Global Health Exam 1

Select all true statement/s (from the Case Studies)

- According to a barrier analysis approach study of breastfeeding women in Burundi, one of the significant findings included the extent to which women believed persons important to them approved exclusive breastfeeding - The implementation of the Polio Eradication Initiative in India suggests that health communication efforts must pay particular attention to cultural context as well as epidemiologic factors and the political environment

Select all that are true about World Health Organization (WHO)

- Although WHO does have relatively small country budgets to assist in the financing of selected health projects in low- and middle-income countries, it is not a financing agency. - WHO is governed through its annual World Health Assembly, which sets policy, reviews and approves the budget, and appoints the director-general of the organization. - WHