnition
problem of reporting maternal deaths
many developing countries do not make it to the hospita so their death is not reported
difference between marasmus and kwasiorkor
marasmus = energy deficiency = thin kwarhiorkor = protein deficient = edema
subdivisions of wasting
marasmus, kwashiorkor
energy deficiency disease
marasmus.
MMR
maternal Mortality Ratio #maternal deaths /#live births x100K NOT number of moms who are pregnant the ratio = # of maternal deaths per 100K live births
IDC 10 definition of maternal death
maternal death under 42 days based on direct . pregnancy related death pregnanyc to 42 days regardless of cause. late maternal death is 42 days -1yr post
differences between MMR(ratio) & MMRate
maternal mortality r____ MMRate : number of maternal deaths in a given period per 100K women of CHILDBEARING AGE MMR: number of maternal deaths during a given period of time per 100K live births during the same time period
MMR
maternal mortality ratio NOT MM rate!
# maternal deaths / # live births x 100K
maternal mortality ratio (MMR)
funding of NGOS
may be totally or partially funded by a government but maintains its nongov status only as long as it excludes gov membershiop
"deaths during pregnancy, childbirth, or the pueperium"
meanst he same thing as pregnancy related death but supposedly clearer. from start of pregnancy to 42 days post
Koplik spots are associated w/
measles
rash that starts on the head then moves down
measles
Koplik spots
measles inside cheek by the 2-3rd molars can appear up to 3 days piro to the rash
disease that can be made worse by a vitamin deficinecyt
measles & vitamin A
how does the measles rash develop
measles rash starts on the head then moves donw
MOE
measure of effectivness
Gini Coefficient
measure of inequality within a population
Gini coefficient
measure of the distribution of income across a pepoulation -the coefficient ranges from 0 (representing perfect equality) and 1 (perfect inequality)
use of hte Gini coeffient
measurement of income across a population 0 = perfect equality 1 = perfect inequality
how to understand the Gini coefficient
measurement of inequality within a population - the greater the Lorenz curve bends towards the right angle, the greater then inequality
purchasing power parity
measurement of prices in different countries that uses the prices of specific goods to compare the absolute purchasing power of the country's currencies
MEDCAP
medical civic action program
MEDRETE
medical readiness training exercise
MSO
medical stability operation
teritary prevention
medical treatments of those already infected
where does the IMF get its money
members pay annual subscription feeds tot he fund -any member can borrow from the fund when needed to help avoid financial crisis
International Monetary Fund
members pay subscription tees any member can borrow money at any time when needed will likely be mandated to change economics within their country (e.g devalue their money, restructure debt/spending, reduce tariffs...)
1948 Dec of Human Righhts
men/woman can marry and form a family w/o race/.nationality constraints, marriage must be entered freely by both parties with full consent, family is a fundamental unit of society and is entitled to protection by society and state
Jimmy Carter and president of S. Africa
met to convince him to allow free HIV treatments into the country. 2003. Carter spoke to a newspaper "I almost punched Mbeki: Former US PResident Jimmy Carter" . Bill Gates also went to try to get Mbeki to change his mind **showed how imprtant it is to get senior leadership 9involved
relationship between GDP and micronutrient deficiencies
micronutrient deficiencies along are estimated to cost some countries 5% of GDP
anthropomorphic measurement for Kwashiorkor
middle upper arm circumference -b/c the edema in Kwashiorkor artifically elevates weight. the edema is not present in the arms and the arms are significantly skinny
test to identify Kwashiorkor & its severity
middle upper arm circumference b/c the edema is not present in the arms. correlates to martality
Stability Operations
mili/civilian activitiers whose objectives are to establish or help maintain order. almost always medical stability are part of hte overall stability operational strategy in the region
MOOTW
military oeprations other than war
to further blur lines of humanitarian and military work
military personnel sometimes use humanitatian activity as a cover for military ops like wearing civilian clothes or driving disguised cars
health and security link
military says "Health is so closely tied to security that I believe each combatant command shoudl have GHE in thgeiur security plans. GHE enhances relationshipos w/countries, enhances readiness from a military standpoint, and shows that collaboration and strong partnerships caon occur between two nations w/o the need for war ***yes they are linked
relationship between military services & combatant commands
military services train for missions by the combatant commands
Generational Ratio
minimum energy = 2100kcal protein = 10-12% of total energy fat = 17% of total energy adjustments -100kcal extra for ever 5 degrees less than 20C -moderate activity needs 140kcal more -high activity needs 350kcal more
unintended pregnancies
mistimed - want more kids but not now unwanted -no more kids desired
vitamin/mineral regimen for trateing severe malnourishment
miultivitamin folic acid zinc copper vitamin A **WAIT UNTIL WEEK 1=2 BEFORE STARTING FE
how to gauge moderate versus severe malnourishment
moderate = 2 standard deviations severe= +3 standard deviations
moderate versus severe nutritional deficiency based on standard deviations
moderate = 2-standard deviations severe = greater tyhan 3 standard deviations
benefits and drawbacks of modern technology in terms of obsetric deaths
modern tech allows woman to survive initial 42 days but die of obsetric causes later. don't count as traditional deaths under current system of data so we use the term "late maternal death" to cover death 42 days-1yr psot
what often precedes preterm birth in developing countries
mom infectious diseases also a risk factor for congential issues
International COmmittee of the Red Cross
monitors compliance w/Geneva Convention Battlefield care supervise POW treatmetn missing persons in armed conflicts organize protection of civilians arbitrate between warring parties
death of aid workers
more aid workers were killed in the Syrian conflict than UN Peaekeepers in last 2 decades, it has been more deadly for humanitarian workers most dead were indigenous personnel that were trained aid projects are closed or suspended trained doubled every year S A RESULT of inseueity or danger to staff ***can't follow the humanitarian principles if there is risk of danger or insecurity to staff
how does the UN coordinate aid
more than 95% of UN aid is oordinated by UN via NGOS (and 95% of that is provided by only ~35 major US/EUropean org)
greatest risk for malaria
mosquiots bite at night
Aedes egypti
mosquito responsible for Dengue
Anopholes
mosquito responsible for malaria
how do NGO's build capacity
most build capacity by using local staff
experience of most people w/cholera
most people have few-no s/s and only 5-10% have it severe neough to require hospital care
Total Fertility Rate
number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance w/the curent age-specific fertility rates
OGAC
office of hte global AIDS C run by D of S
secrtariat
office of officials within an organization taht is responsible for administration like record keepign
Office fo Foreighn Disaster Assistance
office within USAID leads/coordinates USG's reponse to coverseas disasters often sends a DART -disaster action response team mainains stokpiles of emergency supplis in warehouses worldwide maresponsible for lead/coordination US gov response to oversreas disasters mandate-to save lives, alleviate humnabn suffering, similair in intent to FEMA but their chain of command is USAID?State Department
problem of success
often leads to complacency
lack of knowledge/resources/capacity/health sector
often people know what they are lack ing just don't have it. so SME are naieve and condensending. - probably not what they need
how do we often refer to global health security
often referrs to any preventingn infectoiu diseases elsewhere from harming US and the rest of hte world
eyes in River Blindness
once the worms die, its biofilm protection is gone so teh WBC is able to invate leading to white spots on the eye at tgeh edge of the cornea. the whites over the eyes as the worms die leads to the blindness
aka river blindness
onchocerciasis
1 DALY =
one year of healthy life lost
water development in Haiti in 2008 - pre Haiti earthquake w/subsequent cholera outbreak
only 12% of Haiti's population had access to piped treated water. so even prior to earthquake, Haiti was at risk for diseases
Problem w/the INtermediate Regime of INternational Health Regulations
only focused on 3-5 reportable diseases process was too slow to add new ones developed world became less concerned about the diseases that were actually on the list no great mechanicanism for enforcement people in international health actually started to become concerned about people in other countries but IHR wasn't geared for that
where are NGOs
operational in almost every worldwide emergency
OPORD
operational order
OPLAN
operational plan
oral versus IM polio vaccine
oral = 15cents, live vaccine, can infect others IM $203, not live
what can save a life if you have cholera
oral rehydration solution (ORS)
DOD contributions for diarrhea
oral rehydration thearpy develpment safet drinking water choliridination demonstrated typhoid carrier states via Reed-Vaughan-Skakesphere bodies first succesfsul treatment of typhoid fever w/ABX elimination fotyphoid fever as operationally sigificant therat to military forces demonstrated cholera pathogenicity is toxin-mediation not inflammatory eludication of the pathogenesis of shigella reserach into vaccines for shigella, campylbacter, traverl'ers diarrhea refinement in traveler's diarrhea treatmetn
vector
organism that transmits pathogen from reservoir to host
The Global Fund
organization formed to combat the big 3 infectious diseses. HIV, TB, Malaria
UN Cluster system
organizes all responding NGO's under 11 topical clusters so there can be organization at the scene of disasters
etic
outsider view
Foreign Humanitarian Assistance
overarching term for all missions the DOD does to primarily relieve suffering
oversimplistic view of how advances truly occur
oversimplistic view of how advances truly occur promises only to stunt the growth of researchers and research areas not capable of immediately producing great brekthroguhs
when did the US become a global leader
overtook UK in 1872
9 Principles of Reconstruction and Development
ownership capacity buildign sustainability selectivity assessment results partnership flexibility accountability
Nastios Iron Triad
ownership capacity building sustainability
first 3 of Nastios "9 PRinciples of Reconstrucftion and Development"
ownership capacity building sustainability
9 Principles of Reconstruction & Development
ownership capacity building sustainability selectivity assessment results partnership flexibility accountability
what tye of infection is guinea worm
parasite
what is the cause of River Blindness
parasite worm transmitted by repeated bites of blackflies lives near fast moving water
what ensures sustainability after you leave
partnerships
what are the best candidates for infectious disease eradication
pathogens only found in humans
reasons why the Internatioal Health Regulations of Classical Period failed
patwork of treaties were not standardized treaty process to slow for emerging diseases countries were opting in so not enforcable
why is it important to pay attention to GDP when you are involved in GHE projects
pay attention to GDP b/c it is the single most limiting factor for how we and developing countries can afford to spend on health
debt spiral
pay interest per month b/c of debt to finance debt. spending more from the government secctor higher interest rates b/c seen as a big credit risk credit debt leaves the aggregate demand (GDP) calculation b/c the money is eaving the country's economy so doesn't contribute to the consumer c consumption, government consumption, or investments portions of aggregate demand so governments must borrow more and interest rates increase
where was drug trafficking happening in Liberia
people had a us versus them (them = their own military) mentality. since the rural areas of LIberia had greater distrust in the military, that was where the drug traffikers preferred. emerging groups that represent militarnt terror
partner alliance w/Philippeans gov against Abu Sayyaf
peristent engagement showing face Abu Sayyaf did negative info ops aginst US MEDCAPS in the region. US gave the Philippeans all of the credit who could say "we are helping you. what has Abu Sayyaf every doen for you?
eradication of a disease
permanent reduction to zero cases worldwide. may still exist in labs
eradication
permanent reduction to zero worldwide incidences
describes the importance of showing face over and over againt
persistent engagement
repeatedly showing face
persistent engagement
how should you look at "policies" when you are doing GHE
policies are protocols/principles and not rules
how does the military view policies
policy is synomous w/rules
important thing to remember about polio compared to other infectious diseases
polio is not a disease of poverty
why haven't we been able to get polio eradicated
polio vaccination ploy to get DNA sample from the Bin Laden family. led to Pakistan outbreak which as seriously impacted ability to eradicate b/c Pakistan refused to allow the vaccination program to continue
link between malnutraiton and immunity
severe malnutritoin often masks the typical s/s of infecction b/c fever isn't apparent. so routinely on admission give broad spectrum ABX, measles vaccine, also give Flagyl fgor 7 days to hasten repair of intestinal mucosa and decreas the risk of oxidative damage and ysstemic infection from overgrowth of the anaerobic bacteria in the small intetine
modern tool of choice for sex selection
sex selected abortion is preferred nowadays to neglect
phase 0 operations
shaping
what is Phase 0
shaping
what operational plan phase happens at all times
shaping Shaping is Phase 0
Who in the military owns GHE
shared responsibility
how does GOARN work
shares its information w/WHO who ensures prompt international response then shares infomration back w/ the network. reorganizes teh unique role of NGIS and not just government. operational supprot teams responds to requests for assistance
Epideminological transition
shift from type 1 to type 2 diseases
state of nature
self interest dominates . solity, poor, nasty, brutish,. short compelte freedome
limitations of global burden of disease study
self reports of vital records bias no intra-country data
purpose of Humanitarian Civic Assistance
service personnel participant in HCA activities to create strategic, operationa, or tactical effects taht support combatant commander objectives. at the same time, reinforcing skills required for the operational readiness of hte personnel who paeticipated in teh HCA
why do service personnnel participate in HCA activities
service personnel participate in HCA activities to create strategic, operationa, or tactical effects that support combatant commander objectives in security cooperation or designated contingency plans while at the same time reinforcing skills required for operational readiness of the personnnel participateing in the HCA
difference between military "Services" & "Combatant Commands"
services - train & equip (army, navy, air force, marines) Combatant Commands - operations in AOR
SAM
severe acute nutriton
maladaptive cultural behaviors
shun people w/strasbismus. bad omen so even family buisiness shunned
problem of hte middle east culture
their civilization has missed every big modern trend-the religious REformation, democratization, feminism, and entrepreneuralism, and innovative capitalism
if a DOD mission is purely humanitarian
then it is ok to call it so but if it meets other primary objhecjtives like political/stabilitytraining, it shoudln't be called os
if you accept the idea that humans have inalienable rights
then you can rank the cultures and say ones are better than others
Demographic Transition Model
theoretical model that says we should "hurry up and imprve maternal and child survival before it is too late
sociocultural evolution
theorythat culture evolves in a similiar fashion . natural selection affects social as well as biological traits
BIG QUESTION: is what the US military does humanitarian?
there is an arguemnt taht we should not afix humanitarinan principles do our GHE
Middle East's stance on oil as the major part of their economy
they are now diversifying b/c the know the oild won't last forever
How do the GHSA and IHR compare/contrast?
they are related and fill each other's gaps. overlap
overlap between GHSA and IHR
they are related and fill each other's gaps. overlap overlap: surveillance, lab, preparedness, response, zoonotic diseases, human resources
how do mosquiots get malaria
they bite people w/malaria. typically bites at night presence of mosquitos is needed to mature the oocytes of malaria
recovery post Rwanda genocide
they had a success story of reconcilliation & economic recovery -
Cultural PRagmatists
understand the ideals of universalism, sensitivities of cultural relativism, and apply both to support the overall mission in the region
common features of successful health promotion programs
understand/incorporate emic ucltural values/beleifs/behaviors community based approach w/strong ommunity participation recognize gender issues peer group edu caiotn multilevel interventiosn approves
problem of discounting
undervalues pediatric patients relative to elders . Affected conditions that primarily affects pediatric patients thus ranking their likelihood of being prioritized resources based on DALYS (stopped discounting in 2013. good b/c now pediatrics aren't screwed by discounting affecting DALY resource allocation)
why should we care about undesired pregnancies
unintended pregancies -increase lifetime risk of maternal morbidity -associated w/poorer infant health outcomes -lower investment per child -unsafe abortion **contraceptives are very safe**
greatest risk factors for cholera outbreaks
unsafe drinking water poor sanitation poop hyggeine
problem of deficit spending
unsustainable 9increases prices of goods overseas is unstustainable but to the citizens, increasing prices of goods sold overseas is more palatable than worker longer hours
how many times can you get dengue fever in your life
up to 4 worse w/subequent infections. risk fof dengue hemorrhagic fever
when would you use PPP
use PPP to compare GDP between countries -take a basket of goods, see how much they would cost in each country. use that to compare GDP -countries w/lower costs of living appear better in GDP by PPP
how did John Snow figure out the well was responsible for the cholera outbeak
used a Voronoi diagragm
problem of missionary group NGOs
using a missionary group in a muslim coutnry can cause havoc and distrust if the host country doesn't understand that not all NGOs are oriented to promote religion. 1/2 of today's NGO's servi e muslims
activities under Humanitarian Civic Assistance
usual MEDRETE-like planned activities. planned in advance not disaster response
problem with high levels of inequality
usually associated w/widely disparate levels of opportunities (decreased opportu ity to hose at levels.) decreased means poor helath whi h slows economic growth trescends boundsries of socioeconomical classes
how long do River Blindness worms live
worms live for 15 years before dying a natural death we treat w/Ivermectin which is dog heartworm meds
important thing to remember about the 9 PRinciples for REconstruction & Development
written for USAID and not DOD. but are good guidelines but don't be surprised if DOD doesn't follow -DOD doesn't do Global health according tto the princples of global ehalth. we do health/medical foregin assets. both mil-mil and mil-civ have oth national trategic objective snad mil end states
gold standard testing for wasting
wt for height or BMI if adult
eyes fail to produce tears
xeroplthamia
YLD
years lived w/disability
YLL
years of life lost due to premature death compared to life expectancy of Japanese women
work by Walter Reed
yellow fever in CUba during SPanish-aMERICAN WAR
yellow fever in the 1800s
yellow fever under reasonably good control inthe 1800s but in 1878, trade from S. America brought yellow fever to the Missippi Valley area and b/c of the swamp-like conditions - bad -100K cases/20K dead (= six 9/11 events) and total populatino was 1/6 of today's popoulation so 20K dead was a huge hit so DC hosted the 5th INternational Sanitary COnference in 1881
Can one culture be better than another?
yes. one culture can better adhere to human rights and be more favorable to overall development
Can one culture be better than another?
yes. you can rank them based on adherence to human rights and favorability towards development
how much of your GDP can you spend?
you can't spend more than your country's GDP w/o going into debt
social contract by Hobbes
you give up some of your freedomes for hte benefit of everyone else in teh group
how much of a GDP can a LIC spend on health
3%
women in King SOlomon's life
300 wives 700 concubines
widow sex as a profitable business
African Cleansing Ritual
when is vector control a key strategy
malaria, dengue, yellow fever
infectious disease that causes cyclic fevers q48-72hr
malariag
what does human rights theory support
that one culture can be better than another
problem w/ the 9 Principles of Reconstruction & Development
DOD is not able to fulfill these ideals w/their objectives
protection implies...
action. doing something to stop the genocide/massacre/systemic rape
two types of undernourishment
acute (wasting) = marasmus/kwashiorkor chronic = stunting micronutrietn deficiencies
acute versus chronic macronutrient deficiency
acute = wasting chronic - stunting
China & GDP
CHina has the highest GDP and PPP -but becomes #78 in GDP per capita so it is actually a low middle income country with a lot of power
legal authority for Stability Operations
DODI 3000.05 "Military Support for Stability, Security, Transition, & Reconstruction Operations" SSTR
wasting
acute undernourishment of macronutrients
conditional cash transfer
address poverty by encouraging certain behaviors like enrollment or vaccination
lead agency in Foreign Humanitarian Assistance
Host Nation -DOD is not the lead federal agent LFA is USAID or Dept of State
how do you instill ownership in a GHE project
Host Nation must "buy into" the project so much so that the community owns it
"Seven SIns of Humanitarian Medicine"
"
work by Nastios
"9 Principles of Reconstruction & Development"
paper that put global health on the map for policymakers we realized we don't do global health just to be nice/humanitarian- we do it to protect ourselves from threats abroad
"America's Vital Interest" IOM in 1997
Defense Security Cooperation Agency
"Disk-ah"
Marasmus is...
"Energy deficiency"
DOD Instruction DODI 2205.02
"Humanitarain & Civic Assistance Activities'
DOD 2205.02
"Humanitarian & Civic Assistance" legal authority for HCA
DoDD 3000.05
"Military Support for Stability, Security, Transition & Reconstruction Operations" SSTR operatiosn
how to tell the difference between the Red Cross derivatives
"Movement" = umbrella organization "Committee" = battlefield/POW/arbitration "Federation" = national societies
Pan American Health Organization
"Pa-HOE" a regional office of WHO founded by teh US after a realization in 1878 that it needed to engage in global health issues beyonds its borders to actively protect the homeland (b/c trade brought yellow fever from south america to the MIssippi valley swamp leading to 20K deaths and 100K sick)
aka India's Lunch Program
"Right to Food" campaign -corruption -NGO & school leaders stole food, substituted inferior ingredients, pesticides in the food
paper that causes powerful people to realize that global health not only puts the people at risk for threats abroad but also the world order can be disrupted if disease destabilizes a country's internal/external affairs & law enforecement
"The Global Infectious Disease Threat & Its Implications to the US" 1999
document that led to PEPFAR's creation
"The Next Wave of HIV/AIDS: Nigeria, Ethiopias, Russia, & China" 2002 by the National Intelligence Council Impact on the USG cannot be udnerstated. sounded the alarm bells to the destabilizing effect of HIV/AIDS not just in LIC/developing countries. realized developed countries/strategic partners would be affected
quote by President of Turkey Mustafa Ataturk
"We msut liberate our concepts of justice, our laws, and our legal institutions from the bonds which even thogh they are incompatible with teh needs of our current century, still hold a tight grip on us" -he is famous for modernizing Turkey
relationship between DOD & USAID
"a whole government response is meant to be limited in scope and duration" designed to supplement/complement the host nation's efforts. the host nation retains primary responsibility for providing that assistance
"Ownership"
"build on the leadership, participation, and commitment of a country and its people" -a country must drive tis wone de elopmental needs and priorities. teh role fo hte donor organization is to support/assist as the partners drive" -nutruign country ownershipo is a laborous process that emerges w/tgime and effort. (build credibility, trust, and consensus" -what the locals want accounts a great dealt b/c the community belongs to them and not the international organization -what the locals want counts a great deal b/c the commnity belongs to them and not the international organization -w/ownershi, investment in the community will defend, maintain, and expand the project well after the donros have left -if what is left behind does not belong to htem or make sense, or meet their nees or it will be abandoned
using polio eradication for tactical gain
"our ability to convince this improtant work has been severely undermined by the CIA's use of huma nitarian activity as a cover for intelligence gathering"
who retains primary responsibilities in Foreign Humanitarian Assistance
Host Nation retains primary responsibility
ISAF
International Security Assistance Force. NATO-led development and security mission in Afghanistan
largest internaltional health intitiative dedicated to a single disease
PEPFAR (HIV/AIDS)
PM of INdia
PM MOdi
top 5 causes of maternal death
PPH infection unsafe abortions eclampsia obstructed labor
what is often used to compare GDP between countries
PPP - purchasing power parity
what is the intention of Foreign Humanitarian Assistance
DOD activities are limited in scope/duration DOD partners w/USAID/Dep of State Host Nation retains primary respnsibility
quote from America's Vital Interests in Global Health
"the direct interes of hte US are best served when America acts decisively to promote health around teh world. the failure to engage in teh fight to anticipate/prevent/ameliorate global health problems would diminish America's stature om the realm of health and jeopardize our own health, economy, and national security
President of Ireland Mary Robinson perpsective of right to health
"the right to health does not mean the right to be healthy nor does it mean that goverments must put in place expensive health servi es for which they have no resources. does mean the gov/public authorities must put in place policies & action plans that lead to avialable & accessible healthcare for all in the shortest possible time. to ensure this ghappens is the challenge facing both the human rights community and public health professionals
2006 National Security Stategy
"the risks from public health challenges pandemics that knows no bounds to social order. we so great that traditonla public helath papproaches mahy be inadequate necessitating new strategies and responses. if left unaddressed, they can threaten national security
cardinal characteristic of Marasmus
"thinness" no potbelly
picture of someone w/Marasmus
"thinness" w/o potbelly skinny arms/legs/abdomen Old man face baggy pants buttocks hungry
factors affecting 3rd Delay in the 3 Delay Model
"time to receive adequate treatment" Quality of Care
priorities to address teh 3rd delay in the 3 delay model
"time to receive adequate treatment" upgrade EOC service training drugs equipment monitoring
quote from teh Quaddrennial Diplomacy and Development REview
"we invest in GH to strengthen fragile and failing states, to promtoe social and econoimical progress, to protect America's security, to use tools of public diplomacy, and an expression of our compassion
Why do we do GHE?
"we've been told to" - military personnel usually dont' need to be told. so the burden of "why" falls on those who tell us what to do -political pressure/global pressure - we like to tell our gov that we are helping -the SUA has a moral and strategic interst in promoting GH.when a kid dies of a preventable disease, it offensds our conscious. not always just a tactical or morl interest. public opining (COngress/president responds to this) does support military in these operatriosn but polls show that this level of support tends to be short lived (few months like 2-6m) which is conincidentially about as long as our military commits itself to these oepratiaotns. thus, military quick in/out coincides w/public intesrees -b/c we are required to under international treaties or if we are the occupying power -nation bhuilding/COIDn -DOD is often the only ones in the US gov who can field an away team when the stadium is racked w/violence. (rest of the departments has volunteers but we are bound by the UCMJ or G-series orders to go so were're the only ones able to be forced to go = example, in 2007, many State Dept couldn' t get many dipolomates to work in Ira2w/Afghanistan/MIddle east -political objectives -health diplomacy -training to train ourself -support the combatant commander's objectives -BP/BPC -security cooperation -stratregic communciations ***Ask what objectives are we trying to accomplish and achieve
quote in regards to the 5th International Sanitary Confrence
"when diseases threaten or show the potential to threaten national security, military capabilities, geopolitical or regional stability, national populations, economic power, and trade interests, foreign policy makers take notice.
RADM Raquel Bono's practical advice w/ regards to our DOD NGO relations
"when we come in, there's a concern by NGOS and other agences that given our personality as the military, we're going to come in and take over. that's not well perceived. In phase 0 operations, I had to be very keen to understand when I would be perceived as stepping on someone's toes b/c many of the countries we're engaged in already had people form USAID and CDC who had been there for many years. If we could not find ways to complement those efforts, then our presence and efforts were not welcome."
calculate Maternal Mortality ratio (MMR)
# maternal deaths / # live births x 100K
Maternal Mortality Ratio (MMR)
# maternal deaths per 100K live births
total fertility rate
# of kids that would be born to a woman if she lived to the end of her childbearing years and bore children in accordance with current age-specific fertility rates -lower in the DEVEOPED world.
denometer of maternal mortality ratio
# of live births NOT # of women pregnabnt
MMRate
# of maternal deaths per 100K women of reproductive age
denominator of MMRate
# of women of reproductive age
top countries by GDP alone
#1 USA at 18 trillion. so largest economy & military china, japan,, germany/france/uk/brazil/italy/russia/india
why is the maternal mortality ratio (MMR) calculated thus
#maternal deaths / # live births x 100K the denometer isn't # of pregnant women b/c it is hard to count the number of totral pregant woman and easer to count live births
HIC
$13K or more per capita GDP
GDP of USA
$18 trillion adds work of each USA citizen together USA #1 GDP so largest economy in teh world and also largest military
$ spent to combat a single TB epidemic in NYC in the 1990s
$1B spent in the 90s to combat a single ewpidemic of drug resistnt TB in NYC
USA GDP in 2019
$21.43 trillion
how much does WHO say a country should pay per person per year of GDP on health services?
$35 - 50 per person per yr 64 WHO members can't meet this threhold 30 can't meet $20 per person per yr
MIC
$4-13K per capita GDP
trite
(of a remark, opinion, or idea) overused and consequently of little importance. lacking originality and freshness
early 1900s NGOS
+100 NGOS recorded. women's suffrage, scientist rescue, refugee
everyone should spend/invest more in health
-how much can countries really afford to spend on health especially if developing? -outside projects wprking within a country needs to make sure the project is within the sustainable budheyt of that country
3 basic concepts to understand when implementing a GH project in a country
-how to measure the size of an economy -how to assess the capacity to spend more on health -how our actions affect developing country's economies
Keysian economics
-if someone is spending, it goes towards someones earning
ways to boost GDP
-increase the amount of work performed by each person (increase time spent working or increase per worker productivity) -increase number of workers (includes immigration) -increase the prices of goods sold overseas -deficit spending
facts about vitamin A deficiency
-leading cause of preventable blindness -impaires cell proliferation and differentiation -kernicterization (hardening) of epithelial cells like in the eye -0dry mucous membrane surfaces maldeveloped immune cells -Bitot's spots = kertinization (hardening in the eyes) -jmakes measles outbreaks worse so vitamin A is given in measles outbreaks
improve infant mortality to decrease total fertility rate
-less kids needed to ensure at least 1-2 survive to adult -less kids to replace self, farmily/seupport elders/continue bloodline -industralizaton decrease need for labor -urbanization increases cost of kids -child labor laws/edu standards -increase contraceptive -increase female literacy and employment
borrowing from IMF
-members pay annual subscription fees -any member can borrow from the fund when needed to help avoid financial crisis -sets conditions to borrow (e.g countries might have to restrucuture their speinding, allow their currency to devalue, decreawe tariffs...)
endowmnet
-quality/ability possessed or inherited by someone
2009 IOM's Report Updated recommendations for US gov and NGO actors
-scale up existing interventions to achieve significant health gains -generate/share knowledge to address problems prevalent in poor countries -invest in people, ,institutions, and capacity buildign w/global parties -icnrease USA's financial commtiment to GH -set examples of engaging in respectful partnershipos
politics of polio eradication
-spends billions per year to eradicate a disease that isn't a top 20 killer worldwide -a popular way to decide how to spend money/set priorities is to look at cost-benefit analysis (DALYS saved per $ spent). using cost benefit analysis, polio isnt' a priority as indicated by DALY per $ sdpent so it wouldn't be cited as a need. would be considered one of the most expensive GH initiatives in the world. some want to consider control versus eradication to free up money for other projects but we are close -Osama Bin Laden death made it worse
reasons we do GHE
-we're told to -political/publc/global pressure -required to under international law (treaties or Geneva Convention rule that says we must provide for basic needs if we are the occupying country -DOD often the only ones who can field an away team b/c we can't say no -training missions -building partnerships/building partner capacity -strategic communications -means to build developing countriesd
Primary/Secondary/Teritary Prevention
1- efforts to prevent new cases 2- rapid detection/education 3- treatments to prevent advancement of the disease in those already affected
Code of COnduct for ICRC in disasters
1. Humanitarian Imperative comes first 2. Aid is given regardless of race/creed/nationality of recipients and w/o adverse distinctions of any kind. Aid priorities are calculated on the basis of needs alone 3. aid will not be used to further a particular political or religious standpoint 4. we shall endeavor not to act as instruments of government foreign policy 5. we shall attempt to build disaster response on local capacities 7. ways shall be found to involve programme beneficiaries in teh management of relief aid 8. relief must strive to reduce further vulnerabilities to disaster as well as meeting basic needs 9. we hold ourselves accountable to both those we seek to assist and those from who we accept resources 10. in our information, publicity, and advertising activities, we shall recognize our disaster victims as dignified humans, not hopeless objects
3 aspects of global health security
1. achieve widespread acess to essential health services/protect from environmental/behavioral risks to global public health 2. systems and agreements to prevent cross border spread of communicable diseases 3. tools/threats to ameliorate the threat of bioweapons/bioterrorism
How do calculate GDP via expenditure approach (aggregate demand)
1. consumer consumption (everything the people in a country purchase) 2. government consumption (how much the government spends to contribute to GDP 3. investments (business purchases in order to produce goods that other countries buy 4. net exports (exports minus imports)
Why use the metric "pregnancy-related death"
1. counting "maternal death" requires much more sophisticated data collection methods 2. pregnancy is a measurably more dangerous time in a woman's life. (violence risk is statistically higher) so we need to capture that 3. to capture diseases/pre-existing conditions that would place a woman at risk for not having the extra impact of preexisting diseases on death (more likely to die of HIV/malaria/dengue if pregnant than not) so captures those who might not have died if they wern't pregnant at the time of the infection. Pregnancy has an aggravation effect on infectious diseases/malnutrition/pulmonary disorders...
3 reasons for collecting data on pregnancy-related deaith
1. counting maternal death requires more sophistic data collection methods. needs a verbal autopsy or certificate by attendinhg 2. pregnancy is a dangerous time for women 3. captures deaths that would inadvertently be written off as other forms of death. more risk of dying from any infectious disease if also pregnant so you can capture these deaths
steps to combat TB
1. cure pt the first time -no start/stop. r/t access/affordability 2. infection control 3. appropriate second line rx if first line fails (MDR or XXR-TB). problem if the clinic only has the first line abx
NYC attempt to vaccinate agaisnt smallpox
1901: NYC. police posited themself on roof/around apartments. health officials and police knocked on doors. the frighten/furious tenants ran into lighted areas. doctors vaccinated if no mark of vaccination was on their skin
5 thngs wrong with GDP from the GHE perspective
1. does not account for inequality within a country 2. ignores any/all damages done to the en iornment in persuit of increased production 3. doesn't consider sustainability of reosurces used to produce that income 4. doesn't account for artificial increase in aggregate demand 5. doens't account for defensive expenditures which don't increase well being
Treatment of Malnourishment
1. look to see if edema is/isn't presnent (Kwashiorkor or Marasmus 2. Wt for height.
Eradication strategy for smallpox
1. mass vaccination campaign 2. surveillance-containment & ring vaccination
3 ways to prevent neonatal tetnus
1. maternal immunization (protects newborns) 2. hygenic birth practices 3. cord care (no dirt to the site)
3 mistakes we made in Iraq per Brad's friend
1. not supporiting a peaceful transition post fall of USSR> we armed the mujahideen then left. charlie wilson's war 2. allied with the wrong people post 9/11. Taliban are bad so anyone who opposed them are good? yet we supported the NOrthern Alliance and the people actually thought they were worse and preferred Taliban Brad's friend, soemone who grew up in Iraw, thought that the lack of USA cultural awareness of IRaq was just as bad as the mistake as allying w/the wrong peopel
top 2 leading causes of blindness r/t infectious disease
1. trachoma 2. river blindness
ranking of national security interests
1. vital 2. important 3. peripheral
US Army War College's National Security Interests ranked
1. vital - interest that, if unfulfileld, will have immediate consequences for critical national security interests (e.g. WMD) 2. important - interests that, if unfuldilled, will result in damages that will eventually affect critical national interests 3. peripheral - interests that, if unfiulfiled, will result in damages that are unliekly to affect critical national interewsts
3 Q's
1. what is the difference between cult and culture 2. when are cultural concerns of a secondary improtance 3. can one culture be better than another
died of TB in 2018
1.5M died of TB in 2018 -25K had HIV
how many NGOs in USA
1.5million
% of the world population that has latent T B
1/4 of world population has it but not in a transmissionable stage
how much of the world population has ascaris lumbercoides
1/6 of world pop
Dengvaxia controversy
10% of 80K kids who didn't have Dengue fever developed severe disease from the vaccine
date when smallpox first appeared
10,000bc
how many infections of dengue infections/yr
100M 1/3 of world pouplation lives in infected regions
humanitarian efforts in Syria lead to deaths
130 doctors/50 RNs killed 15 physicains tortured to death in prision 12 doctors executed in field 87 field medics executed 57% of public hospitals demaged
Pope Innocent 8
1484. death penalty for birth control. so average woman had 6-7 kids. Black daeth in 1400s dropped world pop form 80M to 50M but pop boom in 1500
how much of GDP does USA spend on health
17%
how long after Jenner's work was smallpox eradicated
175 yrs
1B world population
1804
cholera outbreaks in Europe
1830 1847
infectious disease outbreak during Ca goldrush
1849ers had a cholera outbreak 15K of the first 30K died of cholera while trying to strike it rich brought to the indians for the first time the 1849 cholera outbreak killed 1/3 to 2/3 of all Cheyenne indians
key concepts of the Classical of International Health Regulations
1851 - 1951 report outbreaks of a limited number of diseaseas that were spreading and disrupting travel and trade
Classicical period of IHR
1851 - 1951 stop spread of disease minimize impact of disrupted trade and travel
concern of the classical regime of International Health Regulations
1851- 1951: fundamental concern was lessenign the budent of Europe/N. America trade created by national responts n those regions to the threat of the impoted of Asiatic diseses
problem of International Health regulations during the classical period
1851-1951 only 3-6 diseses discussed -no incentives to report -most countreis not required to report _no ability to monitor compliance -0it was about protecting W. EUorpe and N. AMerica from diseas3esfrom Asia/Africa - patchwiork of treateies that didn't achieve standariszation -each had different rules/regulations -reliance on treateies to get things done is too slow of a process
IHR over the years
1851-1951: "Classical period goal: stop spread of diseases and m9inimize interruption of trade and commercial travel b/c diseses were getting into crowded poor industralized hygiene cyties due to the INdustrail REvolution and spread to other countreis via trade. reporting was limited to less than n 6 diseases and was purely voluntary 1951-1995: INternmediate Period -WHO required member states to report outbreaks fi they had an oubreak of one of hte under 6 dieseases ont eh lsit. replaced individual treaties w/WHO 1995+- massive revision of IHR 2000- GOARN
goals fo the First INtiational Sanitary COnfrence
1851. to report outbraks of infectious diseases and maintain adequate public health capabilities point of disease/entrance/exit
started ICRC
1863 by Henruy Dunant
led to the 5th International Sanitary Confrence
1878 major outbreak of yellow fever spread from South America via trade to the Mississippi River valley -led to the 5th International Sanitary Conference as an example that the recognition of engagement in Global Health can help us protect ourselves. confecne to work with our trading partners to prevent disease from elsewhere from impacting us led to PAHO = Pan American health Organization
sterilization campaign in US
1929 -72: 7600 people in NOrth Carolina were sterilized by the state against their will. many were kids. done on the basis of recommendations by social workers who said they were from "unwholesome environments/poor school performance" CA sterilized 20K 32/50 states practiced eugenics and had sterilization programs so US does have a history of sterilization agaisnt will which gives rumors taht vaccines cause sterilization credit
Lubeck disaster
1929: 250 german infants got a TB vaccination that hd live bacteria 1/3 died, 1/3 very sick, 1/3 okay unscrateched
Tuskeegee experiment
1932-1972. 40 yrs of withholding effective treatment by conducting experiments on syphilis
Bretton Woods Agreement
1944 formed the IMF and World Bank purpose of hte conference: to establish post war international monetary and financial order
formation of IMF and World Bank
1944 BRetton Woods Agreement (at Mt Washington Hotel)
term NGO first used
1945 UN charter
yr WHO founded
1948
yr WHO was created
1948 world health assembly given authority to more sanitary/quarnatine reguiements and other procedures designed to prevent internationsl disease spread (via the WHO constitution)
yr of a mass vaccination campaign of smallpox
1953 but didn't work
3B world population
1960 (33 yrs after the world hit 2B
sureveillance-containment & ring vaccination
1960s-70s policy that ultimately rendered smallpox eradicated
act that created USAID
1961 Foreign Assistance Act
legal documents that describe Foreign Humanitarian Assistance
1961 Foreign Assistance Act of 1961 (created USAID) Title 22 USC Joint PUblication 3-29: Foreign Humanitarian Assistance
legal authority for Foreign Humanitarian Assistance
1961 Foreign Assistance Act. the same act that created USAID
creation fo USAID
1961 by Kennedy's executive order. combind 3 existing agencies
similiar to the World Bank
1966: Asian Development Bank in PHilippeans w/a similiar structure to the World Bank China created the Asian INfrastructure INvestmenbt Bank **Brad isn't clear on why Asia felt they needed their own bank since World Bank already existed. USA/W. Eurpose are also members of the Asian Deveopment Bank
CDC efforts to eliminate smallpox in INdia
1970s INdia: villagers ran and locked doors but CDC chases, broke down doors, and vaccinated. ethical concerns Jennings, BRuce: EThics and PUblic Health Model CUrriculum
4B world populatino
1974 (14 yrs after the world hit 3B
2 diseases eradicated by 2020
1980 = smallpox 2011= calttle plague (Rindenpest)
yearly cases of guinea worm (aka dracunculitis)
1980; 3.5millino in 20 countries (Africa/Asia) 2007: 10K 2013: 148 total cases 2014: 9 cases (Chad & Sudan - impressive to make progress b/c both countries had security/civil unrest issues) 2015: 22 cases 2019; 54. 49 linked to Chad. the rest in S Sudan, Angola
founding of Carter Center
1982: Jimmy, Rosalyn in a partnershipo w/Emory U resovle conflicts, advance democracy/human rights, economic opportunity, rpevent diseases, improve mental health
5B world population
1987 13 years after the world hit 4B
leads the eradication efforts to eradicate polio
1988 - GLobal Polio Eradication initiative -partnership of 4 organizations -WHO, UNICEF, Rotary INternational, CDC
yr the World Health Assemblty announce the intention to eradicate polio
1988 - the Gobal Polio Eradication INitiative was created
how many cases of malaria in 2013
198million case sof malaria 500K dead
rejection of hte UN Declaration of Human Rights
1990. 45 countries. Cario Declaration of Humabn RIghts -all rights and f... stipulated in tehis Declaration are subjected to Islam Sharia. women are gusarenteed equal dignity but not equality in other matters. everyone shall have the right to express his opinion ifreely in such as manner as long as they would not be contrary to the principels of Sharia. the islamic shariah is the only source of reference for the
task force's take on what diseases are potentially eradicable
1993: an INternational Task Force for Disease Eradication looked at 80 diseases and said 6 were potentially eridcatable
International Health Regulations today
1995-today -IHR massively revised 19980 instututions lout sid eof voernment like NOG and academic instuttjions came togewther to form GOARN
when did USAID start a global TB program
1998
quote from "The Global Infectious Disease Threat & Its Implications to the US"
1999 "infectious diseases are likely to slow socioeconomic development in the hardest hit developing & former communist countries and regions. This will challenge the democratic development and transtions and possibly contribute to humanitarian emergenceis and civil conflicts.
"The Global Infectious Disease Threat & Its Implications to the US"
1999. powerful people realized in a big way. clear case that inattention to global health not only puts the US at risk for diseases but also emergent threats can disrupt the whole world by deciminating entire countries and their militaries which destablizes both internal and external affairs including daily life of the people. Dominates law enforcement at all levesl so destabilizes the world
6B world population
1999. 12 years after the world hit 5B
potential for guinea worm eradication
2nd human disease in history to be eradicated form human efforts first parasite disease to be eradicated 1st disease to be eradicated w/o use of Rx or vaccination
"The Global Infectious DIsease Threat and its implications fo rht eUS"
1999. by the National Intelligence Estimates *entire regions can be destabilized if their military is hit w/infectious diseases -as well as international peacekeeeping effrots - if thgeir army is and recruitment pools are hit by HIV infection rates ranged 10-60% -aldso predicted ID to slow socioeconomical development in teh hearest hit developing and former communist regions. this will challenge the decmo cratic de velopment and transitions and possibly contribtue to humanitarian emergenceis and civil conflict
s/s of vitamin A defiencies
1st = night blindness scaly skin, dry eyes. prone to ulcers
factors affecting Delay 1 in the 3 Delay Model
1st Delay = time to decide to seek care -socioeconomical status woman's status ilness characteristics distance roads means of transportation maternal anemia quality of care
3 Delay Model
1st delay = time to decide to seek care 2nd delay = time to reach the medical facility 3rd delay = time to receive adequate treatment
how many died of smallpox in 1967 (10 yrs prior to last case in somalia)
2 million
s/s of smallpox
2 weeks of asymptomatic incubation flu=like/vomit, body aches flu-like stops then lesions appear on skin/mucous membranes contagious in respiratory secretions. leak a serous fluid and eventlly scab/crust over total rash duration was 6 weeks b/c the rash came in waves
how many NGOs in INdia
2-3 million
geographically most common place for HIV
2/3 in Africa
how many people had River Blindness (jOnchocerciasis) in teh 2017 Global Burden of Disease study
20.9M 14.6 had skin s/s, 1.15M had vision loss 99% live in Africa. 1% in Latin Maerica/Yemen
yr of the Indian National School lunch program
2001. provided a midday meal at the schools. "right to food" supported by the courts. was actually quite corrupt
"The NExt Wave of HIV/AIDS: Nigeria, Ethiopia, RUssiam, India, and CHina"
2002 sounded arm bells for senior leads about the destabilizing effect of HIV/AIDS not soleycontained withint he low income countreis and predicted over 10 years it would have a destabilizibg effe ct on larger stregetic countreis. -so not just contained/limited to LIC SSAQ but also would affect us and strategic allies the impact will vary substantially amount the 5 countreis b/c of differnces among thgem in the deveopment of hte disese, likely gov response, availabel resources, and demogratic profiles
yr of SARS
2002. SARS started as an atypical pneumonia in CHina. China disnty disclose tis emergency as a ID and a doctor who traveled between China and HOng Kong spread it -China wasn't required to isclose antying about this b/c the HIR in 202 were tool and only required reports of older diseases like yellow fever...SARS was not on the list and WHO dind't have any legal authority to require CHina to report this infoo
yr of SARS
2003
chrismas tsunami
2004 in Indian ocean
President's Malaria Initaitative
2005- present started 2 years post PEPFAR bed nets, spraying, treatment of pregnant, therapy
2005 IHR responsibilities on teh WHO/GH community and how well countries were able to do 7 years later
2005: IHR conferred new responsibilities on WHO/GH communiteis to share resources, information, and expenes to help nations prepare for and respond to health emergencies 7 yes later, countries were asked to report if they had met core capacities to implement IHR regulations. 80% had not includign many at an increased risk for infectious disease oubreaks and public health emergencies
renewing of PEPFAR
2008. increased budget x3 from initial $15B to $48B
Global Health Initiative
2009 post the 2009 IOM Report Updated Recommendations for USG/Non-governmental actors and used those recommendations to formulate the GHI
led to the creation of the Global Health Initiativer
2009 IOM Report Updated Recommendations for USG/Non-governmental actors
second disease human actions have been able to eradicate
2011 = cattle plague (Ridenpest) s
example of a security cooperation in Africa
2011 Horn of Africa pirates -too expensive for US alone so we partnered with nations in the region to secure the waters so more effective & financially responsible
Operation Tomadachi
2011 earthquake/tsunami/nuclear disaster
7B world population
2012.
African country famous for their recent stance against homosexuality
2014. Uganda did death penalty/life in prison for homosexuality even if comitted outside of uganda. could extradite back in. even punished media/comapny/NGO supporters. *remember, cultural relativists said no culture is better/worse, just different
Global Health Security Agenda
2014: 40 countries to enhance global capacities to prevent/detect/rapidly respond to infectious diseases to acheive measurable targets -to implement WHO's INternational Health Regulations
Guatamalan women and immigration
2014: Board of Immigration (agency in DOJ) said married women in Guatamala who could not escabe their abusive spouses are a party with a social group potentially deserving of refugee status b/c the risk to violence faces and limited govenrment portection
today's diagnostics for HIV
2014: CDC no longer recommends initial ELISA then doing Western Blot on positives. instead ELISA then conform iwth a HIV differentiation test
transition of development goals
2015: transition of MIllenial Development Goals replaced by sustainable development goals
year world population is projected to reach 8B
2026
# of women who die of preventable causes r/t childbrith
250K per year. 99% in development country risk of dying in childbirth in developing countries =
% of world population that gets malaria each yar
3%
study "Estimating the Lost Benefit of Antriretrovirals Durg use in SOuth Africa" - HIV/AIDS
330K lives lost b/c a feasible timely antiretroviral program was not implemented. 35K babies born w/HI/AIDS b/c no prophylaxis program implemented for pregnent women (00-05). Carter couldn't even get the rpesident to agree to give treatment to pregnant women only. almost had a fistfight
how many Hatians died of cholera by the first annviersary of the Haiti earthquake
3600 by the first anniversary
how many people livigbn w/aids in 2006
39.5M
yrs of hte TUskeegee experiment
40yrs. 1932-1972. syphilis
"White Paper of Foreiogn A"
5 core development Goals: promote transformational devleopemnt, strengthen fragil states, provide humanitarian releif in support o fUS geo strategic interests, mitigate global and transnational policy
global health enagement under Obama
5 months into his term, they took teh recommendations from the 2009 IOM Report Updated REcommendations for US gov and Nongov actors -took teh recommendations and started the US GLobal Health INitiatvie
risk of developing TB if latent infection
5-15%
example of how our GHE's in AFghanistan aren't humanitarian
50% of Afghan kids under 5 are chornically undermalnourished foreign assitance disproportiately gives providences where the concentraiton of the troops/fighing has been the heaviest. yet these regions are not where the kids most in need of nutrition are. thus, if this mission was purely humanitarian, the nutrition interviotinons would not happen there
legal charitable status in USA
501(c)(3)
2 major attempts to combat smallpox from 1950s onward
50s-60s: mass vaccinaton failed 60s-70s: "sueveillance containment strategy w/ring vaccination" (detect cases followed by isoation of infected indivals and intense vaccination of the local area
how many cases of Guinea Worm in 2019
54 human cases Angola -1, South Sudan -4, Cameroon-1 but probably acquired in Chad, Chad 48
how many newborns died of Neonatal Tetnus per year
58K babies in 2010 - 18 seats in a stadium so would fill 3 stadiums w/dead babies
recorded cases of polio in 1952
58K new recorded cases 3K dead 21K paralyzed
how many lives dsaved via TB dx/traetment betweewn 00-18
58M
Hammurabi's code
5th King of Babylon. 1750bc code civil, criminal, and commercial lawd didn't have the peopel to enforce it
puerperium
6 weeks post delivery when a woman's body goes back to prepregnancy
inclubation phase of polio
6-20 days
polio cases in USA alone in 1987
640K people living with sequale of paralytic polio in US alonw
world population in October 2020
7.8 billion
rehydration guidelins for severe acute malnourishment
70-100ml/kg in first 12 hours (teaspoons) rehydrate first. begin feeds within 3 hours or immediately if no severe dehydration/sepsis/hypothermia
% who go to bed hungery
796M mostly in devleoping countries
s/s of polio
95% are asymptomatic or so mild that the s/s aren't distinct -5% have flu-liek s/s indistinguishable from similar diseases (of that 5%, 20% geet neurological ss/ of aseptic meningitis. <1% get permanent flaccid paralysis0
s/s of polio
95% have mild or asymptomatic 5% have flu-like and later 20% of that 5% get neuro meningitis s/s which is 1-2% of total cases so less than 1% has falccid paralysis and died of respiratory muscle paralyssi
why isnt' River Blindness a big problem for travelers to the region
99% in Africa 1% in Latin America & YEmen b/c you need repeated bites from blackflies that live near fast moving water
where is the greatest burden of disease from River BLindness
99% of all cases are in Africa
Treatment of Severe Acute Malnourishmnt
=dehydrated & septic shock -treat w/ABX b/c malnourishment means they won't be able to get their body to mount s/s of infection -can't give regular foods b/c GI system can't handle it -ORS (oral rehydration salts like ReSoMal) or F-75 or F-100 -only IVF if circulatory collapse. otherwise IVF supplies used up and dont have the staff. you also need to stimulate the GI system
formula for Gini coefficient
A/ A+B
treatment of HIV
AZT. antiretrovirals, high quality barriers like condoms to reduce transmission, behavioral chanhes/education to decrease high risk sexual behaviors, ensure availability of appropriate health services
mosquito that causes dengue fever
Aedes egypti
spread of Dengue
Aedes egypti
mosquito that spread Zika
Aedes egypti also spreads dengue
where is Pashtunwali practiced
Afghanistan. social code that rejects core modern state institutions like police and law
2002 Nationals Secureity Strategy
Afmerica is now thereatned less by conquoring states than by failing ones
how did the news media report cholera in Haiti
Al Jazeera- filmed peacekeepsers in Haiti empty latrines of black liquid directly into the river Assocaited PRess- observed overflowign septic tanks at UN base and discovered the landfill open pits in a residential area uphill from community hbathing springs
Iraqi farmer who hid Sadaam Hussain
Alaa Namiq. beleived Arab tribal traidition and Islamic law. when someone needs help, we help him
why does america need NGOS
America could not succeed in its objectives of shaping a freerer, more prosperous, and more secure world w/o NGOS -issues the world faces are so complex and deeply intertwined that no power even a superpower could solve on its own =NGO and government cooperation is desirable, necessary, and essential
Principles of eradication & polio
Animal reservior -nope. only humans Animal vector - nope. spreads via fecal oral (so animal harboring the virus was not a threat to eradication efforts) effective/stable/transportable vaccine -yes. live po and Im carrier state/subclinical disease - 95% never get recognizable s/s but can spread the virus w/subclinical levels of disease so that is a barrier adequate dx tools -not really b/c s/s are similiar to flu so difficult to identify cases
Principles of Eradicability r/t polio
Animal reservor/vector: only humabns are affected Vaccination = yes Carrier/Subcarrier state= yes. 95% never have s/s but are able to spread it Adequate diagnosis= 95% are asymptomatic, 5% have indistinguishable flu-like (20% of that 5% get asepstic meningitis and <1% get permanent flaccid paralysis0
Arab Human Development Report
Arab countries need to em ark on rebuilding their societies on the basis of 1. full respect for human rights/freedom as the cornersotone of good governance which leds to human devleopment 2. complete empowerment of Arab woman. take advantage of all opportunities to build their capacity and to enable them to exercise those capaciticieties to the full
sometimes we do GHE b/c International Law requires it
Article 55 - the occupying power has the duty of ensuring food/medical supplies of the populaton to the fullest extent of the means availablw to it Articel 56 - the oppupyting power has the responsibility to maintain hospitals and public health/hygiene with teh cooperation of natioanl and local authoriteis
worm that climbs into the lungs, climbs up trachea, triggers the cough reflex, and you reswallow. also in poop
Ascaris lumbricoides
worms that trigger the cough reflex when they climb up your trachea into your lugns
Ascaris lumbricoides (ass care is lumber coi deez
suspect if you cough up worms
Ascaris lumbriocoides (ass care is lumber coi dez) ingest. burrows into intestines and travels via bloodstream to lungs. crawls up trachea and triggers cough so you reswallow.
priorities to treate severe dehydration
BIG 3: hypoglycemia, hypothermia, dehydration -brain needs glucose to function -electrolyte imabalnce -infection risk so give ABX empiricall
helping them so they will later be able to help themselves
BP/BPC building partner capacity
IHR in 200s
Big changes states are required to report "all pblic health emergencies of international concern" emxplain what constitutes a public health emergency states can make confidential notification WHO can get ino from unofficial sources states are required to develop minimal national capacities to detect, assess, report, and respond to any potential public health emergenceis *big change b/c no longer focused no extremly short list of reportable diseases moved away from states fulfilling lwgal requirement to report -- which is why GOARN/WHO started accepting iconfidential notifications and info from non=gob dources
effect of Black Death on worldwide population
Black Death barely put a dent in the world population trajectory
proximate determinants of fertility
Bongaarts indices, Stover revisions
London containated water`
Broad Steet Cholera oubreak in 1854 part of the worldwide cholera outbreak 1846 - 60 616 died FLorence Nightengale went to help out
US government intervention into HIV relief
Bush. PEPFAR - US PResident's Emergency Plan for AIDS relief
differences in the movement of the rash of chickenpox versus smallpox
C - starts at core and moves outwards s- mucous membrane then face then extremities then core
principle committees of GHI
CDC USAID OGA (led PEPFAR and resported to SofS)
Cultural Relativism versus Univeraslims
CR= each culture has their own way. it's just differnt but not wrong Universalism= every human is endowed w/certain inalienable rights. they are universal and cannot be negotiated away. human rights cannot trump culture or deny basic human rights
answer to the Universal Declaration of Human Rights
Cairo Declaration of Human Rights in Islam (1990)
what organization is intervening into Guinea Worm
Carter Center (founded by Jummy Carter_
when did Carter Center become involved in Guinea Worm
Carter Center began to lead the GUinea Worm eradication efforts in 1986 (when there were 3.5M cases annually. works w/WHO, UNICEF, CDC) WHO - certifies countries as guinea worm free UNICEF- helps governments w/drinking water programs CDC- provides technical advice and verifies infeciousns are truly guinea worm
efforts to combat guinea worm
Carter center w/UNICEF, WHO, CDC. community based education and clean drinking water intiatives
lion killed by the American dentist
Cecil the lion was killed by the American dentist
story of a car company that shows cultural differneces
Chevy Nova wasn't bought in Mexio b/c Nova means "doesn't go"
GDP versus per capital GDP
China and US are the top countries by GDP but USA falls to #10 and China #78 in per capita GDP
controversy of giving PEFPAR money (HIV relief money under Bush) to CHina
China owns $1.2 Trillion of money in US treasury bonds. so we owe China $1.2T in bonds. US haS A BUSDGET DIECIFY EACH EYEAR SO ANY MONEY WE SPEND ON THINGS LIKE pepfar IS ACUTALLY MONEY WE ARE BORROWING FROM TOHER COUNTRIES THAT FUTURE GENERATIONS WILL HAVE TO PAY BACK. the #1 country we are borring money from is XCHina so we are borrowing money from china. that we are spending on HIV treatments that we are giving to china CHina already does gobal health diplomacy in Africa. US borrows money from CHina to fund PEPFAR in china -money given back. yet China built a Peace Ark to sail to Africa/S. Asia to do health diplomatic missions. so critism - why is the PEPFAR money given to China when the above is happening?
China's equivalent to Mercy/Comfort
China's Peace Ark goes to Africa
why didn't USA want China to create their own bank
China's lending bank is the Asian Infrastructure Investment Bank 0USb/c the economic sphere in US has concerns taht chind would use its outsized inflence in thi iinternal bank to expand its influence at the expense of US/Jap. AIIB might fail to live up to the environmental, labor, and procurement standards taht are essential to the mission of deveopment leaders
Asian INfrastructure INvestment Bank
China's own world bank despite the existance of World Bank & teh Asian Development Bank China said they did it b/c Asian Deveopment Bank said $85T in funded was needed between 2010-20 and that need couldn't be met by the WOrld Bank and Asian Deveopment Bank alone -AIIB couldn't fill that gap either but China believed financing was good
what happened to INternational Health Regulations whoen WHO was established
Classical Period of IHR was 1851 - 1951 WHO established 1948 World Health Assembly was given the authority to manage"sanitary and quarantine" requirements and other procedures designed to prevent the international spread of diseases
4 operational plans for the Global Health Initiative
Collaborate for Impact Do what works innovate for results build on country-owned platforms for stronger systems and sustainable results
CCDR
Combatant Commander
4 levels of getting rid of a disesase
Control Elimination Eradication Extinction
Dengue versus Malaria
D = virus, M= parasite D- Aedes egypti, M=Anopheles D- supportative care & b. transfusion., M= multiple optiosn D- Central America, M- not in central america
accounts for both morbidity & mortality as well as time discrepencies between different diseses so their burden can be more accurately measured
DALY
what has replaced "life expectancy" as a metric to measure disease burden
DALY
double burden of disease versus double burden of nu
DB of Disease= country has both group 1 and group2 at the same time DB of NUtr= being overnourished w/processed sugars so micronutrient deficiencies
prevent River Blindness
DEET Rx to kill the larvae (Ivermectin (same as dog heartworm) treat by deworming people
effective measurres to prevent River Blindness
DEETm long sleaves, avoid blackfly bites
DOD's Executive agency for the tecnical assistance, managemnt, and admin support of global HIV/AIDS prevention, care, and treatment of foreign militaries
DHAPP = DOD HIV/AIDS Prevention PRogram
effort by DOD to specifically help foreign miltaries combat HIV/AIDS
DHAPP = DOD HIV/AIDS Prevention Program *some funding is from PEPFAR
program were the US DOD works with other militaries on HIV
DHAPP. DOD HIV/AIDS? PRevention PRogram.
legal authority for HCA
DOD 2205.02 "Humanitarian & Civic Assistance" Title 10 USC Section 401
examples of building partnership capacity
DOD HIV prevention program to build tegh long-term capacity of militaries to respond to and manage the HIV threat
DHAPP
DOD HIV/AIDS PRevention PRogram -to decrease HIV/AIDS incidences among unioformed personnal across the globe including w/foreign militaries -DOD executive agent for the technical assistance, management, and admin suppor to fthe global HIV/AIDS prevention care and treatment of foreign militaries. -ingegrated into PEPFAR
DHAPP
DOD HIV/AIDs Prevention PRogram
examples of building partner capacity
DOD HIVB/AIDS program like PEPFAR Provincial Reconstruction teams in Afghanistan
expansion of the DOTS program
DOTS - directly observed treatment shortcourse popular in 90s. 2006- expanded to "STOP TB STRATEGY" kept the 5 steps of DOTS but allso addressed TB-HIV & MDR_TB, poor vulnerable populationh health care system strength, engage all health care pvoiders, empower people w/TB, enable/rpromote reserach **all abiout health system strengthing
demand siders in the debate about population policy
DS 0 focus on enhancing woman's eocio0economic and social empowerments
Priorities to treat severe dehydration
Days 1=3" low glucose, dehydration, & low temp. sepsis risk brain needs glucose to function
where was the SCopes monkey trial
Dayton, TN
DHA
Defense Health Agency
DIMO
Defense Institute for Militayr Operations
Thew 3 Delay MOdel
Delay 1- time it takes to seek care Delay 2- distance to reach medical facility Delay 3- time to receive adequate care
aka breakbone fever
Dengue
differences in mosquito based diseases
Dengue - Aedes egypti Malaria- ANopholes
Aedes mosquitos and disease
Dengue, Zika, CHikungunya, and other virus
GDP growth of developed versus developing
Developed countries have a GDP growth of 1-3% per yer DevelopING countries have potential to grow more rapidly but only if they adopt practices/technologies arleady in use by developED countries
mapping the relationships between determinents
Development Web
DALY stands for
Disability adjusted life year
DART
Disaster Assistance Response Team -under OFDA = Office of Foreign Disaster Assistance -ofda is under USAID
established legitimacy for monarchs
Divine Rights of Kngs
work by GHE military projects
DoD/USAID does not do humanitarian operations b/c we can't abide by the core principles. we do do FOREIGN HUMANITARIAN ASSISTANCE
SSTR Operations
DoDD 300.05 "Military Support for Stability, Security, Transition, & Reconstruction (SSTR) operations
directive for SSTR operations
DoDD 3000.05
developing world is now experiencing both type 1 and type 2 diseases
Double burden of disease
Pakistani who helped the CIA get info on Bin Laden's whereabouts
Dr Shakil Afridi. told Pakistani interrogators that he was recruited by the CIA via a senior official at Save the CHildren CIA said he worked for them but denied the Save the CHildren linke -Dr. was detained shortly post Bin Laden raid and sentenced to 33yrs jail. told them he was recruited by CIA at an Islamabad dinner party by Save the CHildren
aka guinea worm
Dracunculitis
aka guinea worm
Dracunculitis (drag uhn koo lia uh sis)
3 types of Neglected Tropical Diseases based on worms
Dracunculitis = guinea worm. crawls out of painful foot boils Taenia solium = brain seizures Ascaris lumbriocides = lungs/crawls up trachea
aka guinea worm pronouncination
Drag uhn koo litis
UN Population FUnd
EMOC - emergency ob setric care to ensrue timely access to care for women experiencing complication
created to ensure timely access of care to pregnant/laboring womenb
EmOC = Emergency Obsetric Care *basic & comprehensive
EmOC
Emergency Obsetric Care **to ensure timely access of care to pregnant/laboring women**
shift from type 1 disesases to type 2 diseases
Epideminological transition
XDR-TB
Extensively drug resistant TB -resistant to INH/rifampin & fluorquionolonbes (MDR-TB is resistnant tio INH/rifampin but others work)
who approves vaccines in the US
FDA
legal authority for FDA & HCA
FDA = Foreign Assistance Act of 1961 HCA = DOD 2205.02 "Humanitarian & Civic Assistance"
difference between FDA & HCA
FDA = Foreign Disaster Assistance. basic humanitarian assistance for essentials & infrastructure. HCA= training exercises to build partnerships w/goal of meeting Combatant Commander's strategic & operational effects
hx of March of DImes
FDR founded the National FOundation for Infantile Paralysis in 1937 which gave Salk money to develop his vaccine and the organization later became March of DImes
different types of GHE
FDR=foreign disaster relief HCA=humanitarian civic assistance support aims of USG Global Health Initiative MSO= medical security operations building partner capacity health diplomacy global health security
differences between HCA & FHA
FHA - to relieve human suffering HCA - to promote security/policy interests of US & the contruities there the activities are performed. specific operationasl readiness skills of the service members ALSO have different funding sources & legal authority allowing activities
differences in goals of FDA & HCA
FHA = relieves human suffering HCA = promotes security/policy interests of US where activities will be performed. specifically intended to enhance operational readiness of perticipatnts but cannot build capacity of the HN military
all missions DOD does to primarily relieve suffering
FOreign Humanitarian Assistance
why do we delay giving Fe supplementation if malnourished
Fe can make infections worse. wait until gaining weight and has an appetite. genverally 1=2 weks
3 things the Military Health System does
Force Health Protection (TCCC & theatre hospital) Garrison (CONUS) hospitals GHE
legal authority for FHA
Foreign Assistance Act USCC TItle 22
authority for FHA
Foreign Assistance Act of 1961
legal authority for Foreign Humanitarian Assistance
Foreign Assistance Act of 1961 Title 22 USC
Foreign Humanitarian Assistance
Foreign Disaster Relief Humanitarian Assistance Disaster REsponse
DOD activities conducted outside US/its territorities to directly relieve human suffering, disease, hunger, and
Foreign Humanatarian Assistance
FHA
Foreign Humanitarian Assistance
definition of FHA
Foreign Humanitarian Assistance -DOD OCONUS activities directly to relieve/reduce human suffering -limited in scope/duration -designed to supplement/complement HN activities -humanitarian related basic needs/infrastructure IN RESPONSE TO nature/human causes of disaster
GHE activities where you help out with basic needs s/o natural or man-induced disasters
Foreign Humanitarian Assistance - FHA
DOD humanitarian/disaster relief versus pre-planned training
Foreign Humanitarian Assistance- relieve human suffering in a disaster Humanitarian Civic Assitance - preplanned
tool used to measure QOL
GDP
what measures standard of living
GDP
what measures the value of the worth of work in a country
GDP
How expensive can your GH program be?
GDP (per capita) x %GDP spent on health *to spend more on health, one of these two needs to icnrease
how to measure the size of an economy
GDP - to
influences the ability of a country to inflence others in the workd
GDP and military
impact of HIV on the economy
GDP decreased in SSA post HIV
per capita GDP
GDP divided by population
what does GDP growth indicate
GDP growth indicates an increased standard of living
what is GDP supposed to measure
GDP is supposed to be a measure of QOL -take all goods ervices produced in a country (total wealth generated by that country) and divide by the num,ber of people in that population **DXP is not a good metric for measuring QOL
what does GDP measure
GDP measures standard of living total sum of all goods/services in a country in a year
USA's global health budget per person
GDP per capita ($55 per person per year) x % spent on health budget (17%) = total health budget of $9K per person per year **considering how most people dont' need much healthcare in a year, $9K per person per year is a lot ***compare to myanmar $900 per capita GDP x 2% of GDP spent on health = $18 on health spent by the country. this is a country with multiple infectiouis diseases so $18 per person per year is too low to be effective
How expensive can your GHE project be?
GDP x (% GDP spent on health)
what factors need to be affected so a country can spend more money on health
GHE projects focus on calculation GDP x %GDP spent on health *to spend more on health, you need to increase either GDP or % money wspent on health
differences between GHSA and IHR
GHSA =- nosocominal, biosurveillance IHR - ports of entry, food safety, CBRNE
flexibility
adjust to changing ocnditions, take advanteage of opportunities, max efficiency
differences between GHSA and IHR
GHSA: vaccines, regional biosurveillance, sample sharing, novel diagnosis, sharing medical countmersures IHR: legislation, policy, fisk communciation, point of entry, food safety, chemical events, radiological meegency
resource to check how we are doing in the fight to eradicate polio
GLobal POlio INitiative has a "Polio Today" map on its website Biggest cluster is in Afghanistan/Pakistan cluster in SSA. also in the Indonesia area
relationship between GOARN and IHR in 2005
GOARN = diverse indepdnetnt netowerk of technical instututes IHR - legal framework between states who are WHO members
collaborative agreement to pool information about infectious diseases from a variety of sources
GOARN = global outbreak and alert response -formally began in 2000
GOARN and IHR
GOARN is a broad diverse netowrk to voluntarily report and share information IHR in 200s: legal framework where states part of WHO are required to report evdents that meet certain conditions. no longer only reporting the mandatory under 6 diseases but not report diseases taht mewet criteria to report
relationship between GOARN and WHO
GOARN is an indepdent network fo technical injstutions but HWO is the secretariat (secretary/admin duties) for GOARN
establiehed to create an international coordinated response to ID outbreaks
GOARN. Global Outbreak Alert & REsponse NEtwork
"Learning Counterinsurgency: Observations from Soldiering in Iraq"
Gen Petraeus
first to use the term "persistent engagement"
General Mattis during his lectures on counterinsurgency
example of persistent engagement
General Mattis during his lectures on counterinsurgency PE via continuous security cooperations has been used to great effect expertly in the Philippeans
measure of inequality within a population
Gini Coefficient
"GLobal Fund" and pandemics
Global FUnd to fight AIDS< TB, and Malaria -0independent public-private initiative to fight the big 3 ID
preventing infectious diseases and resulting civil insecurity over there so we are protected here
Global Health Security
GOARN
Global Outbreak Alert & Response Network established 2000. to create an international coordinatied response to ID outbreaks
who should we partner during disasters
Goodle has a 24/7 crisis support center during disasters -
security cooperation during Guatamalian Civil War
Guatamalan Civil War 36 yrs (1960-1996) atrocities, human rights violations government versus population distrust US cared b/c of its geographical location. human trafficking, mass migration r/t duress. impaired development, drug trafficking ineffective government leads to impaired development
considerations if pt has flaccid paralysis
Guillain Barre Poliomhyelitis
human verus legal rights
H - rights that cannot be negotiated away as part of a social contract L- rights provided by a social contract like the right to vote
bird flu
H5N1
Humanitarian Civic Assistance
HCA refers to specific overseas activities like MEDCAP/MEDRETE planned/deliberate not in response to a disaster -to create strategic/operational training objectives
training exercises to enhance partnerships & meet combatant commander's strategic/tactical objectives
HCA = Humanitarian Civic Assistance
what kind of activities are MEDCAP & MEDRETE
HCA = Humanitarian Civic Assistance
what can't HCA do
HCA operations may involve cooperation with host nation military elements but ARE NOT SUPPOSED to build HN military capacity. that is what security operations do
first recognization of HIV
HIV first recognized in US in '81 but started in 70s SSA.
BIG 3 INfectious diseases
HIV, TB, Malaria
themes of 1980s
HIV, multi drug restistant TB, biological ewpons
what has significantly decreased life expenctancy in SSA
HIV. b/c impacts development/security/economics...
top two infectious disease killers
HIV/AIDS TB
HIV and impact on labor
HIV/AIDS created a high % of labor force and military/security worker lives. also created a mass createion of orphans
Asian Development Ba k
HQ in Philippeans. 1966. goal: to facilitate economic deveopment in Asia similiar structure to the WOrld Bank 2 divisions. one manages loans to governmenta t reasonable rates like World Banks's IBRD and to other gives cncessional loans/gransa like IDA
HCA
Hamanitarian Civic Assistance
role of Dr without Boarders in the Hatian cholera epidemic
Hatians anticipated compensation by the UN so they flooded treatment centers to seek medical certificates to attest they had cholera. Dr w/o Borders had to set up a special unit to process requiests
what happened in Haiti when the link between the UN bases & cholera was discoveredd
Hatians marched on the base w/demonstrations. riots. class action suit against UN but the UN said they had diplomatic immunity
state of nature
Hobbes. w/o social contract theory, life would be "solitary, poor, nasty, brutish, and short" in absence of poltical order/law. everyoen would have unlimited natural freeedoms including the rights to all things including the right to plunder/rape/murder. there would be endless war agaisnt all
who retains responsibility when we come to the aid of another nation
Host Nation
name for the leader at USAID
administrator
DOD activities that support Combatant Commander strategic, operational, or tactical objectives while also supporting personnel operational readiness
Humanitarian Civic Assistance
HCA
Humanitarian Civic Assistance
refers to a type of overseas activities that fall under Title 10 USC section 401
Humanitarian Civic Assistance
example of HCA activities
Humanitarian Civic Assistance -MEDCAP/MEDRETE -to create strategic/operational effects to support combatant commander objectives and strengthen operational readiness by enhancing trusting relationships
authorizes HCA
Humanitarian Civic Assistance Humanitarian & Civic Assistance (DOD 2205.02)
formation of the World Bank
IBRD and IDA has evolved from lending just for infrastructure to lone that now lends for health programs
what gives the International Bank for Reconstruction and Development the ability to borrow money
IBRD is a triple AAA rated financial instution w/good credit so it can borrow from investors under its good name w/reasonably low interest rates xrather than reloan to poorer develping nations at rates one point higher than it borrows for itself
2 main organizations in the International Red Cross and Red crescent MOvement
ICRC - INternational Ommittee of the REd ross IFRCR- International Federation of the REd Cross and the REd Crescent Societies
International Red Cross & REd Crescent
ICRC = primary wartime issues IFRCR- natioanl societies with community resources (like American REd Cross)
approaches versus strategiews to comabt ID
ID approaches -prevent exposure, minimize M&M, prevdnt spread to others, make susceptible individuals immune ID strategies- vector control,vacinate, massive chemotherapy/Mass drug administration (MDA), improve treatment, imprve sanitation, isolation & quarantine, behavior change, partnerships
oversees national Red Cross organizations
IFRCRC = International Federation for the Red Cross & Red Crescent Societies
"a fundamental condition of international prosperity is an orderly monetary system that will encourage trade, create jobs, expand economic activity, and riase living standards throughout the world"
IMF
exists to maintain stability in world markets
IMF
how do the IMF and World bank work tohgether
IMF - assesses the country's general economic situations and policy for the Bank is measured the potential de velopment projects and reforms Bank -adivec on structural ND XEC TGORAL REFORMS. INFORMS imf POLICY AGICE
what is the IMF NOT
IMF is not a humanitarian org unapologic b/c it says it sprimary mission is to maintain stability in world matters
meets the need raised by the concern that developing countries don't have the luxury of borrowing during times of crisis at reasonable rates
IMF tries to meet that need
stats of INdia's GDP per capita and stunted
INdia in 2012 had GDP per capita of $1500 and 48% stunted kids VIetnam has a similar GDP at $1200 per capita but only 23% stunted
2 divisions of the World Bank
INternational Bank for Reconstruction and Development International Developent Association
services offered by the World Bank
INternational Bank for Reconstruction and Development = lends for 12-15yr terms w/interest rates usally 1 point above what the Bank is able to borrow for itself International Development Association =lends interest free to the poorest countries for 35-40 year terms
ICRC
INternational COmmittee of the REd Cross -monitors compliance w/Geneva COnventions ORganizes nursing care supervises POW treatment missing persons in armed conflict protection of Civilians arbitrate between warring parties in armed onflict
keep symptomatic away from healthy
ISOLATION not quarantine
divisions of World Bank
International Bank For Reconstruction & Development -LIC/MIC International Developjental Association - interest free to poorest
ICRC
International Committee of the Red Cross
what organization monitors compliance w/Geneva Convention, battlefield care, POW, civilian protection, arbitration
International Committee of the Red Cross
IFRCRC
International Federation for the Red Cross & Red Crescent Socities -oversees national Red Cross organizations
IFRCRC
International Federation of the Red Cross & Red Crescent SOcieties
pool of funds member countries can access in time of crisis to curtail potential economic collapse
International Monetary Fund
who leads the USAID
administrator
how does World Bank get its money
Investors would never directly lend to LIC b/c too risky. the World Bank is AAA institution so they can borrow on good credit.. sells bonds then gives the money to LIC or very LIC for 12-40yr loans either interest free or low interest free
flag w/ a lion, sword, sun
Iran
Islam & vaccinations
Islam allows vaccinatiosn
ROM symptomatic peopel
Isolation
primary treatment for River Blindnesss
Ivermectin (same as dog heart worm. acts like a larvae birth control)
yr of the London well reserach
JOhn SNow and cholera in 1854
DOD played a role in vaccine developmenbt for
Japanese encephalitis meningitis hepatis A influenza adenovirus typhoid RSV
critique of Edward Jenner
Jennhis vaccination revolutionized the fight agaisnt smallpox. important for sure but his most important contribution was his public education efforts, not necessarily the discovery itself. Jenner wasn't teh first to find the cowpox link but was teh first to publicize and variolate 23 people so it is not correct to say he singlehandedly discovered everything. there seems be somewthing that happens w/medical breakthroughs like Jenner wen over time they are given greater and great levels of significance and importance probably driven by a desire to be brief and to simplify what was really a complex evolution of human understanding of the disease. probably b/c it sleads peopel to believe that progress in infectious diseases is via huge scientific breakthroughs when in reality, that is rare
what was the cause of the retreat of the COntinential Army from Quebec
John Adams said smallpox was worse than the BRitish/Canadian/Indians theat combine and was the cause of their retreat form qUEWBEC
founding father of IMF and World Bank
John Maynard Keynes even he is confused by the differences between the IMF and World Bank thinks the fund should be called a bank and the bank a fund
documents that synthesize efforts across services
Joint Doctrine
Joint Pub
Joint PUblications
examples of JP's
Joint Publications "Force Health Protection" "Health Security Systems" "Counterinsurgency" "Stability Operations"
advisor arm to the DOD/president
Joint staff
"We will bury you"
Khruschev at UN w/choe
characteristic of measles
Koplik spots
what measles s/s appears prior to the rash
Koplik spots inside cheek by the 2-3rd molar can appear up to 3 days prior to the rash
what does the CIA official say about future uses of humanitarian efforts to gather intelligence
Lisa Monaco = Assistant to the PResident for HOmeland Security and COunterterrorism in a letter to deans of PUblic Health who said the humanitarin ruse to get DNA samples that led to intellgioence that allowed us to assassinate Bin Laden destroys trust in teh community and damages future non-nefarious humanatarian attempts she said we would not do this again but we do need to understand rumors hostile to how others perceie our action
highest GDP per capita
Luxemberg Norway WQatar Switzerland
MMWR
M&M weekly report
MD
MASS DRUG ADMINISTRAITON
nutrition and Millenium/Sustainable development goals
MDG #1 was to half abetween 1990-2015 the proprotion of people who suffere from hunger| SDG made it $2 below end poverty
activities under HCA
MEDCAP MEDRETE
difference in MM rate and MM ratio
MM rate is affected by the fertility level of a population
calculate # maternal deaths
MMR (maternal mortality ratio) x # babies born = # maternal deaths
ratio of maternal deaths per 100K live birthds
MMR or maternal mortality ratio
# of maternal deaths per 100K of women of reprductive age
MMRate
source to see how the us is doing in terms of disease
MMWR - M&M Weekly REport
start of Doctors w/o Borders
MSF = Medecins sans Frontiers -started by Bernard Kouchner post Nigerian Civil war in Biafra (a province) in 1968. believed the Red Cross principle of neutrality didn't serve the non-combatant Nigerians. felt compromised so he left the Red Cross and formed his own organization where neutrality was not a principle
Support for North Korea's invasion of South Korea
Mao & Stalin supported. both McArthur and Dean Atchinson gave speeches that said the US wouldn't come to the aid of S Korea if this happened
"energy deficiency" macronutrient deficiency
Marasmus
skin forms a "baggy pant" look
Marasmus
when has inflencing aggregate demand in developing fragile countries worked
Marshall Plan especially in Japan and Germany not in modern MIddle East
calculate MMR
Maternal Mortality Ratio #maternal deaths/#live births x 100K = #maternal deaths per 100K live births
when was Bin Laden assassinated
May 2 2011
when do you use PPP versus GDP
PPP better for local (b/c local salaries are r/t local standards) GDP better for out of country purchasing of goods on the world market **consider what is best for hte given prices for local prices or nominal world prices
Middle East and polio eradication
May 2 2011- Operation Neptune Spear in Pakistan killed Osama Bin Laden a team collected DNA samples from his family members under the guise of offering vacicnations. when details of hte covert program emerged, all health workers were considered spies. Taliban said no polio vaccinations until drone strikes stoppped. hindered polio vaccinations in Pakistan
french name for doctors w/o borders
Medecins Sans Forenteires. MSF
MEDRETE
Medical Readiness Training Exercise
MERS-CoV
Middle East Respiratory Syndrome Coronavirus
Middle East/Africa and INformation age
Middle East/Africa will miss the developmental benefits of the INformation Age if they do not make ucltueral changes favorable towards deveopmnet
2 types of ___ Develpment Goals
Millenium in the 200s replaced by Sustainable Develpoment Goals
Standard rations for an adult when you refeed post moderate malnourishment
Minimal energy = 2100kcal protein = 10-12% of total energy fat = 17% of total energy adjustments -100kal per q5 degrees over 20C -moderate activity level extra 140kcal -high activity level extra 350kcal
Muslims & vaccination
Mullahs in Afghanistan (Taliban) granted letters in 2010 to aid workers so they woul have safe passage to immunize people against polio in 2010, thge Islamic Development Bank gave money to Pakistan to cover cost of polio vaccine and also Afghanistan to cover Afghanistan polio eradication efforts Osama Bin Laden killing was linked to avaccination program so Pakistan distrusted, harassed/killed aid workers, and said the programs couldn't continue until aid programs stopped
Muslim countries and immunization
Mullahs in Afghanistant sent letters in 2010 that directed carriers of the letter to have safe passaage to immunize people agaisnt polio. so even a brutal regime like the Taliban recognized importance of immunization
symbolism fo the Red Cross/Crescent
Muslims complained about operating under a Red Cross symbol so the org started using REd Crescent bc the Ottoman Empire used the crescent 2006- Isral's red star or david allowed some say the red cross isn't meant to be christian and the red cross is the inverse of the Swiss flag but the argument says that even that is christian based
reason for the name "REd Cross & REd Crescent"
Muslims complained about operating under a red cross. the ottomman empire were using a crescent at ithge time. so referring to the entire organizaiton is the Red Cross and Red crescent. individual country organizations under it = AMerican REd Cross or Pakistan REd Crescent
how much can a LIC like Myanmar pay per yr on health
Myanmar per capita GDP is $900 can spend 2% of GDP on health services $900 x 2% = $18 per person per year on health services country has ID, ....
distinction between nutrtion specific and nutrition sensitive
N. Specific = primary objective to address nutritiuon that targets the immediate causes of undernutrition (give viamins, feeding) N. Sensitive= primary objective is not nutriton but has the potential to improve the food & natiobnal security of the beneficiaries
what does NATO say about humanitarian operations
NATO states that a humanitarian operation is an operation specifically mounted to alleviate human suffering
sports authority for colleges
NCAA. national collegiate athlweti soiety
NGO/agencies and military
NGO/agenceis don't peerceive well when the military comes in and stops on their toes so isn't always well received
IMF & humanitarian crisis
NOT a humanitarian organization. its primary mission is to maintain stability in world matters injected $430M into countries effected by Ebola (2014: like Siera LEone, GHUinea, LIberia) specifically done to make sure ebola didn't collapse the economic sysem. not for humanitarian health system but still interwined
belief of IMF
NOT a humanitarin organization. its primary mission is to maintain stability in world matters belief: a fundamental condition of internation prosperity is an orderly monetary system taht encourages trade, creates jobs, expands economic acting, raises standards of living throughout the world
what isn't capacity buildign
NOT direct medical care. i
goal of the World Bank
NOT to generate maximum profit goal is to maximize development in less developed regions
definition of Neglected Tropical DIseases
NTD subset of diseas considered "neglected" by large pharmacuetical companies/decision makers in teh developing world
impact of Neglected Tropical DIseases on overall GHE goals
NTD frustrate Sustainable Development Goals, affects 1 billion worldwide, immense human suffering/dealth, obstacel to public health/poverty decreased, overall socioeconomical
"The GLobal Infectious Disease threat and its implications for hte united states"
National Intelligence Agency
HQ of DHAPP
Naval Health Research SCetner in San DIego DHAPP = DOD HIV/AIDS PRevention PRogram. DOD's intervention to help foreign militaries combat HIV/AIDS under PEPFAR
Theresienstadt
Nazi camp allwoed the Danish Red Cross to visit, beautified it,transported the people to AUschwitz. treated teh dignitaries to a party. kinda like how Dennis Rodman and co. sees NOrth KOrea
what is River BLindness
Neglected tropical disease a parasite worm carried by repeated bites of blackflies that live near fast flowing streams/rivers
compensation for the post Haiti 2010 cholera outbreak
Nepal UN soldiers liked to cholera oubreak form their base. the Hatians want compensation so Haiti distrusts UN.
Principles of Eradicatability
No animal reservoir/vector No carrier state/subclinical disease Effective & transportable vaccine Practical dx tools w/sufficient sensitivity & specificity
Taenia solium versus Ascaris lumbricoides
Taenia solium - brain seizures Ascaris lumbriocides= lungs/crawls up trachea
Factors of Eradicatability that lead to smallpox being identified as a good candidate for ultimate eradication
No animal reservoir/vector: only humans get sick No carrier state/subclinical disease: has an incubation phase where you aren't contagious. you are contagious when the fever/rash appears. by then you are easily identifiable and bedridden from teh fever -physical findings are distinct vacccination worked seasonal fluctuatiosn only one serotype of the virus even in the worst cases, one person only infected another 3-5 peole
Principles of Eradicability r/t mealses
No animal reservor/vector has a subclincial carirer state. contagious before the obvious rash appears there is a vaccine appropriate diagnostic tools w/IgM but the rash is fairly distinct
reasons why smallpox was a good candidate for eradication
No other animal reservoir/vector -humans only Incubation phase -does have an incubation phase but you are not contagious during it. spike a fever which makes you bedridden so when the contagious rash appears, you are away from people VACCINATION -from a related virus so not actually smallpox but works well dx tools w/sensitivity or specificity -- smallpox is distinct and appears on visible parts of hte body so easy to tell if someone has it
501(c)(3)
Nonprofit group that is permitted to lobby and campaign; donations to it are not tax deductible.
communities that get new access to processed foods and become overnourished creating a nutritional deficiency
Nutritional Transition
ensures there is a framework for bringing together humanitarian actors to ensure a coherent response to emergencies
OCHA = Office of Coordination of Humanitarian Affairs USG version is under USAID also a UN version
difference between OFDA & OCHA
OCHA is much more explicit in its adherence towards humanitarian principles
who does OCHA report to
OCHA is the UN's version of the US program's OFTA. part of hte UN's Secretarian responsible for brigning together humanitarian actors
responsible for leading/coording the UDG response to disasters overseas
OFDA (Office of Foreign Disaster Assistance) under USAID
which group maintains stockpiles of emergency relief supplies in wharehouses
OFDA = Disaster Assistance REsponse Team under OFDA under USAID
example of an office within USAID
OFDA = Office of Foreign Disaster Assistance
why do kids who are recovering from severe malnourishment/dehdyration and receive treatment get diarrhea
OFTEN MISTAKEN FOR LACTOSE INTOLERANCE -b/c the villi are flat/atropy so lack of surface for rebsorption. so diarrhea/loose stools in the first few weeks as the gut healx isn't lactose intolerance and the villi will be okay once they heal in a few weeks
Principle Committee for the Global Health Initiative
OGAC (leads PEPFAR and reports to SofS) USAID CDC
options for rehydration w/severe acute malnourishment
ORS (oral rehydation salts) like ReSoMal F-75 or F-100: lighter in protein/fat/Na. higer in carbs. has Mg to help w/K balance
options for rehydration if severely malnourished
ORS (oral rehydration salts (ReSoMal) 70-100ml/kg in first 12hours (2L if 4-5yrs) NG if exhausted, resp distress, vomiting IV only if circulatorey collapse. often they are in end state at that point. if use IV, you are using up eqipment so save supplies for ABX/meds if in short supply
family that causes smallpox
ORTHOPOX: samllpox, cowpox, monkey pox
created the US GLobal Health Initiative
Obama
parent of OFDA
Office fo foreign disaster assistance parent is USAID which reports to the State Dept but is not controlled by them
OCHA
Office of Coordination of Humanitarian Affairs under USAID
OFDA
Office of Foreign Disaster AssistaNCE
Major Jim Grant
One Tribe at a TIme
response to the 2011 earthquake/tsunami/nuclear disaster
Operation Tomadachi
recent empire
Ottoman EMpire ended post WW1
example of a regional arm of WHO
PAHO
primary source of funding for DHAPP
PEPFAR
sources of fundign for DHAPP
PEPFAR DHA gives $13M/yr also
using PPP versus GDP when planning a GHE project
PPP is more appropriate when you are talking about staffing the hospital with local people and resources. b/c you are sourcing locally and want to use those prices. if you are looking for products on the world market, use GDP
benefits versus drawbacks of GHE that is direct medical care
PRO- immediate benefit, good photo opminimal plan time, mission can be as short as desired, short/sweet, can push whatever resources, you have, persistent engagement CON- not capacity buildign, doesn't encourage the HN to buy in or provide for itslelf, no long term benefit, little/no evident that MEDRETE actually achieve strategical objectives, lack of coordination may lead to duplication of effects, often displaces/harms the HN health sector, increased hostility to US military if doesn't go well, can delegitimize the HN in the eyes of its people (they can't provide/care for us)
catagorizing Kwashiorkor & Marasmus
PRotein-energy malnourishment macronutrient deficiency "acute wasting"
development projects during the early Afghanistan/Iraq War
PRovincial Reconstruction Teams 80 member teams from different disciplines. gave them the security to have freedom to operation int he province. -intended to build host nation capacity
lowest GDP countries
Pacific/Indian/Caribbean small **but not the lowest when you look at the per capita GDP - African/Middle East countries have the lowest per capita GDP
hotspot for polio today
Pakistan. b/c suspicious of aid workers b/c humanitarin vaccination was used as a ruse to get DNA evidence from family to kill Bin Laden
what led t the creation of PAHO
Pan American HO regional of WHO
PAHO
Pan American Health ORganization
PAHO
Pan American Health Organization = regional arm of WHO
PAHO
Pan American Helath ROganization
Phases of Operational Plans
Phase 0 - shaping (shaping, deter, seize initiative, dominate, stabilize, enable civili authority, return to shaping) yet shaping should happen during all phases
Shaping (phase...)
Phase 0 = shaping
Phases of operations
Phase 0 = shaping deter, seize initiative, dominate, stabilize Phase V = enhance civil authority
insurgency in Philippeans
Philippens has been managing an insurgency since the 1970s that killed +120K. peace achieved via agreement by 1996 employing an abundance of violence which is distasteful in its own right and alienates larger population and drives the population to insurgency -so PHilippeans military and USA does "persistence engagement" -Abu Sayyaf tried to disseminate negative information to counter MEDCAPS said the people shouldn't trust the US mil b/c they won't stick around. the us military didn't hide their role and wore uniforms while doing their work. the USA deflected most of the credit to their Philippean counterparts "show what the PHilippean military can do for the people. what has Abu Sayyaf done for you?"
pope & HIV
Pope Benedict 16 had to be convinced to support birth control as a way to morallyjustivy lower HIV. so supported condoms in some cases
PEPFAR
President's Emergency Plan for AIDS Relief
PEPFAR stands for...
President's Emergency Plan for AIDS Relief
infectious disease program created 2 years after PEPFAR
President's Malaria Initiative 2005 to now 2yrs post PEPFAR
diffiuclty of polio eradication in Africa
Prez of Nigeria Johnathan GOodluck says "we still have some cultural issues.". religions/gov leaders said it was a plot to make their population infertile
Mustafa Ataturk
Prez of Turkey who did Modernization. secularized the country. dissolved the caliph, women edu/off. ended the alcohol ban, allowed westernized medicine and penalized superstititon medi ine
how do we divide undernourishment
Protein-energy malnourishment (macronutrient deficiencies) (acute = wasting, chronic = stunting) acute wasting = Kwashiorkor & marasmsus
QDR
Quaddrennial Defensive REview
ROM healthy people who are exposed
Quarantine
Quarantine
ROM healthy people who were exposed
Isolation
ROM symptomatic people
effect of cattle plague on history
Rindenpest. eradicated in 2011 sped the fall of hte Roman Emprie aided the conquest of Ghengis Khan hinded Charlemagne's campaign opened the way for French and Russian Revolutions subjugated East Africa to colonization seriously harmed any community socity dependent on cattle/water buffalo/Himalyan yakss by killing the entire heard in 1-2 weeks. rec
suspect if a person had a completely white eye
River blindness (Onchocorciasis) once the worm dies, the WBC can invade which leads to the whites over the eyes
ran the World Bank
Robert McNamara in 68-81
dx in the House pilot episode
Taenia solium tapeworm seizures
invasion of Afghanistan
Taliban in 1979
opposite of cultural relativism
Universalism: every human is endowed w/certain inalienable rights. human rights cannot trump culture or deny basic human rights
case study about risk benefit analysis for treatments taht aren't promoted in US but are in developing worlds
Rotavirus causes 1/3 of childhood diarrhea worldwide Rotashield vaccine causes a 20-30x risk for intusscepton so USA doesn't give it in the states. WHO still promotes it worldwide. a good case study about what is worth the risk. so many lives ar e lost to rotavirus worldwide that it makes sense for them to take the risk of insussception there but not in teh US where rotavirus is better treated and not as much of a problem doesn't mean we care more about kids here versus tehre or that we are pushing our vaccinations on other countries for profit, it just means that we have different risk-benefit analysis. not wirht the risk for us but it is for them
why do other countries feel uneasy about vaccination programs
Rumors spread when events happen that inject doubt USA has done experiments on vulnerable populations based on ruse of medical care (TUskeegee, South Carolina forced sterilization, BOston measles vaccination on disabled/mentally retarted kids taht led to thenm gettinh measles
who partnered w/USA to intervene in Darfur
Rwanda had a great recovery from their genocide. they had the African lay of the land knowledge and a vested interest in Darfur. US partnered w/them for expeditioanry medicine capacity and heavy equipmwner
who gave buildign partner capacity a big push
S of Gates
led to the Marshall plan
S of S Marshall's commendcement speech to Harvard in 1947
supply siders in teh debate about population policy
SS - focus on family planning program management. givinhg them supplies like contraceptives
criticism of PEPFAR
SSA affections who truly need help so ok to help SSA okay to help SAM/Latin/Caribbean b/c neighbors in our hemisphere $ to Ukraine to help w/HIV/AIDS makes sense b/c of our tug of war figight w/it w/russia so it is both humanitarian & strategic to give money for UKaraine ALSO GAVE MONEY TO RUSSIA AND CHINA - controversioal
survived ebola but died post[partum
Salome Karwah was a 26yo LIberian woman who survived Ebola, Time Person of hte Year, died of eclampsia 4 days post partum. wasn't helped b.c she had treated ebola pts
largest international relief organization in Pakistan at the time of Osama Bin Laden's assination
Save the CHildren - May 2011
frequently cited study for nation building
Securing Health: Lessons from Nation-Building MIssions
Security Cooperation versus BP/BPC
Security cooperation is a more specific event (help Rwanda in Darfur) while BPC is more specific and meanbt to be long=term w/eventual goal of independence *both involve building partnerships to address mutual security objectives
USA HQ of biosurveillance
Silver Springs
what did Washington say was the greatest enemy of the Continential Army
Smallpox GW recognized the importance of public health set up hospitals, mandatory variolation of smallpox (controversial b/c not safe), and camps sanitation
problem of saying NGO's are a force multiplier
SofS Colin Powell said "NGO's are a force multiplier" and important part of the combat team. NGO's not happy b/c it threatened the whole value of humanitarian space
examples of Security Cooperatiosn
Somalia Pirates Guatamalan Civil War partnering w/Rwanda in Darfur
last major African campaign prior to Darfur
Somalia.
Demographic Transition Model
Stage 1 - high death rates but also high birth rates. population stable and flat over time Stage 2- industrfood imp;rove so crude birth rate stays stable but death rate down so population rate increases Stage 3- crude death rate decreases, birth rate decreases b/c population preferences cause it to decrease but pop rate increases Stage 4- birth rate drops so birth and death rates match. pop rate is flat
most common infection in people w/HIV
TB
types of TB classified by respnse to meds
TB MDR-TB : multidrug resistant TB XDR-TB: extensively drug resitant TB
total fertility rates inu developed versus developing world
TFR is higher in developing
founder of the Red Cross
TRICKY QUESTION 1863: Henruy Dunant did the International Red Cross & Red Crescent Movement in 1863 1881: American REd Cross under Clara Barton (part of the IFRCR- INternational Rederation fo hte REd Xross and REd Crescen Soceities)
responsible for a lot of seizures in the developing world
Taenia SOlium (tan ee ah sol ee uhm) tapeworm that invates muscle/liver/brain
cause of a lot of seizures in the developing world
Taenia solium (tapeworm)
greatest limititation to how much we can spend on health
country GDP
guiding principle of Doctors w/o Borders
Temoignange = witnessing Advocating on behalf of hte victims of suffering and not be neutral/speak out to protect and help victims. their willingness to speak out when necessary to "alleviate human suffering, protect life and health, and to restroe respect for human beings and their fundamental human rights. The policy of T can come into conflict w/humanitarian principles of neutrality and independence."
organization formed to combat the "Big 3" infectious diseases
The GLobal Fund
US lead agency for developmental assistance
USAID. UN agency for international development
2nd Delay in the 3 Delay Model
Time to reach the medical facility
created the DOD & National Security Agency
Truman
main deliberative body of UN
UN General Assembly
UNHCR
UN High COmmissioner for REfugees
OCHA
UN Office for hte Coordination for Humanatarian Affaris
USAID
UN agency for Internatioanal Development
chain of command for USAID
UN agnecy for international development lead angency for develompental assistance not part of state dept but its administrators reports to state department
problems fo the UN's cluster sysetm
UN is funded via voluntarty contributions and most countries aren't genoursly contirbuting to the UN system authority limit- UN can't compel anyone do do anything OCHA is a steward in off-time crisies but they dont ' have much fundign integrated missions- combo fo a normal peacekeeping in the country's civil conflicts pulus a humananitarian crisis
funding for the UN
UN is funed by volunary contributors and most countries aren't generous in giving to the UN system.
OCHA
UN office of cordination for humanitarian assistance
public health crisis post 2010 Hait earthquake
UN responders Nepal had cholera leak out of their base into the water due to poor sanitation
OCHA
UN's version of the US goverment's OFTA
UN program to help kids
UNICEF - UN CHildren's FUnd
USAID
US Agency for INternational sDeveopment
USAID acronym
US Agency for International Development
Defesne Languagte INstitute FOreign Language Center
US MIlitary premiere language training center. culture isn't part of hte curriculum
PEPFAR
US PResident's EMergtency Plan for AIDS RElief
USAID
US agency for International Development
InterAction
US consortium of US based international organizational NGOs. +170 members
what gives credit to rumors that US is using medical programs/vaccinations for nefarious purposes
US has a history of using vulnerable populatiosn to study disease and vaccinations. so there is a legitimate reason why people are wary -Tuskeegee withhold syphilis treatment to study Guatamalans were given syphilis/STD's to sudy Boston used metnally retarted/physically diasbled kids to study a measles vaccination that led to them geting measles
if DOD was purely humanitarina
US military would aid places/populations w/ the greatest need but sometimes we aid more fortunate places nrather than the most vulnerable b/c strategic objectives
Soviet's perspective about the hardest military in the world to predict
US military. not because we're good but because the US doesn't read its own doctrine
benefits of building partner capacity
USA has less to do only so many places in the world we can go/things to do -if partners contribute, that minimizes the amount that we have to provide and gives our partners a sense of contribution to a colaition that is brought together to meet various contingenceis
global health security
USA mainland is kept safe from ID & overseas threats
how much can USA spend per yr on health
USA per capita GDP is $55K 17% able to spend on health $55K x 17% = $9K per person per year on health great b/c most won't need 9K worth of health services in a year
who is the lead federal agency for developmental assistance
USAID
GHI stretegy councils
USAID PEPFAR D of S DOD Dep of HHS PEace Corps
Strategic Council for GLobal Health INitiative
USAID PEPFAR DofState DofD DofHS Peace Corp
who does USAID report to
USAID is not a part of the State Department but its leader (the Administrator) does report to SofS
what organization is USAID the parent of
USAID is the parent organization of OFDA
whom does the Office of FOreign Disaster Assistance report to
USAID then State Department has DART teams -disaster assistance response teams
what does WHO require in order for a guinea worm (dracunculitis) to be eradicated from a country
WHO says a country must have zero cases of transmission w/active surveillance for 3 years. then a surveillance teamm visits and reviews records/checks water, report submitted to the International Commission for the Certification of Dracunculitis ERADICATION (guinea worm) . *incubation is a year so a single missed case delays eradication by a year mor more -Chad was zero cases for 10 yrs then reemerged a country is believed to have an interrupted cases if 14 months w/o transmiission
examples of NTD
WHO says there are 17 NTD includes: leprocy, guinea, worm, dengue, rabies
disease prevention during Spanish-American war
Walter Reed and yellow fever in CUba Aeds egypti mosquiot
WASH campaign
Water, Sanitation, and Hygeine
op-ed
Why Failed States shoudl not be considered as our biggest national security fear
exists to provide LIC w/funds for development
World Bank
difference in how World Bank & IMF get funding
World Bank - AAA rated credit so they sell secure bonds then give the money to countries for development at low or interest free. IMF- countries pay subscription fees and borrow when in trouble. may need to restructure economy such as devalue money/reduce tariffs as a condition
under $1,100 per capita GDP
World Bank designated low income country
$4-13k per capita GDP
World Bank designated middle income country
determines a low income country from a high income counry
World Bank designation
definition of a middle income country
World Bank says $4-13K per capita GDP
definition of a high income country
World Bank says per GDP capita of over $13k
definition of a low income country
World Bank says under $1,100 per capita GDP
action by the World Health Assembly in 2005
World Health Assembly agreed to revise the IHR. aimed to prevent, preotect agianst, control, and provide a respone to the international spread of sieases in a way that is commesurate w/ public health riskas and which avoid unnecessary interference w/international trade and traffic
calculation formula of a DALY
YLL + YLD
Double Burden of Disease
a comminity has both Group 1 & 2 diseases at the same time communicable/maternal-infant/nutritional diseses & noncommunciable
Global Health Security Agenda
a commitment by WHO, US< and a dozen of countries including China/India to ensure all nations, and indibiduals collectivley identify and manage health
when does a country go into debt
a country can't spend more than its GDP w/o going into debt
when does WHO say a disease on teh verge of eradication has interrupted cases
a country is believed to have an interrupted case if 14 months w/o transmission. eradication if zero cases w/active surveillance programs for 3 years. a team comes out to verify records/check water/complile a report to submit
benefits from services offered by the International Bank for Reconstruction and Developmnet
a division of hte world bank lends to somewhat poor countries on 12-15year terms with reasonable interest rates the reasonable interest rates are usually 1 point above what the bank can borrow for itself
basic EmOC care
a health center w/o OR capabilities -Abx, oxytocin, anticonvulsants, manual removal of placenta, assisted vaginal delivery,, removal of retained products
greatest challenge of modern IHR
a lack of enrorcement was one of hte biggest challwnges to the IHR but GOARN helped to solve that problem
purchasing power parity
a measurement of prices in different countries that uses the prices of specific goods to compare the absolute purchasing power of the country's currencies
GH policy
a set of principoles or protocols to guide decisions in GH
WHO definition of health
a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
Humanitarian Civic Assistance
a type of overseas activities that fall under Title 10 section 401
Ascaris lubricoides
a worm spread via night soil (fecal fertilizer) burrows out of the intestines, gets into the lungs, climbs up the trachea, triggers the cough reflex, you reswallow. also can poop out
triggers for you to think the person has ascaris lumbercoides
abdominal pain worms in stool/cough bowel obstruciton
what strategy has not helped HIV
abstinence
advocacy that influences policy
academic advocacy
DOD doesn't do GHE
according to the principoles of global health. we do both healdh rmedical related foreign engagments, mil-mil, mil-0civ specifically for national security strategies objectives and military end states
description of a DALY
accounts for both morbidity & mortality as well as time discrepencies between different diseases so their burden can be more accurately measured
Global Health Security
achieving widespread access to essential health services & protection from enviornmental/behavioral risks to global public health -systems & agreements to prevent the cross-border spread of communicable diseases and other threats to public health -tools/instrumwents to ameliorate the threat of biological weapons & bioterrorism
Medical Stability Operations
acitivities that MHS soes to help establish/maintain order. Almost always, MSO are part of the overall stability operations strategy in a region
African Cleansing Ritual
after woman spouse dies, they hav sex w/his bro to cleanse7 of evil spirits. if bro isnt available/willing, they can hire a designated male in town for sex. spreads HIV. -must have sex with the deisgnated male in order to attend the funderal -women never liked it but now they have to question if they much change the tradition b/c of AIDS
what is against the law for HCA to do
against the law to use HCA funds to build up HN military but can use the HCA funds to partner w/HN military to accomplished authorized HCA objectives. also not supposed to use HCA funds for operational reasons (road for military purposes)
what aspect of DALY was stopped in 2013
age weighing and discounting
total demand for goods/servi ecs in a country's economy
aggregate demand
Anopheles
ah noh pho lees female mosquito that spreds malaria
neutrality
aid is rendered based on need as the sole criterion. its a state of mind attitute that msut guide every step taken by the movement's components
how should aid not be used
aid should not be used to further political/religion
is decision to remain neutral always a moreal or right one?
aid workers are proud of their work but the decision to remain silent is not always good -Internaional REd Cross remained quiet when they became aware of hte HOlocast in hopes that they could still deliver care and feared loosing access to deliver care to victims if speak up
7 principles of the Global Health Initiative
aimed to take all of the desparate groups and organize them around 7 core principles (women/children, strengthen health systems for sustainability, coordinate/integrate strategically, research/innovate....)
Rindenpest
aka cattle plague
Onchocerciasis
aka river blindness
Security Cooperations
all DOD interactions w/foreign defense establishements to buyild defense relationshipps that promote speccific US security interests, develp allied partner military capabilities for self-=defense and multinational operations/provide US forces w/peacetime and contingency access to host nations
what are security cooperations
all DOD interactions w/foreign defense establishments to build defense, relationships that promote specific US security interests, develop military capability for self defense, and multinational operations, and provide US forces with peacetime and contingency access to HN
what activities are included under Foreign Humanitarian Assistance
all FDR and HA/DR including USAID
how many in the world were undernourished in 1990
almost 1 billion
how did smallpox spread
along trade lines
s/s of Fe deficiencies
anemia, fatigue, poor mom/baby outcomes, low cognition
source of income/food in many rural developing countries
animal husbandry is a source of iincome/food so it is the foundational element in the local economies in developoing countries
for every woman who dies in childrbirth, another
another 30 suffer long-term disabilities r/t maternal causes like incontinence/reproductive organ damage. often underreported
SofD Rumsfeld offered to resign
answer to "why aren't we given armor for our trucks" "you go to war with the army you have, not the army you might want or wish to have" -bush declined the resignation
dx tools for macronutrient defieienceis
anthropomorphic like height/weight/length -underweight versus overweight versus stunted versus wasted
-azole
antiprotozoa/helmith
azt
antiretroviral therpay used in HIV
definition of an NGO
any non-profit voluntary citizens group task oriented and driven by people w/common interests legally constituty entity created by private organizations w/o participation or recognization in any government.
shaping operations
any of a series of actions taken in anticipation of an engagement/tactical opeation designed to promote accomplishment of strategic objectives
not political in nature
apolitical
Jehovah's Witnesses and blood transfustion
are okay when the decision is taken out of their hands and into teh courts
The Demographic Transition Model
argues to hurry and improve maternal health before too late. explains how crude brith rate and crude death rates changes as a soiety goes through teh stages of development
example of US using a vaccination program with unwilling participants
as late as 1958, US doctors from BOston used mentally retarted/physically diasbled kids to conduct crude tests of a meaSLES VACCINATION THAT ACTUALLY LED MANY TO GET MEASLES
obama said
as the wealthiest nation on the planet erarth, I believe the US has a moral obligation to lead the fight agaisnt humger and mulnutation and to partner w/others
differences between worms that infect humans in developoing countries
ascaris lumbercoides - poo pwrms and the worms get into your GI tract/lungs. jcough up worms guinea worms - worms come out via burning boils in foot
Ascaris lubriocoides
ass care is lumber -coi deez a worm that affects 1/6 of worl pop
how do you get Ascaris lumbricoides
ass care is lumber coi deez worm that infects 1/6 of world population can grow 1ft lives in intestine excretes eggs taht come out when you poop gets into the soil and you reingest it. typically put into the soil as "night soil" -when people use the poop collected overnight to fertilize can survige as eggs in soil for 10 yrs then hatch inside intestines
how do you use policies
create, debate, implement, modify all the time
best way to increase GDP (wealth) is to icnrease per worker productivity
better tools, labs, facilities... foreign direct investiment better education infrastructure (for better transport of goods) trade deals to give comparative advantage improving health of workforce - healthy workers can produce mroe
complexities of disease control
biological, societal, political, economical
stage 3 on the Demographic Transition Model
birth rate drops significantly b/c spontaneous shifts in population preferences. birth and deth rates both drop significantly population continues to rise
stage 4 on the Demographic Transition Model
birth rates fall to a level closely matching the death rate population lien is flat b/c the crude birth/death rates match STAGE 4 IS THE GOAL
how do you get malaria
bite by female mosquite Anopheles (ah noh pho lees_). gets into bloodstream, invades RBC, multiples in RBC then burts, then infects new ones cyclic fevers q48-72h
how do you get River Blindness
blackfly bites. near fast moving water need multiple bites bites put parasitic worm larvae into skin
geography of the places w/the greatest risk for River BLindness
blacklies that cause river blindness need fast water (oxygenated) often at the bases of mountains. rarely fly more than 1 mile from home but can be blown foarhter in storms
importance of trade agreements
boosts GDP by giving a comparative advantage
differences between the IMF and World Bank
both have the same goal of increasing the standard of living of member nations IMF - focuses on macroeconomic and financial stability World Bank - focuses on long-term economic development and poverty reduction
what is similiar between building partner capacity and security cooperations
both involve building partnerships to address mutual security objectives
country ranking GDP per GDP per capita
bottom 16 per GDP only = smallest island nations bottom 16 per capita GDP = SSA/civil instability USA and china re not top per capita (Luxemberg, Norway, Qatar, Switzerland, Australia). USA falls to #10 and China becomes a MIC GDP alone = USA then China
common complication from ascaris lumbericoides
bowel obstruction
what don't hospital ships do
build capacity
BP/BPC
buildign partnership/buildign partner capacity
BP/BPC
building partnerships/buildign partner capacity
Bitot's spots
buildup of keratin in the eye r/t vitamin A deficiency
how do you design accountability and transpoarency into a system
buyild effective chesks and balances to guiode aginst corruption
important thing to remember about facility-based sueveys
bwe aware they may make broad sweeping population claims
"America's VItal Interest in GHj"
by INstitute of Medicine in 1997 first document to say GH was in our interest but also to say it was our "vital interest"
"America's Vital Interest in Global Health"
by IOM in 1997 really put global health on the map in the eyes of USG policymakers we realized that we don't just do global health to be nice and humanitarian - we do it b/c we need to protect ourselves from threatws abroad
pluralistic
c
consumer consumpton + government consumption + investments +net exports
calculation for aggregate demand aka total demand for goods/services in a country's economy
1994 Cairo International Development on Population Developm3nt
called for a fundamental redefinition of population of policy that focused on status of women. went behyond population policy and gave prominence to reprodu ce health and empowerment of women while downplaying the demographic for population and economic development
how can/can't you pass HIV
can - body fliud, blood, breastmilk, SVD delivery NOT- kiss, hug, shake hands, share water/food/objects
s/s of TB
can be mild for month so dont' seek care cough fever night sweats bloody spuntum wt loss
humanitarian rhetoric
can be quite useful as it puts forward a moreal appeal of near universal vlalue but in the end, challenge to humantarian action is tendency since 1980s to use humananitarian efforts to win orver hearts and mids. pst 911, many humanitarian orgs in afrghanistan rejected the principle of impartiality/neutrality/independence in favor of a more overt assistance to rebuild democratic instability
can you get cholera if you;ve had it once
can be reinfected w/cholera short term immunity
guinea worm in other animals
can exist in fish but can't reporduce can reporduce in warm blooded animals but only reliably in humans - probably b/c we drink out of vessels when other animals lap up water which causes the fleas to scatter
benefits of cultural adaptions and beliefs
can foster mental resilliance it is the will of allah
4 reasons why maternal illiteracy ontributes to low nutrition of kids
can't get healthcare/nutritional education less able to care for themselves and, by extension, the kdis uneducatioed women marry earlier and have higher fertility less likely to voite which decreases provision of healthcar
what are the principles of eradication that are barriers to eradicating polio
carrier state/subclinical diseSE - 95% never get recognizable s/s but can spread the virus w/subclinical levels of disease so that is a barrier adequate dx tools - not really b/c s/s are similiar to flu so difficult to ID cases
Millenium Development Goals
created in the 2000s to organized newly allocated global health funds for priority setting -replaced by SDG
interventions for HIV/AIDS
male circ antiretrovirals prevent mom to baby transmission condoms
Problem of CIA using humanitarin programs
casts doubts on the intentions and integrity of all humanitary actions in Pakistan. this undermines the international community's effotts to eradicate polio and provide critical herath servi ecs and extend lifesaving assistance during time of crisis like Pakistani floods also led to harassment/violence agaisnt aid workers
what changes a woman's desire to have kids
changes in society's health status
benefits of the oral polio vaccination
cheaper easier to administer mroe stable more effective can cause and actual case of polio/local outbreak that can affect family and contacts as well
difference between chickenpox and smallpox rash
chickenpox is superficial so no scarring smallpox was deeper so scarring
when is improved sanitation and clean water a strategy to combat ID
cholera
examples of enteric infections
cholera rotavirus ecoli shigella campylobacter cryptosporidium ascaria
stunting
chronich undernourishment of macronutrients
male intervention to reduce HIV risk
circumscision drops HIV risk by 50%
cause of neonatal tetnus
clostridium in soil everwhere in teh world
4 operationa plans for the US GLobal HEalth (INitiative
collaborate for impact do more of what works build on country woned platforms for stronger systems and sustainable results innovate for results
Force Health Protection
combat casualty care med transport theatre hospital
health concerns r/t economy
commercial trade sperads disease along tade routes
communicable/non cases worldwide
communicable cases going down noncommunicable going up
Group 1 diseases
communicable, maternal/perinatal/nutritional
how to address Delay #1 in the 3 Delay Model
community education campaign
what is FHA designed to do
complement host nation activities
live birth
complete extraction w/signs of life regardless of pregnancy duration varies acround the world. ioften used
what must you do before implementing a project
comprehensive study
principle of "mass" in the military
concentrate military power at the decisive place and time
what should be remembered about remarkable breakthroughds in ifnectious diseases
concept of remarkable breakthroguhs in ID are often in reality a longer series of incremental accomplishments
Humanitarian Space
conceptual/figurative space in a conflict zone in which humanitarian actors who are pledged to abide by the humananitarian principles (humanity, neutrality, independence, impartiality) are afforded teh right to complete their messions) =in theoriy, this is done to benefit both sides of a conflict
preventative check
conscious decision to delay marriage or abstain procreation based on a lack of resources
effect of increasing productivity
consider a fishing village if someone invvests in new equipment, the number of harvested fish increases thus increasing the GDP of the village for a few years. yet if they do so well that there is no significant fish in the water the increase in GDP can't be maintained over time due to the environment's destruction -e.g. oil fields are not going to last. so countries are seeking to find sustainable methods to diversify when the economy/resources are used up **GDP doesnt' account for tradeoffs. economi gorwth via sustainable means is preferable than ones taht are at the cost of environmental destruction
everything people in a country produces
consumer consumption
forms the biggest proportion of USA 's GDP
consumer consumption (everything people in a country purchase) 70% of USA's GDP. that's why we care so much about consumer confidence
US military fighting/promoting infectious idease prvention/intervention
continential army of 1770s
reduction of incidence/prevalence of M&M to a locally acceptable level
control
5 levels of combating infectious diseases in terms of reducing to getting ride of them entirely
control (efforts to decrease the incidence/prevalence/overall M& oif ID elimination of infection- elimination of the organism itself from a geographical are elimination of disease eradication extinction
"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." .....
copied from teh ENlightenment
Stability Ops
core military missions that DOD conducts/supports. they should be given priorityt to combat operations and be explicity addressed/integrated across all DOD activities
what was one of the greatest reasons we failed in AFghanistan
corruption
problems w'India's national school lunch program
corruption principles take food from kids no longer enrolled producers substituted inferior ingredients (23 kids died when pesticides got in) NGO's steal from the program
priority setting in GH
cost benefit geostrategic populist human rights MDG/Sustainable Develpment Goals
COIN
counterinsurgency
COIN
countersurgency
data collection methods for maternal morality
counting maternal death only requires more sophisticated data collection methods and needs specialist to interpret. household surbveys are cheaper and easier b/c you don't need highly trained pros
cultural awarenes quote by BGeneral Petreaus
cultural awareness is a force multiplier. it reflects our recognization that knowledge of a cultural tradition can be more improtant than any geographic terrain. and we must study that in the same way we have always studied geographic terrain
a good skill set to have if you are a health diplomat
cultural billingual
cultural relativism teachings
cultural differents aren't wrong/right but just different. there are consequences to beign different and that can impair economical development
each culture has their own way of doing things. they aren't wrong, just differnet
cultural relativism
able to understand multiple cultures and bring out the ones best suited to the situation
culturally bilingual
relationship between culture & development
culture may hold a community back from development
what happens when something is not understood by science
culture often fills that gap
s/s of malaria
cyclic fevers q48-74 hours (for 3/4 serotypes. one does not have cyclic fever) chills HA N/V muscles/back ache swats dry cough enlarged spleen if serious = brain infected seizures/LOC
post Haiti earthquake decision for amputation
damaged limb is a septic risk. so salvage isn't a risk wortht taking -hatians had a strong preference to keep the limb b/ they are a society w/ADA accommodations so it would be a hard life to be disabled. the surgeons looked at the conondrum w/ an etic view
International Health Regulations
dating back to 1851 that mainly govern ID
cause of death in neonatal tetnus
death from spastic asphyxiation
leading cause of worldwide death in woen 15-19
death in childbirth
what is considered a "late maternal death"
death of a woman 42 days - 1 year after termination of pregnancy (to capture deaths that may have a link but would otherwise be missed in civil registration systems for death. better care postpartum today means more women are surving the initial 6 weeks postpartum and die at a later time)
late maternal death
death of a woman from direct or indirect obsetric causes more than 42 days but less than one year after pregnancy termination
pregnancy-related death
death of a woman while pregnant or within 42 days of pregnancy termination irrespective of the cause of death (so car accident counts as a death of pregnant woman)
pregnancy-related death
death of a woman while pregnant or within 42 days of termination irrespective of the cause of death. like car accident
maternal death
death of a woman while pregnant/within 42 days of termination of pregnancy regardless of duration and site of pregnancy from any cause rt or aggregated by pregnancy or its management but not from accident or incidential cuases
how do you die in neonatal tetnus
death of asphysxiation r/t paralyzed muscels of respiration
what health statistic demonstrates the largest gap between rich and poor countries
death of women in childbirth r/t preventable causes
priorities to fix the 2nd Delay in the 3 Delay Model
decentral EOC, services at the community level
DOD INstruction 3000.45
declared stability oerpations are now a core US military mission and shall be given priority comparable to combat operations
obstacles to HIV treatment
decreased lab/trained staff, culture and leaders, hop, lack of universal access to antiretroviral, even in US, some peopel aren't willing to recoginize HIV at risk populations like homosexualis as deserving of intervejtion
concept of improving infant mortality
decreasing the fetal mortality rate also decreases fertility families are spontaneously choosing to have fewer children b/c maternal and child health are improving fewer chidren are needed to ensure at least 1-2 survive to adulthood/replace self/farm/support elders/continue bloodline industralization deceases need for labor urbanization increases the cost of children child labor laws education standards improved female literacy & employment improved contraceptives
greater priority that actually feeding someone who is severely malnourished
dehydration hypothermia hypoglycemia ABX for septic versus hypovolemic shock
death from cholera
dehydration related hypovolemic shock
cholera s/s
dehydration s/s,profuse diarrhea "rice water stool complications -renal fail, severe electrolyte imbalance, shock coma
compare dengue fever versus malaria
dengue - virus malaria - parasite both transmitted by mosquotos but differnt types D- Aedes egypti M- ANopheles d- supprotive care only M- multipel rx options dengue is prevealewnt in centrial amwrica malaria has low presence in central america
example of an infectious disease that is worse if you get reinfected 2-3 more times
dengue fever can become dengue hemorrhagic fever which is dnegue s/s pllus plasma leakage an thrombocytopenia (low plt. leaks fluid aout of circulating system but also bleed profusely b/c low ptl
"breakbone fever"
dengue fever. b/c of the high fever pulus joint/muscle/bone pain
repeated infection w/dengue
dengue hemorrhagic fever -all of dengue s/s but also plasma leakage and low plt (so you blood becomes to thick leading to shock & low plt so you bleed profusely) *prob need blood transfusion
worse form of dengue fever
dengue hemorrhagic fever. high mortality often in people who are on their 2-3rd case of dengue fever. dengue is often worse w/subsequent infections which is opposite form most ID where subsequent infections fare better in your body if happen at all
dengue versus malaria in Central america
dengue is prevalent (aedes egypti mosquito) Malaria is not common (ANophaoles)
when does the guinea worm emerge based on climate characteristiscs
dry climates: emerges during rainy season b/c even if overall dry climate, it will have the best chance to reporduce in wet climates- comes out duriy dry season to max chance of transmission b/c less water so higher conecentration
UN's stance on the cholera epidemic post 2010 Haiti erathquake
during the initail outbreak, the UN resisted any suggestion that its workfrorce was responseible but all evidence including a molecular study that linked the strain to a cholera epidemic in Nepal pointed towards the UN compound base as the place
cultural relativism
each culture has their own way of doing things. they aren't wrong just differnt
impact of HIV/AIDS
economic activities, agriculture practices, childhood development, credibility of political leaders, education,
HIV is particulary devestating to...
economic growth. hits peopel in the prime of their working years when they make max ontributions to economic grwoth and reproduce -prolonged illness that taes teh heatlhcar system -kids left w/o biologic parents
why should I care about inequality?
economic inequality is linked w/health inequality health inequality further slows economic growth an threatens everyone high levels of inequality are usually associated w/lack of opportunity and economic inefficiency
cardinal characteristics of Kwasniorkor
edema
how to tell by looking at someone if they have severe malnourishment
edema = kwashiorkor weight for heigh.
specific sign of kwashiorkor
edema especially in abdomen and feet no edema in arms flag sign in hair - shows acute period of low protein
modern healtgh systems require funcigning...
edu, economy, pharmaceuticals, transportation, reccord keeping, communication, physical infrastructure, supply chain managemnet, secuerity
GLobal Health Security Agenda
effort between the UDS gov/nations/public & privator section to accelerate progress towards a world safe and secure from infectious disese -global health security is a shared responsibility that cannot be achieved by a single sector -globalhealth.gov
Global Health Security Agenda
effort between the USG/nations/internal orgs/private...to accelerarate progress towards a safer world and security from infectious diseses/promte globval health security
how does Ascaris lumbriocoides infect humans
eggs in soil. ingested. burrow thorugh the lining of the intestines. travel via bloodstream to the lungs (live there for 1-2 weeks), crawl up the trachea and trigger the cough reflex. coughing reswallows. back down int the intestinal system. fully formed at that pont. 240K egs/day. the feed on the same food we eat so you are also malnourished
NGOs
either tax exempt ior not form the structure of ivil society civil society not only helped our soiety but also helped sustain and power wour nation into the future can still receive a lot of funding from gov aren't just to give people enrichment during a midlife risis. they are also the fabric that holds a demoratic society together
reduction to zero of disease/agent presence in a geographical regions
elimination
difference between elimination and eradication of a disease
elimination meens it is still present in the world but not completely eradicated or extinct eradication - permanent reduction to zero of worldwide incidence extinction if no longer present including in labs
2 important NGO activities
emergency response and development
insider view
emic
view of a culture as an insider
emic
population policy prior to 1994
emphasized family planning and economic -intended to reduce fertility and thus, pop growth "Deliberate COntrol of Fertility" =edu methods of fertility control, promote breastfeeding, contraceptive, abortion, sterilize, postpone marriage
population policy prior to 1994
emphasized family planning/economic devellopment. intended to reduce fertility and therefore population grwoth
marasmus
energy deficient. think, old man's face, baggy pant legs, skinny arms/legs. wasting undernourishment
infectious diseases that affect the stomach/GI
enteric
where is Malaria a threat
equator-ish SE Asia, SSA< AMazone
ID still exists in labs but not in general population
eradication
permanent reduction of zero cases of an infectious disease worldwide but may still be kept in labs
eradication
permanent reduction to zero of worldwide incidences
eradication
when is eradication a more feasible target for an ID
eradication is more feasible if humans are only infected and is a deliberate part of an organism's life sycle
economical impact of eradication
eradication programs consume majory money and economic resources
GOARN
established officially in 2000 as a network of technical instututes, research, universities, international health organization , and technical networks willing to contribute and participate in internationally coordinated responses to infectious diseases outreaks. reflects recognizeation of hte needd to strengthen and cordinate mobilization of experts. the network partners agreed that WHO would coordinateion teh network and porovide a secretariat which would also function as the oeprational support team
outsider vieqw
etic
view of a culture from an outsider looking in
etic
US code labels money as humanitarian assistance
even though DOD is not tru humanitarian b/c can't follow the humanitarian principles
what does everything we do in DOD in relation to GH need to do
everhything we do in DOD in relation to GHE needs to be planned/executed to help accomplish COCOM objectives. usually r/t access, influence, interoperatability, security coopr, threat refuction, persistance face. **health by itself is rarely the sole objective
foreign policy intervention at the start of each presidency
every administration shoudl strongly review our nations overseas commitments
% of USA's GDP that is r/t consumer consumption
everything the people in a country purchase 70% of USA's GDP that's why we care so much about consumer confidence
what command does the work of DOD support
everything we do in DOD is to support COCOM (COmbatant COmmand -has 11 commands each with a differnet function_ *functions usually r/t access, finfluence, interoperatiability, security coperation, threat reduction, engagement. HEALTH BY ITSELFG is rarely an objective
creation of USAID
executive order under Kennedy in 1961
EMEDS
expeditioanry medical support
how do exports and imports impact GDP
exports add to GDP imports subtract from GDP
effect of USA"s net exports on GDP
exports minus imports exports add to GDP imports subtract GDP in the USA, we export so much oil that we have negative net exxxports so net exports overall contribute the least to GDP -but countries able to export high amounts of natural resources = net exports makes a very high % of their GDP
XDR-TB
extensively drug resistant TB
what does the Dept of Homeland Security called an "emerging threat to the homeland"
extensively multi drug resistant TB XDR- TB
an ID no longer exists in general pop or in a lab
extinction
not present in nature or lab
extinction
effective way to decrease female mortality rate
family planning
spread via night soil
fecal fertilizer Ascaris lumbricoides
how does polio spread
fecal oral
how is cholera spread
fecal oral route via contaiminated water vibrio cholerae. single celled bacteria. stool o peopl with cholera containmates the water
spread of cholera
fecal-oral bacteria
what happened when the hospital ship visited Trinidad and Tobago
felt the visit was patronizing
when is deference to a culture of a secondary concern?
female circ? starve girls and feed boys? culture beliefs directly counter to health
transmits malaria
female moquito -Anopheles ah noh pho lees
cult versus culture
few 100s in Waco and that is a cult but thousands/millions in a utlure -longevity . culture has generational parts some people who support a culture w/reverancec disparage a ult if we critique cults, perhaps it is not out of line to critique cultures
what is happening to the HIV cases # now
fewer dying of HIV/AIDS more living w/HIV/AIDS
how have efforts to eradicate polio gone
first goal was polio free world by 2000, 2008 bill gates joined and the new goal was 2018 **assination of Bin Laden meant Pakistan distrusted the efforts so cases increased in Pakistan b/c couln'd vacinate
garrison theatre
fixed hospitals for routine care
Neonatal tetnus
flaccid paralysis paralyzes respiratory muscles constant state of painful contractions/spasms of large muscle groups **paralyzed into a constant state of contraction
"Decisions for Assessment and NOtification of Events that COnstutute a CPublic Helath Mergency Of INternational COncern"
flow chart for GOARN
supply-side population policy
focus on family planning management
demand side population policy
focus on women's socioeconomicall status. overall desire to reduce maternal mortality rate. family planning is a way to reduce MMR. the already high MMRate in the developing world is greatly exacerbated by the fact that women in the developing world have 2-3x more children. so the goal is to decrease the total number of children each woman has
easy way to decrease cholera risk
fold a sari x4 then filter water through it drops cholera 99% -tried to teach in bangledesh. returne to see if the intervention had worked. showed that the rates of women taught to fold the sari to make a filter dropped to 26% and of those people,, most only folded once when they were taught x4. shows that even simple interventions need periodic reinforcement
FAO
food and agriculatureal organization
disease & food security
food security is directly lined to zoonotic diseases in rural communiteis. plays an important role in development
ideal distribution of EmOC
for every 500K people, there should be at least 4 facilities offering Basic EmOC & one offering Comprehensive EmOC
EmOCC recommendations
for every 500K people, there should be at least 4 facilities offering Basic EmOC and one w/advanced EmoOC
example of when the UN was sued
for the Nepal solider basie putting cholera into the water system in Nepal post the 2010 earthquake. asserted they responsibel for introducing the bacteria via seqage form itds barracks UN claimed diplomatic immunity for the negligence clims when the Haiti people whings is a violation of UN primicples
RAND
founded by DOD to do research about DOD?
Nigerian Civil War in Biafra in 1968
founding of Drs w/o Borders b/c the founders felt conclicted about not speaking up due tot he humanitarian principles of neutrality/impartiality
seconday/teritary effects of Direct Medical Care instead of capacity buildign
free food puts foarmers out of buisness, free medical puts pharmacists out of business free healthcare undercuts host nation doc RN/midwife hiring translators typically means brain drain of the doc and other highly educated in the region.
liberty
freedom to live in full expression of one's natural or human rights
legal versus human rights
freedoms that can/can't be negotiated away as a part of a social contract
how many did smallpox kill in 20th century
from 1900 to 1977 (last 77 yrs prior to extinction), 300 million were killed
how did Salk get funding for his polio vaccination
from FDR's National FOundatin for Infantile Paralysis which later became March of DImes
how did cholear get to Haiti
from UN troops form Nepal who was having an outbreak. sent to help post Haiti earthquake in 2010. Nepal had an endemic cholera. leaked into the water system via poor sewage form the base
orign fo the ward quarantine
from the Italian world for 40 days
division of Combatant Commands
geographic function
how does malaria affect humans
gets into blood stream the RBC's multiplies in RBC"s then bursts enters new RBC **relapsing fevers r/t when the RBC's burst
when do people get guinea worm
gget when drink contaminated water. after a yr, a foot long worm emergens through a painful bliser int eh ski. incapacitates person for weeks
global versus international health
global = issues that transcend borders international =us helping them bilateral projectsq
total impact that poor health has on various societies/economies/families
global burden of disease
USA mainland is kept safe from infectious diseases & overseas threats
global healht security
global health efforts USA versus aborad
global health is not about how things are done in the US -in some places, cars are pulled over and if the kids are under 5yo, they are vaccinated w/o checking their immunization record
concept that USA is now threatened less from conquoring staates than we are failing ones
global health security
sector that is responsible for global health security
global health security is a shared responsibility that cannot be achieved by a single sector
GOARN
global outbreak and alert response -collaborati e of institutions like NGO, acadmeic, IO -started in 1998 and formalized in 2000 agreement to pool info about infectious diseses
difference in credit between developED and developING countries
good faith and credit is a benefit not available to developing countreis b/c their government is not able to borrow heavily to prop up the government while it waits for the ability to print more money (often what they choose to do whenever you are in trouble) -higher interest rates (stressed countries have higher interest rates)
what is a good idea to consider before planning GH projects for a country
good idea to start w/their GDP -RADM in the US Pacific COmmand said one of the first things she does (trauma surgeon by tradeO is to look at the GDP of a contry and especially its % of money spent on health b/c that will give you some indication of hte interests a government might have in health engagement
Red Cross recommendations to governments of disaster regions
gov should recognize/respect the independent humanitarian and imparital actors host governments should facilitate rapid access to disaster victims governments should faciliatate the timely flow of relief goods/information during disasters governmetns should seek to provide a coordinatied disaster information and planing services
partnership
gov, community, donor, nonprofit, private section, university, international rog
deficit spending
government takes action during fluctuations in GDP to prevent instability. so spending on credit yet this still contributes to GDP
w/o NGOs
government would have to take a larger role in society
"Give Well"
group formed by wealthy invest,ment bankers w/venture capital who reserched charities to see if they are really working
GEF
guidence for employment of the force
GFDF
guidence for the deployment of the force
ancient finding of guinea worm
guinea wor has been found in mummies
Dracunculitis
guinea worm
next disease scheduled to be eradicated
guinea worm aka Dracunculiasis (drag uhn koo lia uh sis)
suspect if you see a picture of a thin white worm coming out from a lower extremity burning boil (or if you see a leg in a bucket/body of water) and it is twisted around a stick
guinea worm aka Dracunculitis
what is a Neglected Tropical Disease that we are close to eradicating
guinea worm aka Dracunculitis
differences in infectious disease worms
guinea worm aka dracunculitis -drink contaiminated curstations w/blackflu. larvae grows and penetrates intestinal wall. migrates downwards. causes burning boil when the worm chooses to exit Ascaris lumbricoides (ass care is lumber coi deez) -worm with eggs in soil. burrows through intestines into bloodstream to lungs, cough up worms then reingest. can poop out worms Taenia Solium tan ee ah sol ee um -tapeworm. invades intestinal wall into striated muscles/liver/rbain. responsibile for a large number of seizures in the developing world
morbidity and mortality of guinea worm
guinea worm is rarely fatal but does debilitate for weeks
how did we eradicate smallpox veia vaccination
had to chase and force people to vaccinate India & NYC
definition of global health engagement
health activities DOD conducts in support of national security policy & military strategy of the US -partnering w/ other nations for security coops/exchanges, build partner capacity **to build trust/confidence, coordinate activities, maintain influence, achieve interoperatability
DOD definition the closed to GHE
health activities teh DOD conducts in support of national security policy and military strategy of the US. means to partner w/other nations to achieve security cooperation and build partner capacity via health related activities and exchanges. partner capacity via health related exchanges -allows the US to build trust/confidence, share information, achieve interoperatability
bidirectionally linked
health and economic development
increasing recognize subset of Global Health Engagement
health diplomacy
impact of health sector improvements on GDP
healthy workers can produce more
Ivermectin
heartworm for dogs River Blindness for humans
gold standard testing for stuntin
height for age
mid upper arm circumferenmce
helps detect kwashiorkor b/c weight is artificially higher due to abdomen/feet edema but the arms aren't affected by the edema
IDA
helps the poorest countries w/concessional loans and sometimes grants
Top 5 causes of maternal death
hemorrhage infection unsafe abortion eclampsia obstructed labor
s/s of Dengue
high fever severe HA behind the eyes joint/muscle/bone pain
s/s of dengue fever
high fever, severe HA behindeyes, joint/muscle/bone pain "breakboen fever"
land is a finite resource
higher populations need more land. no sons for land so army becomes an option. suprpulus population feeds instability. if modern soieties can't accommodate modern population then resources cant' support this growth. population growth up agianst constrained resources causes war
spread of measles
highly contagious! contagious before the rash appears so if you spot the Koplik spots, that is an early warning sign runny nose/eyes are s/s
how does culture view hospitality
hospitality is viewed as a cultural religious obligation (Africa/Afghanistan, Christianity) likely evolved as a cultural survival trait. if you help my people, I will help your people
BRad's thoughts on sustainability in the health sector
host nation must be able and willing
what does the Demographic Transition Model explain
how a population's crude birth/death rate change as the population progresses through different stages of development/industralization
% of USA's GDP that is r/t goverment consumption
how much the government spends to contribute to GDP 15-19% GDP
alternative way of answering the question "How does a country increase its wealth?"
how to increase the country's GDP
where do human rights actually come frome
human rights actually come from an evolutional adaption. -made some societies better -cultures that don't adopt human rights are at a development l disadvantage
what trumpts culture in Unviersalism
human rights trump culture in Universalisms
3 selectivity criteria for allocating resources
humanitarian need foreign policy interests of US commitment of a country/eadership to reform
what is important to consider when you establish partnershipos
humanitarian space
The Seven Fundamental Priniples of hte REd Cross/REd Crescent MOvement
humanity impartiality neutrality independence oluntary service unity universality
7 Principles for IRCRC
humanity impartiality neutrality independence voluntary service unity universality
4 fundamental humanitarian principles
humanity neutrality impartiality independence
core humanitarian principles
humanity, humanitarian imperative, impartiality, indepdnence neutrality -US gov can't do. even most NGO's can't
4 humanitarian principles
humanity, neutrality, independence, impartiality
appetite of someone w/Marasmus
hungry
innoculation and Jenner
ideal to innoculate was a few 100s of years prior to Jenner but Jenner's contribution was to test the hypothesis and show it was effective. of not, germ theoyr was not proven at the time
how to intervene if you need a water-based isease in a population
identify local bodies of water determine how the people use/interact w/the water -for food, sewage, dump waste in it, drink it, bathe in it, wash in it
when do you suspect someone has guinea worm
if a burning blister on lower extremities produces a white thin worm. pull out a few centimeter sper day and twist around a stick
immune system and nutriton
if malnutrition is extreme, extreme immunity decreases into "nutritionally acquired immune deficiency"
Principles for eradicability criteria
if meet them, then a good candiate no animal reservori no animal vector no carrier state/subclinical disease effective/stable/transportable vaccine practice dx tactics w/ sufficent sensitivty and specificaty
when isn't it worth it to give contraceptive to women
if they are not allowed to have a say in their reporoductive choices
how to get people in rural areas to report smallpox
if you get sick in a rural area, what incentive do you have to report smallpox to a world level organization when you don't understand vaccinations. so they offered $1000 reward to report
important thing to remember about how inequality clouds your understanding of using GDP to measure QOL
inequality. few people are making high $ yet lots with lower income so the average GDP of the entire country is artifically inflatedf e.g. if teh 300 richest in USA each saw they income incresaed by $1B per year, the per capita GDP would raise per capita GDP by $1k per person . yet not many people are doing better as a result of htis change **so you should not use exclusive use of per capita GDP
transmission of cholera
infected stool gets into water source
top 13 causes of DALYS in kids living in develping countries
infectious disease related including lower respiratory, rpeterm, diarrhea, malaria, neonatal encophatholapty
greatest afflictions to mankind
infectious diseases malnutrition famine
term for a community having both group 1 & 2 disease at the same time
infectious/maternal infant/nutr diseaes & noncommunicable -Double burden of disease
World Health Assembly Stratiggiv directions for HIV
information to focus action (know your epidemic/response) interventions for impact (cover range of services needed) deliverying for equity (cover range of affected populations) finance for sustainabiliy (cover costs for services)innovation for acceleartion (innovate to the future
5 C's per WHO for HIV testing
informed consent confidentiality counseling correct test results connections (clinic to care, treat...)
$ for PEPFAR
initial $15B in 2003-208 increased to $#48B in 2008
impact of PEPFAR
initial 5 year commitment of $15B (2003-2008) for HIV/AIDS second round increased to $48B and included money tof rTB and Malaria by 2012: 5.1M peopel were getting ART (antiretrovial therapy) , ART to 750K pregnant and 230K babies were prevented from deveoping HIV direct supprort to 5 million orphans
original PEPFAR
initial 5 year commitment of $15Billion (03-08) for HIV/AIDS and expanded in 2008 for $48B despite the decreased stock market and high unemployemnt -this move was suprising to GHE experts b/c Bush jr more financially conservative and there was no signgs they were interested in spending this much money on foreign aid....suddenly announced $15B in seed money
comitment of PEPFAR
initial commitment of $15billion (2003 - 2008) renewed in 2008 for additional $48B (x3 initial amount)
one of the most serious failures of foriegn aid programs
inject too much money into local instiuttions that cannot responsibly spend that much money
Group 3 diseases
injuries
important thing to know about innoculation and Jenner
innoculation of smallpox was happening for generations prior to Jenner. he was even innoculated as a kid. innocultation with cowpox was happening for 20yrs prior to Jenner's work and that is documented. so his work was significant but was one of many
Koplik spots
inside cheek by 2-3rd molar. round pale white/target shaped lesion appears up to 3 days prior to the rash so is a early warning sign plus distinguishes measles from other viruses
what is happening in debt spirals
interest and debt spirals out of control bc/ the anser to it is supposed to be increased spending
policy versus politics
interest s of 2 distincts that makes this a spectator sport in government the ability to balance the two distinguish good development workers from the bad
IDP's
internally displeaced persons
important of NGO's using local staff
internastional NGOs have moved to using local staff in response to buildign local capacity, stafety, and credibility
foreign direct investment
investment in the form of controlling ownership in a business in one country by an entity based in another country
% of USA's GDP r/t investments
investments = business purchases in order to produce goods that consumers buy 10% GDP
what do investors desire
investors in your country's economic sector want reasonable assurance that they will get their money back. so stability and anticorruption practices are important
security cooperations
inviovles the partnering in practical ways w/other nations to accomplish mutual security objectives
cause of irreversible mental retaredation
iodine deficiency
what mineral do you wait to give in a patient has a nutritional deficiency
iron needs to have a healing gut so wait 1-2 weeks before giving
s/s of iodine deficiencies
irreversible mental retardation if low during pregnancy creatinism & goider
Discounting
is a year of healthy life now worth more than a year sometime later? (would you rather be paid $50 today or $100 in 50 years?) they used to apply a3% discount rate to all DALY calculations problem: a year of life is a year of life and it doesn't matter WHEN it was saved
topics to ponder
is the UN legally responsible fort he cholera outbreaks in Haiti? what does it meant to be legally responsibel? what, fi anything, does the UN owe to Haiti for the cholera oubreak linked to the UN Nepal soldiers barracks poor sanitation? what possibel implications are there for humanitarian workers sued when things go worng even if guity, is the UN protedcterd by dipolomatic immunity? separate form legal obligations, is there an ethical/moral requirement? thoughts on giving money to CHina via PEPFAR or devleopment assistance to CHina in general? what is the argument for doing so?
Q's for the UN about their role in the cholera epidemic post Haiti earthquake of 2010
is the UN legally responsible? should they compensate victims? what are the likely implications if a prescedent is set that humanitarian workers can be sued when things go wrong? UN says even if theyir workers are guilty, they are protected by dipolomatic immunity
isolation versus quarantine
isolation -keep symptomatic from healthy quarantine - ROM healthy who were in contact
why did the USA go cautious into Darfur
last major African campaign was in Somalia - disaster US was already in 2 major conflicteds and Iraq was at its height -so we partnered w/Rwanda b/c we both had the same interest Rwanda- familiar w/continent, culture, language USA gave Rwanda airlift, logistics, expeditionary. let us contrubute to mutual interests w/o comitting troops
Global Health Security Agenda
launched 2014. w +40 countries to enhance global capacities to prevent/detec/t/rapidly repsond to ID threats to achieve measureable... intended to accelerate action and spur progres towards impromenttativo of the WHO's INternational Health REgulations -also engages in NGO secorove , academic/research insitutions, thin tan ks, industry, philantorpy, prvate sector
role of USAID
lead US government agency for developmental assistance DEVELOPMENTAL not a pure global health focus
what did early leaders in hx say about the laws
leaders learned to say the rules were sent down from God
problems of vitamin A deficiency
leading cause of preventable blindness makes measles worse
eyes & vitamin A
leading cause of preventable blinness Bitot's spots =buildup of keratin in the eye
Lawrence of Arabia
led Arabians agaisnt the Ottomans wrote 27 Articles good at cultural competence
Foreign Assistance Act of 1961
legal authority for Foreign Humanitarian Assistance (FHA) & created USAID
Title 22 USC
legal authority under Foreign Humanitarian assistance to conduct these types of operations
International Development Assocation
lends to the poorest countries interest rate free for 35-40 years
what is considered a well managed epidemic
less than 1% case fatality rate is considered a well managed epidemic
US budget for foreign assistance
less than 1% of US budget is allocate dfor foreign assistnce and OFTA gets 1% of that
how do get the locals on your side when the local insurgency disseminate negative information about your operation
like in the PHilippeans, Abu Sayyaf said the US miltiary would leave. USA deflected most of the credit to their Philippean counterparts, had them ask "show what the the Philippean military can do for the people. what has Abu Sayyaf done?
where did smallpox first develop
likely started in North Africa then moved by traders to Asia
chambray shift
linin finished gingham cloth w/a white weft and a coulored warp producing a mottled appearence
concessional loans
loans offered for more favorable terms than would be obtained byu the borrower under any other means
perception of US military in other countries
locals in Africa & South America like the US military but not their own country's military
strengths teh US military brings to the world stage
logistics, communication, seucirty
political impact of giving someone motrin
long-term impact is not to give motrin to someone who has a HA today and then you leave tomorrow. no lasting impact of that action on the body. instead, it is an act that shows thepeople that their government thought you were important enought to be sent an asset to help so there was a poltical impact
what is a good way to calculate the budget each country can afford to spend on each person for GHE projects
look at GDP per capita x % GDP spent on health -may differ based on subpopulations -often the number is appalijngly lo9w
how should you look at global heath
look at global health as acomponent of greater pictureo of development
first thing to look at when you are starting a GHE project
look at that country's GDP
to-do list for sustainability
look up the country's per capita GDP estimate what % can be spent on all health services ask yourself if your program can be supported within that constraint. if not, do you have afunding streams?
relationship between GDP and nutritional deficienies
loss of GDP is attributable to nutr deficiencies *Pakistan's iodine deficiency decreased GDP 3% *Bangledesh had its GDP decreased 1.9% due to iron deficiencies
stunting
low height for age
risk factors for enteric infections
low socioeconomial status lack to clean water/sopa/modern fertilizer, caccess to care
cause of night blindness
low vitamin A
increases mortality risk of measles
low vitamin A
nutritent given during a measles outbreak
low vitamin A makes measles worse so vitamin A is given in measles outbreaks
what makes measles worse
low vitamin A so vitamin A often given in measles outbreaks
wasting
low weight for height
potential cause of diaper rash in malnourished
low zinc can cause dermatitis which is often a cause of diaper rash
divisions of undernourishment
macro and micro macro - wasting/stunting micronutrient OVER = highly processed b/c cna't afford better
malnourishment in Kwashiorkor
macronutrient protein deficiency cardinal characteristic = edema
simplistic cause of Marasmus
macronutrient deficiency acute wasting "energy deficiency"
impartiality
make no discrimination based on nationality, race, religious beliefs, class, or political opionion -must be guided solely based on teh needs of individuals and priorities given to the msot urgent of cases in distress
goals long term
make response sustainable w/o large international presence need development storng good health care system money
stance of S. Africa to HIV
movement of anti-HIV was strong and president Mbeki believed them. refuesed free HIV treatment despite Jimmy Carter (who almost punched him) & Bill Gates trying to intervene. magizine promoting anti-HIV supported this but they no longer are publishing b/c the editors died of HIV
who gets the worst malaria
msot deaths in kids/pregnant poor birth outcomes so helath/economic/development problem
MDR-TB
multi drug resitstant TB
vector of River Blindness
multiple blacky fly bites that deposite pasitic worm larvee
to be a not for profit
must be charitable in mission, managed/accounted for by a board of directors with financial interests , main financial accountability open to public at all
how to be a humanifarian organization
must keep to humanitarian principles impartiality, universality, neutrality, independence
cause of TB
mycobacterium TB affects lungs spred via drpets
why is the denometer of MMR (maternal mortality ratio) # live births?
n developing countries, it is really hard to count number of pregnant women and easier to count live births
how do you enforce IHR's?
naming and shaming
when do people w/TB get ill
nearly everyone infected w/TB get sick int eh first 2 years. reserachers have spent hundreds of millions chasing TB latency butthe whole ideas that 1/4 of the world's population has latent TB may be a misunderstanding. so people dx w/TB latency are not necessarily ticking time bombs
vital interest
necessary to the continued existence/continuoation of life/essentia
what vitamin should you wait to reintroduce if correcting malnourishment
need a functioning gut so wait 1 week to reintroduce Fe or until gainign weight
everything we do in DOD in the realm of GHE
needs to be planned/executed to help the COCOM relevant objectives -usually objectives r/t access/influence/interoperatability/security cooprs/threat reduction/persietent engagement... health by itself is rarely ano objective ***so if I want to do a GHE project, I need COCOM buy-9jng
NTD
neglected tropical disease
soil based infectious disease
neonatal tetnus (clostridium) - asphyxia spasms ascaris lumbriocoides - worm that has its eggs int the soil
aka Taenia SOlium
neurocystircerosis neuro sis ah cer coisosis
first sign of low vitamin A
night blindness
infectious disease linked to night soil
night soil is when you use poop collected over night to fertilize your crops Ascaris lubriocoides is a worm from the soil
chance of measles being eradicated using the eradication framework
no animal resrevoir/vector good vaccine does have a carrier state-contagious a few days prior to s/s so difficult to quarantine/isolate **they loked at eradicated it . they have a strategic plan to decrease but not yet eradicate 1. immunization coverag 2. suerveillance 3. preparedness to rapidly deploy resource once detect outbreaks 4. build public confidence to vacineate 5. reserach/develpment
principles of eradicability
no animal resrvori no animal vector no carrier state/sympotomatic subclinical disease practical/sensitive specific dx good vaccination
Principles of eradication (what criteria makes a ID good for eradication)
no animal vector no animal reservori no carrier or subclinical state effective/stable/transportable vaccine practical diagnostic tools w/sufficient sensitivity and specificity
public health crisis post Haiti earthquake
no cases of cholera. post 2010 earthquake, UN sent reinforcements to help including Nepal soldiers. Nepal was having an outbreak & bad septic on the base which leaked into thewater
Haiti & cholera
no causes unti the 2010 Hait earthquake brought UN troops to help. included Nepal soldiers. their base didn't have good sanitation and it leadked into water source
cultural relativism
no culture is viewed as better or worse; just different
how do we consider USAID today
no longer operates on teh periphery of US foreign government. now it is considered vital ot US national strategy interests
Group 2 diseases
non-communicable
definition of NGO
nonprofit, voluntary citizen org =task oriented, driven by people w/similiar itnerests of service/jmantarian functions, citizen coerns to o , advocate/monitor poli;ocies -some are organized around issues like human rights/enrironment/heath -gives analysis, expertise, early warming mechanisms, and helps monitor/implement international agencies _their relatio
Principle of eradicability & neonatal tentus
not a candidate for eradication b/c it exits worldwide in the soil ***can control/eliminate via vaccination
guidelines for using middle upper arm circumference
not for prevalence studies use as treatment facility admissions screeings use secpndary testing to conform
problem of anthropomorphic measurments to detect nutritional deficiencies
not great for edema conditions like kwashiorkort
why is lack of opportunity a bad thing
not just b/c it is unfair or unjust in economic terms, it represents lost potential economi growth
Human security
not just freedom from harm -UN states HS is protection within 7 domains: economic, food, health, enviornment, personal, community, political
extinction
not present in lab or nature
what increases the risk fo a GHE program failing
not taking into account the 9 PRinciples of REconstruction & Development
the business of getting elected
politics
the process of securing popular supprot
politics
how do you get taenia solium aka neurocystircerosis
poop in water or eat undercooked pork contaiminated w/taenia solium
s/s of low zinc
poor growth lethargy anorexia dermatitis (often a cause of diaper rash) hypogonaditism
world population 1500
pop boom post Black Death
Malthusian catastrophe
population outgrowth outpaces agricultural production causing populations to be limited by famine or war
city in Haiti
port a brince
severe undernourishment w/potbelly versus thin all over w/sagging pant buttock
potbelly = edema = Kwashiorkor thin all over = Marasmus
characteristics of Kwahiorkor
potbelly edema. arms will stay thin moon face reddish hari flaky-paint discoloration enlarged liver flag sign in hair that shows acute periods of low protein
principle cause of hunger
poverty
causes of hunger
poverty is the principle cause of hunger harmful economic is a princple cause of po erty/hunger conflicts cause poverty/hunger
a pregnant woman dies in car crash caused by a drunk driver
pregnancy-related death so the fact that she was pregnant & died is accounted for in statistics and isn't missed
stage 1 on the Demographic Transition Model
premodern times OR today's developing world high death rates & high birth rates = stable population over time
when did President Carter almost punch/get into fistfight w/a world leader
president of S. African in the 90s denied the link of HIV an thought it was r/t poverty. declined offers for free rx to be donated and obstructed global health grants to people hin his own country. essentially rejected 20 yrs of science.
3 groupings of GHSA objectives
prevent detect respond
primary prevention
prevent new cases from developing interrupt transmission of pathogen to host increase resistance to pathogen such as vaccination
prognosis for TB
preventable cureable
criteria common in Neglected Tropical DIseases
primarily affects the poorest in less developed doesn't threated health in developied not a profitable market to develop cures lack of political will in teh develiped world to prioritize govermet founded research towards the condition subset of diseases considered "neglected" by large pharmecutical companeis/decision makers in teh developed world **other times, the cure exists but people can't affor4d and little outside money to help
where does almost all of the world's population growth occur
primarily in the developing countries. this trend is expected to continue through at least 2050
policy (GH)
principle or protocol to guide decisions and achieve rational outcomes
policy
principles/protocol to guide decisions and achieve rational outcomes
what do developed countries do when they are in economic trouble
print more money stressed countries have higher interest rates
how did we change the way we think about global health as a vital interest
prior to 1997: GH was just thought of as something we do to be nice/humanitarian -the "America's VItal Interest in GH" by IOM in 1997 said it was actually in OUR interest taht we engage in GH 1) distincition between domestic/international health problems are losing their usefulness and are also misleading 2) the direct interests of America are best surved when AMerica acts decisively to promtoe health aroudn the world 3) the failure to engage in teh fight to anticipate, prevent, ad ameliorate GH problems would diminish American states int he realm of health and jeopardize our own health, economy, and national security
abaya by US military women stationed in Middle East
prior to 2002, US military woman in Saudi Arabia were required to werar an abaya when the left base. not imposed on males. in 2002, ongress said DOD can't force abaya on us service women stationed in SA> this law only applied to SA so the issue revisited a few years later in Afghanistan
when are you contagious if you have measles
prior to the apparance of the resh
prerequisite for COIN
security is needed as a prerequistie for COIN
Cost-effectiveness for Global health priority setting
prioritize funds to get more bang for your buck. address the greatest M&M needs limits: doesn't take into account future ramifications (lots of money spent to combat polio but it isnt M&M inpactful on a grand scale these days), health security concerns (prevalence of infectious disease sprad), helath system strengthening today leads to benefits/cost saving later
ICRC
private assocaition udner Swiss CIvil COde. its existence itself isn't mandated under gov mandate yet its function/activities protect/assist ictims ogf conflict-are mandated under by the internatioan community of statues are are founded by the international community of states
who was sent to respond to Hurricane Katrina
private docs on the scene said they would leave. they relied on Medicare to be paid for services but the COmfort paid for free so they would leave due to no reimbursement. so even in developed countries, we need to consider how direct medical caren isn't buildign capacity and you are problmen influenceing the system in ways you haven't considerd -Castro also offered to send docs but we decliend
PVO
private voluntary organization
adult lifetime risk of maternal death
probabiliyty of dying from maternal death during a woman's reporductive lifespand usually expressed as a ratio
how many NGOs in Russia
probably 300K
what should you suspect if you see pictures of people in developing nations on scooters like what I used in gym class
probably has polio
problem of humanitarian space
problem happens when theyt enter a conflict zone and do not have their safety protected. then they need to defend their reputation as an impartial actor. coordination w/an organization such as the USG can damage reputation as an impartial actor
problem of short signeted politices
problmatic tha tHIV/AIDS or UN policies didn't address more than . most endemic policies have only been in reaction to specific instances of public outcry -HIV is not curativeand intervdentions msut cover the person's entire life -to be effective, programs must be funded for many years, not just short term, so a massive wave of death once the funding for a HIV/AIDS program runs out
framework of MOE
process-outcome-impact process- programmed sequence of things done to carry out the project outcome- results/effects causes by or attributed to the program. often refers to more immediate effects impact -= long term and higher level effects
s/s of cholera
profuse watery "rice-water stool" dehydration s/s hypovolemic shock
Global Burden of Disease
project starting in 1990s. Framework for integrating, validating, analyzing, and disseminating information neeeded to assess the comparative importance of diseases/injuries in causing premature death, loss of health/disabiliyt, in different populations
purpose of World Bank
promote economic/social progress in developing countries by helping to raise the productivity so their people may live better and fuller lives
World Bank
promtoes economic and social progress in developing countries by helping increase productivity so people may life a better and fuller life
problems w/traditional health care indicators
prostate & breast cancer have the same mortality rate (~23 per 100K males/females) we spend $301 million more on breast cancer research b/c DALY breast cancer death ~68 & prostate cancer death ~80 so more years of life lost (traditional health indicators don't take this into account
basic gist of "America's Vital Interest in lGobal Health"
protect americans enhance US economy apply the best practices overseas it is a good investment we aren't doing GH to be nice...we are protecting ourselves from threats abroad so it is a vital interest of USG
Global Health Security
protect us from infectious diseases abroad concept = poor health elsewhere causes insecurity there and that insecurity harms us here. America is now threatened less by conquorign states than we are from failing ones
preE s/s
protein in urine, edema, HTN
DTRA
prounounced "dit-rah" Defensde Threat Reduction Agency
what is one of the primary responsibilities of a democratically elected governe,mtn
provide essential services which, in tern, builds public support and loyalty
DOTS
prpular int eh 90s. directly observed treatment shortcourse 1.. gov commitment 2. case detection via spuntum 3. 6-8m rx therapy 4. uninterruptred rx supply 5. standaridized record systm
what led to the creation of PEPFAR
publication "The NExt Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, INdia, and CHina -scared us into action
"The Impact of AIDS"
published by tegh UN Department of Economic and SOcial Affairs
PPP
purchasing power parity
how do you use PPP
purchasing power parity means by which to adjust for hte fact that the prices of foods/servi ecs varies widely around the world (e.g. can live great on $80K in the midwest but not in NYC)
World Food SUmmit
q
ROM healthy who were in contact
quarantine
purpose of IMF
quick access credit/funds to avoid global catastrophe. not a humanitarian purpose! they admit their main purpose is to maintaitain stability in world markets!
cause of the spike in world undernourishment in 2007
r/t spike in energy prices. price of fuel impacts worldwide fuel prices. in 2007, was when US gas was $4 per gallon. so high energy prices can put people in a maourished state
can one culture be better than another?
rank base don freeom/corruption, religionous tolerance, women's rights -you can colonialism was so bad and justified by progpaganda of cultural superiority so politically incorrect to do cultural omparisions
secondary prevention
rapid detection of new cases and educate people
s/s of neonatal tetnus
rapid paralysis so you have spasmas ans asphyxiation
Measles s/s
rash fever runny nose/eyes Koplik spots
s/s of measles
rash starts at the head the mmoves down fever runny eyes/nose Koplik spots
RUTF
ready to use therapeutic foods example = Plumpy Nut -a brand version. good nutrition/taste. no aditional processeing on site, stable, texture ok for kids
purpose of the International Monetary Fund
realizes quick access to credit/money is needed when a country is in trouble to avoid global catastrophe.
How do you inforce IHR?
really comes down to naming and shaming
easy way to recognize that the PEPFAR initiative was successful
reauthorized x2
"Global Lessions in Achieving Nutritional Security and their Appreciation to the INdian COntext"
recommendatios to fix political will/leadership multisectoral target keep people support/empower women central coordination/monitoring involve local communities and the private sectior increase accountability
what is a good way to get rural communities to accept and endorse public health measures
recruit local leaders/religous
Control
reduction of incidence/prevalence M&M to a locally acceptable level as a result of deliberate efforts & continued intervention measures to maintain the reduction
Elimination
reduction to zero of disease/agent presence in a geographical region
what are defense expenditures
reequired to maintain consumption levels or functioning of society could be viewed as an imtermediate input leading to no direct benefit or it could gi e rise ot -not direclty source of utility themselves but arenecessary input for
what population is at the greated risk for measles
refugee camps/IDP, malnourishment. has a contagious and asymptomatic carrier phase
role of zinc
regulates DNA synthesis/metabolism, cell differentiation
Feeding guidelines for severely malnourished/needs rehydration
rehydrate first. feed ReSoMal or F-75 or F-100 3hrs later, begin feeds immediately if no sepsis or severe deehydration F-75/F-100 arte light in protein/fat/sodium but high in carbs and Magnesium to help K
treatment for cholera
rehydration w/electrolytes. small spips ABX zinc
characteristics of malaria
relapsing fevers. the malaria parasite invades the RBC, multiples in them, then burts the burst is associated w/the fever 4 subtypes of malaria vivax = fever q48hr ovale= fever q48h malariae = fever q72hr falciparum - no cyclic fever and is the most deadly
how should you bring in relief supplies
relief supplies are brough in to a country for the sole purpose to alleviate suffering -not for commercial benefit
religion as an advantage to early societies
religion offered a competitive advantage to early societies. faith bolstered social order amongst followers and helped bind a tribe together and that is why religions are so widespread today *for ancient societies, the idea of an all-seing being who scrutinizes conduct is a wonderful way to increase compliance
how do we inflence aggregate demand in fragile devoping countries
remember: LIC don't have borrowing capacities) -we build in a way that sincerely inflences per worker productivity in a sustanable way to increase natural GDP aND WEAN SLOWLY AWAY SO THE CONTRY'S TAKES RESPONSIBILITY AD ENVIROMENT OF FGOOD VO ERNA NCE AND SECRETLY SO NATION BUILDING CAN WORK.
life cycle of River BLidness
repeated blackfly bites deposit larvae into skin the larvae stage is reached inn blackfly bites and matures in humans
persistent engagement
repeatedly showing face
RAMOS
reproductive age mortlaity studies
Pashtunwali
requries people/followers to seek reventge to defend honor. possibly a survival trait in premodern timess impedent to development in modern times
trained local laypeople who are familiar & trusted to the locals who are able to provide immunizations to the communty in order to enhance communication
resident vaccinators
Rx for TB
rifampin & isoniazid multi-drug resistant isn't suspceptible to those so needs differnet ones
what are human rights
rights that cannot be negotiated away as part of a social contract. a seurlar moral code
4 goals of the GLobal Polio Eradication INitiatbve
routine immunization of infants annual national immunization days intense local immunization campaings forcused on specific areas sensitive surveillance and lab tests for cases of acute flaccid paralysis
difference between security cooperation & building partner capacity
security cooperation is a more specific event (helping Rwandans respond to Darfur) while BPC is more long-term and specific (like building South Korea to better repel N. Korea)
what has become increasingly important as part of our national security strategy
security cooperations
when isn't a nation's security forces effective
security forces aren't effective when they don't have a good working relationship w/their people
short-term voluntary programs
simply serve as a new form of exploitation using por/marginalized as a stepping stone on the volunteers own personal journey of self disco ery. *1 group used voluntaeers to build compost toilets. the people didn't want to sit where otherts did their business and thoguht it ws more sanitary to do business in the jungle so used it as warehouse
cause of malaria
single celled parasite
how do you d/c River Blindness
skin sample. dn't need to draw blood
cause of the most cumultative deaths in history
smallpox
pox that starts in the mucous membranes then face then extremities then core
smallpox
what has caused more deaths than all combined wars
smallpox
differnce in eradication between polio and smallpox
smallpox had a rash so distinct that laypeople could be trained to recognize the distinct rash. **in last few years of smallpox, strategy was targeted surveillance w/ring vaccination
case fatality rate of smallpox
smallpox has a case fatality rate of 5-15% but was up to 30% in some places
smallpox versus HIV/AIDS in terms of deaths causes
smallpox killed more however, HIV really didn't exist before 1970s and its killed many
what disease has been found on the face of pharoahs
smallpox lesions
what would happen if the samples of smallpox were destoryed in the Russian & US labs
smallpox would be considered extinct, not eradicated
when is vaccination an approach for ID
smallpox, polio, tetnus
greatest enemy of the continential army
smallpox. Washington mandated variolation. probalby daed many lives
Hobbes
social contract. an occurance in which individuals cam etogether and ceded some of their individual rights so others would cede theirs
military & USAID
some military in USAID
role of NGOs
some provide direct service others focus on advocacy
what medical condition did FDR have?
some think he might have haid Guillean Barre rather than polio -had high fevers which is more consitent w/polio **if FDR actually had GB and not polio it was the misdx that saved millions of lives b/c it put attention on polio. FDR inspirated to foundt eh National foundation for infantile parallysis which later became march of dimes and funded the salk vaccine
neutrality and a smokescreen
some think neutrality princple can be used as a mokescreen for a political agentda if it is use to topple a regime or put political pressure on an occupying country
how were babies affected by smallpox
some weren't even named until they proved they were able to survive smallpox
problem of culture
sometimes culture itself is what is retarding development even through that runs counter to the basic "my culture isn't better than yours/teachers who believe cultural relativism taht says "everything is just 'different'"
flag sign
specific sigh for kwashiorkor in the hari that shows a period of low protein
4 Freedoms of FDR
speech worship from want from fear
important concept to remember if a country is deficit spendign
spending on credit still contributes to GDP
what DOD dept is responsible for GHE
spread across DOD
how to remove guinea worm
squirms around under skin, emerges on it so own through burning boils. white thin worm. can be 3ft long. if pull too quickly, it braks. remove by gentle traction and twist around a stick. can only remove a few cm at a time so the whole process can take weeks. painful to remove and no other treatment
when are stability operations conducted
stability operations are conducted across the spectrum from peace to conflict -many think that stability operations are after combat operations are ending but activel when when stability opperations should be happen even during conflict -kinda like how you prepare for hospital discharge the moment they enter the ER
SSTR
stability, security, transition, & reconstruction operations
movement of water & disease risk
stagnant water - guinea worm, mosquito based disease fast moving water- river blindness
Treatment for moderate malnourishment
standard rations for adults w/adjustments based on tempeature & activity level blanketed feeding program = everyoen gets it Targeted supplentary= only give to those acutally malnourished Ready to use therapeutic foods like PlumpyNut
US Global Health Initiativer 2009
started 5 months into Obama's presidency 7 principles = aimed to take desparete grousp and organize them around 7 core principles -focus on women/girls/kids -supprot country ownership -strengthen global health system sustainability -leverage org partnershisp in the private sector -coordinate/integrate strategically -improve metrics/monitoring,eval -conduct research and innovate
started GOARN
started in 1998 and formally began in 2000 b/c the processes by major orgs was taking too long
code of Doctors w/o borders
temoignange = french for to witness describes how they speak out when necessary to "alleviate human sufering, protect life/health, and to resptore srespoect for human beings and their fundamental human rights". created when teh founders felt conflicted about not being able to speak up due to the humantarian principles during the Nigerian Civil War in Biafra in 1968
understand USA's 2008 economic reession in terms of aggregate demand
started: period of low interest rate w/new ways for bank to gi ve easy credit to borrowers led to more people to buy homes for the first time increased prices of real estate more people bought homes housing bubble increased (increased consumer confidence in other appliences/services to improve the home buying experience people made the money then spent elsewhere housing prices began to climb and people tookk out home equity loans more money spent on credit (money spent on credit still counts towards GDP which incrases consumer spending (the largerst art of aggregate demand in USA's economy in any year GDP growth increased alll in the consumer sector. gov setor spent money dramatically so no safety net and goverment spending fueled more onsumer confidence people wern't able to buy expensive homes drove the decreased housing. weath/decreased vacations/products/businesses invetments decreased b/c people wern't buying oil prices were increasing so trade balance not good either US had a crash of epic proprtions USA had to borrow heavily (stimulus packages) and printed money then loaned it to itself and banks
Samanitarian's Purse
state they have a single=minded commitment to evangelicism via aid relief
IHR 2005 "The NEw IHR
states are required to report all public health emergencies of international concern PHEIC states can make confidential notification must report polio and SARS who can get intel from unofficial sources like GOARN stgates are required to develop minimal national capacities to detect/assess/report/respond to PHEIC
Universalism
states that individuals are entitled to certain unalienable rights simply b/c they are a human and these rights shoudl not be denied under the guise of cltures
aka stanima
staying power
problem of INternational Health Regulatiosn of 1951-1994
still focused on too limited numebr of diesases couldn't generate a timely approach to novel diseases the developed world became less concerned about diseases on teh lest. fell they were deveoped enought o not feel worried by Asia's diseses -not great mechanisms for enforceent so no incentive to report 0people in international health actually started to care about people in other countreis but IHR wern't geraed for that
dx cholera
stool sample (frequent stools to the point of dehydration. too weak to get up so best to put on a "cholera cot" which as a hole to poop
what did eradication of smallpox requrie
strong leadership combo of international will & cooperation focused effort of many healthcare workings in multiple countries mass vaccination and case detection/isolation/vaccination which wasn't possibel in Jenner's time
shorter than normal
stunted
education if kids are stunted
stunted kids have lower IQ
chronic undernourishment of macronutrients
stunting
low height for weight
stunting
far reaching effects of malnutrition in girls
stunting,, prevents girls from growing to full adult potential, stunting correlates w/small pelvic size so failure to progress/shoulder
picures of River blindness
subcutaneous nodules, lumphatic obstruction (elephantitis/Lizard SKin)
treatment for dengue/dengue hemorrhagiv fever
suppeotive care. may also need blood transfusion if dengue hemorrhagic fever b/c low plt so bleed profusely
Debate about population policy
supply siders demand siders
treatment of cholera
supportative rehydration ABX Zinc **ReSoMal doesn't not have sufficient Na content to replace Na loss in cholera
treatment of measles
supportative care like hydration vaccination (ok for pregant despite being a live virus) viramin A
similiarities between GHSA and IHR
surveillance, laboratory, preparedness, response, human resources, zoonotic. -related, fill each other's gaps, overlap
BM with worms in iits
suspect ascaris lumbercoids
pox that starts at the core and moves outwards
suspect chickenpox not smallpox
Why do we have joint doctrine (JP #)
synthesizes efforts across services
responsible for a lot of seizures in the developing world
taenia solium (tapeworm)
Taenia Solium
tan-ee-ah sol-ee-um tapeworm 2-7 meters long in GI tract invades intestinal wall, migrates via straited muscles/liver and brain where they imbed and develop into sistercee which is responsible for a lot of the seizures in teh developing world
Taenia solium
tapeworm that invades the intestinal wall, migrates into the muscle, and can embed in the brain responsible for a lot of seizures in the developing world House Pilot episode
how do you get Taenia SOlium
tapeworm. eggs out in human stool. also, pigs can ingest and it gets into their muscles which eat. so infected if undercooked
final strategy used in the last few years of smallpox prior to eradication
targeted surveillance w/ring vaccination worked well
how does HIV infect the body
targets the immune system, weakens defesne against infections/cancers so opportunistic infections/AIDS -immune functions measurd via CD4 count
princples of hte Doctors w/o borders
temoignage - french for to witness eeach time, they conider speaking out, we face the diffiuct question of whether our actions could jeopardize the safety fo the people we are seeking to protect, our own staff or the country's medical workers. and the programs ewe are running. on issues is essential, we have to decide th thtaking a public stand forces to sop our work in that country or region. risky to speak out b/c that might end their much needed aid to that region
human rights are freedoms
that cannot be negotiated away in any poart by the social contract
NGO's post Bin Laden assassination
the CIA led immunizaiton campaign compromised the perception of US NGO's as indepdndent actors focused on common good and casts suspician on humanitarian workers thus, the CIA's fake vaccination campaign endangered us all
link between freedom and GDP
the Human Freedom INdex foudn a link between freedom and per capita GDP
lender to LIC on 12-15 year terms w/reasonable interest rates
the International Bank for Reconstruction and Development divison of the WOrld Bank
lends to the poorest countries interest free for 35-40 years
the International Development Assocation divion of the World Bank
a corndrestone of the effective GH surveillance programs
the ability to build systems thtat identify, track, and respond to public health threats in a timely man ner
staying power
the ability to maintain an activity or commitment despite fatigue or difficulty stamina
important thing to remember about grad school
the answers are not supposed to be easy
Politics
the business of getting elected process of securing popular support
fundamental concerns of "classical period of IHR" from 1981-1951
the classical regime's fundamental concern was to lessent he budent on EUropean/N. American trade created by national repsondess in the region to the threat of imported Asiatic disesases
humanitarian space
the conceptual/figurative space in a conflict zone in which humantarian actors who are pledge to abide by teh principles are afforded the rights to tend to they humanitarian pactivityes. thus, humanbitariean actors need to defend their reputations as impartial actors just as much as a marine defends their rifle. if perceived as a us military associated that could lead to violent death at the hands of someone who does not believe they are neutral. thus, NGOs didn't react favoarbly when Secretary Powell called NGOs a force multiplier. he meant it as acompliment but this actually is an infamous example of a misunderstanding between a NGO and military. threatening b/c violates the whole notion of humanitarian space
curve in the Gini coefficient
the curve that bends is Lorenz curve. the more bent the curve, the more the inequality in a population
maternal death
the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes
problem of "live birth" statistics
the definition of live birth isn't evenly divided around the world
what affects MMRate?
the fertility level of a population
strategic communication
the focuesed US gov process and efforts to undestand/strength/preserve conditions favorable to USG intestest,s ploclies, and objectives via the use of coordinated programs, llames, themes, messages, and product syunchronized w/the all elements of the national power -using health engagement to communicate strategic messages to the pople
strategic communication
the focused USG process and efforts to understand/engagte key audiences and create/strengthen conditions favorable to USG interests, policies, and objectives via the use of coordinated programs, plans, themes, messages, and product synch
global health is...
the health component of global development
the lone genius paradigm of breakthroughs
the lone genius paradigm is potentially ingerous to the research process =widely unrealistic expectations can only yield unsuccessful scientifc investigations but small steps by investigators supported by an informed public can build towards giant leaps...
military and humanitarian
the military cannot be but its people can. when arguing with NGO reps, present yoursel fhonorably
characteristic ofr the best politiciands
the ones w/an emic proespective when they are acutally etic
what is the best way to increase per capita GDP
the only real way to increase per capita GDP is to improve per worker productivity -increased inequality decreases opportnity . so increse productive capacity of your economy
Locke said
the reason why men enter society is the preervation of their property
what does the Ascaris lumbriocoides eat when it is in worm form
the same food we eat so the perosn becomes malnourished
what is needed for any disease eradication initiative to be successful
the success of any disease eradication initiative depends steongly on the level of societal and political commitment from begining to end
2010 National Security Strategy
the threat of contagious diseases transcends political burdens and the ability to prevent, quickly detect, and contain outbreaks w/pandemic potential has never been so important. addresses these trasnnational risk requires extensive collaboration w/the global community
humanity
the top priority of humanity needs to be the relief of human suffering. work that is funed and primarily indended to accomplish something alse but also provides a humanitarian benefit is said to not meet the humanity principle **Red Cross says the principles of humanity expresses what the movement places above all else = the need to act in order to prevent and alleviate human suffering
differences between the International Bank for Reconstruction and Development & INternational Development Assocation
the two divisions of the world Bank IBRD= 12-15yr tearm loans w/interest rate 1% above what the bank borrowed for itself IDA= interest free to the poorest countries for 35-40yr telrms
cause of River BLindness
the worm Onchocercae volvulus
what happens if you cut a River Blindness skin nodule open
the worms spill out. can have 1M babies/day
what should you think about when you consider the Development Web
think of hte whole development web and not just you sector's specialty -Doc looks at health -military looks at security -economists look at the economy -Trump needs to balance all
wasting
thinner than normal. acute
factors affecting the 2nd Delay in the 3 Delay Model
time to reach the medical facility -distance, means of transportation, roads, maternal anemia
why do we do HCA?
to create strategic, operational, or tactical effects that support the COmbatant Commander, security cooperation, or designated objectives while at the same time, reinforcing skills required for hte operational readiness of the personnel who participate
improvement of infant mortaity rate
to decrease total fertility rate -economic development and fertility rate are related -key to improvements in health and economic development help overpopulation problem
what religion receives the brunt of humantarian work
today 1/2 of today's world beneficiaries are muslim
prblem of what health capacity building has turned otu to be
too much of building health capacity has turned out to be training sessions, workshops, and nice trips from mid-level developing coutry professionals to London/DC/Paris...
treatment for severe malnoursishment
top concerns: infection, hypoglycemia, dehydration =broad spectrum ABX, measles vaccination b/c low A is a risk *multivitamin, folic acid, zinc, copper *Fe 1-2 weeks alter
GDP
total amount of goods and services produced by a country ion a year
GDP
total amount of goods/services produced within a country in a given year
aggregate demand
total demand for goods/ervices in a country's eonomy
calculate aggregate demand
total demand for goods/services in a country's economy C+G+I+NE consumer consumption government consumption investments net exports
comparision of total fertility rates around the world
total fertility rate is higher in developING than developED
why are there more maternal deaths in developING countries
total fertility rate is higher so more chances to become pregnant
global burden of diesease
total impact that poor health has on various societies/economies/families & individuals around the world (what, where, and how much burden)
how should every military operation move
towards clearly defined decisive and obtainable objectives. understanding strategic aims, set appropriate objectives, and ensure these objectives contribtue to overally unity of effect
what ails the middle east today
toxic mix of tribalism, SHiite-SUnni sectarinism, fundamentalism, and oil that constantly tempts us to intervene
capacity building
transfer technical knowledge/skills to individuals/institutions so they can acquire the long-term ability to establish effective policies and deliver competent public services -the country increases its ability to retain/absorb/facilitate economic investment -ultimately, an improved governance/investment environment is a necessary condition for sustained economic growth in any country
capacity buildign
transfer the technical knowledge and skills to individuals/instutiotions so that they acquire the long-term ability to establish effective policies and deliver
nutritional transition
transition from cereals/fiber to sugar and processed cugars -"double burden of nutrition" = overnourished (overwt) but not w/good nutrition so micronutrient deficiency
strategies to treat iron deficiencies
treat worms and malaria Fe supplements/fortification
pictures of people w/their heads down prior to an eye exam
trying to move the worms of River Blindness forward for easier viewing
what is important to know about MEDRETE
typically naieve and dont' have GHE trainign
what is an advantagous characteristic of a pathogen in its vector
typically the pathogen doesn't harm the vector which is advantagious
chain of command of the AMerican REd Cross
umbrella organization = International REd Cross & Red Crescent MOvement -under the division: IFRCR: INternational Federation of hte REd Cross and REd Crescent SOceieties
InterAction
umbrella organization of +180 prominent NGO's from all around the world
IFRCR
umbrella organization to coordinate all of hte individualal national RedCross/Crescent societi3s -American red cross is under this -disaster response, community certification
umprella org of Red Cross Derivatives
umprella = Internaltional REd Cross and Red Crescent MOvemnet
LIC
under $1,100 per capita GDP
how did we find Bin Laden
under the guise of a polio vaccination program, the CIA was able to get DNA samples from his family memebrs
first division under the malnourishment umbrella
under versus over nutrition
kwashiorkor
undernourishment protein deficiency
s/s kwashiorkor
undernourishmnt protein deficiency iirritable, moon face, edema, pale sparce hair, enlarged liver, flaky paint skin
operational necessity
understand culture specifically to help people build stable political/soial/economic installations. as muhc of a matter of com as
how are HCA activities usually conducted
usually conducted in conjinction w/authorized operations and exercises of the military service in a foriegn country. complement but dont' other forms of social/economical assistance to the HN by DOS/USAID
all GHE projects should do a needs assessment and post evaluation as part of the overall plan
usually these plans are more about site selection and hotel for the staff coming in - logistics -so be aware that the actual plan might be lackignt
how is YLD calculated
value determined via surveys where people are asked to weigh the burden of disability. severity weights calculated based on data
virus that causes smallpox
variola
asking pts surviving family members/community about the factors that contributed to the person's death
verbal autopsy
mistreatment during childbirth
verbal/physical abuse discrimination nonconsent procedusres nonsupportati ve care
what is a characteristic of countries which make it very difficult to create sustainable health programs
very difficult to create sustainable health programs in countries who are not experiencing rapid economic growth *so can't afford to spend $ on GHE projects
International Health REgulations
very specific set of reuglations dating back to 1851 that mainly r/t DI
cause of cholera
vibrio cholerae. a single celled bacteria
violence in Liberia
violent coups in 1980s-2003 where citizens suffered at the hands of the soldiers. (violence continued beyond the peace agreement in 03 and free election in 05) one person said "many LIberians have a love-hate relationship w/the military. They hate their own but love the American miliatary" -the ebola crisis caused the ability to both combat an infectious disease and also ti improve the working relationship w/their people -the citizens of LIberia ferer to their military as "us versus them." like "they raped my daughter" even though "they" is the military in their own country -widespread distrust in their military
what type of infection is measles
virus
spread of polio
virus spread via fecal-oral
variola
virus that causes smallpox
how does measles spread
virus that spreads via respiratory dorplets. more contagious than smallpox. not airborne unless cough
complications of River BLindness
vision loss/blindness skin disfigurement
necessary to continued existence/continuation of lfie/essential
vital interest
National Security's defition of a "vital" interest
vital interests = ones that, if unfulfilled, would have "immediate" consequences for critical national security interests
what is a "vital interest"
vital means necessary to continuation of life/continued existence
leading cause of preventable blindness
vitamin A
4 most common micronutrient deficiencies
vitamin A iron iodine irone
supplementation given to refugee camps
vitamin A and measles are linked to worse outcomes. so pretreat at risk like refugees at camps before anyone shows s/s
leading cause of preventable blindness
vitamin A deficiency
what makes measles worse
vitamin A deficiency
when is measles worse/mortality worse
vitamin A deficiency
top 2 preventable causs of blindness
vitamin A deficiency trachoma
vitamin given to refugee camps
vitamin A deficiency makes measles outbreaks worse
purpose of giving a specific vitamin to refugee camps
vitamin A deficiency worsens measles outbreaks so give prophylactically
4 most common micronutrient deficiencies
vitamin A, ZInc, iodine, iron
humanitarian label shoudl not be affixed to military GHEI
w
what can be concluded when the special forces are utilized
w/special forces, there is usually a vewry clear p[olitical intentent behind the missions
when do you give Fe to someone recovering from nutritional deficiency
wait 1-2 weeks b/c gut needs to be in the process of healing
treatment strategy for iron deficiencty
wait 1-2 weeks into treatment for GI to recover treat worms, malaria, Fe fortification
vitamin reintroduction to malnourished
wait to reintroduce Fe for 1 week or until gaining weight b/c you need a functioning gut to absorb Fe
acute undernourishment of macronutrients
wasting
low weight for height
wasting
acute nourishment of macronutrients
wasting andstuntin
thinner than normal
wasting. acute
WASH campaign
water, sanitation, hydgeine CDC supports use for cholera
major s/s of cholera
watery diarrhea to dehydration, vomit, possibel death
culture
ways of life passed down from generation to generation shared ideas, meanings, values socially learned/not genetic often exit at a subconcsicous level
why can't the US military be a humanitarian organization
we can't follow the humanitarian principles -humanity, neutrality, impartiality, independence
impact of occupation and opium trade in Afghanistan
we don't like drug trade but suden cessation of poppy fields in Afghanistan -little opium trade in Afghanistan under Taliban -0flourished more post USA intervention and opium became an important part of Afghanistan/s aggregate demand -so consider micro/macroeconomic impact of crop disruption . contributes to GDP
well known fact that foreigners are more familiar w/US doctrine than US
we know this b/c we can see where our publications are being uploaded faster & in greater numbers -Pakistan, Iran, Russia, CHina
Sociocultural evolution
we lived in a state of nature (every man for himself) until we realized that ourganizing ourselves was a more productive way to life. we could travel farther for food and opportunity b/c we knw our possessions and family back home were safe. early humans who followed this had a cultural advantage over others
what is a criticism of military missions
we often critize them as unsustainable
what does GDP measure
wealth and the work done by everyone in the country all added together
Guinea Worm & the development web
weeks of pain. cripples kids so they can't go to school. parents can't work. suffering the worms like to come out during farming season lack of development like clean water leads to guinea worm. the guinea worm retards economic development
measuring malnutrition w/weight, length, & height
weight for age = underweight height for age = stunted wt for length = wasted
MOE
what impact do you hope to achieve how can you best measure this impact what specific benchmark will indicate if you accomplished your objective
important consideration for human rights
what they are and where did they come from
what does HIV/AIDS link to
when HIV/AIDS startd, few leaders of even the hardest hit SSA countries recognized the link between HIV/AIDS and social stability/national security
NGO's funded partially or totally by the government
when a NGO is funded totally or partially by a government, it maintains its nongovernmetal status only as long as it excludes governmental representation from its membershop
NGO's and protection versus assistance
when assitance takes the form of the provision of raw commodities or services, protection means helping local populations avoid being targeted for persecution or attacks. also a distinction between protection and security. protection means keep safe form harm & quel violence or guard the aid commodities. protection is what civilian agencies do and seucrity is what armed guards/military forces do. protection implies action = doing something to stop/reduce a genocide/massacre/systemic rape
in the parlance of aid agencies, protection is distinct from assistance
when assitance takes the provision of raw commodities (food) or serviecs (health) protection refers to teh orgs citizens. protection has a distinct meaning from security (prtoection of stuff from harm)
importance of foreign investment to increase GDP
when foreign countries invest in you, your capital stock increases (so the stability and anticorruption practices in your country helps other countries feel comfortable investing in you. investors want reasonable assurance that they will get their money back
prisioners who wrote in teh KOran in US prisions
when prisioners wrote in teh Koran to communicate w/fellow prisioners, teh US troops confiscated the Korans and burned in the way we typically would do. created riots across the country and some died
putting feet into water if you have guinea worm aka Dracunculitis
when the worms come up independently through the skin, it causes a burning boil. this is painful so they put their foot into water for comfort. this triggers the worm to release 100Ks of eggs. if you dump the water into a water source, this is problematic for future cases
When are cultural concerns fo secondary imprtance?
when they conflict w/human rights
when do countries look better when you only look at GDP
when you look at their purchasing power parity
when can you make great impact on the Development Web
when you use health to promtoe economic growth, you are doing a lot of good on the health secctor
where must human suffering be alleviated
wherever it is found
perception of African women to widow cleansing
widow cleansing in Africa isn't forced. woman choose to do it b/c they are afraid of being cursed.
nursing interventions for cholera
will become dehydrated/weak/vomit death from hypovolemic shock frequent stools. cant' get up b/c too weak best to put on cholera cot w/a hole for poop treat- supportative care. sips of water w/electorlytes ABX is helpufl but WHO hasn't been big to promote oral vaccinations offer short term limited prevention frequent sips of water
first step in bringing a GHE intervention to a developing nation community
win over local religions/infuencial people
example of teaching a simple intervention to a rural community
women in Bangledesh were taught to fold sari to decrease cholera risk reterned to evaluate later. only 26% of women were still folding the saris. of those, most only did so once when they were taught x4 folding the sari to make a filter was shown to drop the cholera rate 99%
how much do men get paid to be widow cleansers in Africa
women pay $50 when the minimum wage is $1 per day
what happened when there was a long line for medical supplies and men kept cutting women/children
women were removed to another room under the ruse of breastfeeding education and they didn't like that b/c they already knew the topic. actually were given a ticket so they could see what they really wanted to see. the men didn't findou t
Dr Birx
worked on PERPFAR. had a vision fo the 3rd phase of PEPFAR to include sustainability, shared responsibility w/other countries, focus on quality, oversight, transparancy , accontability
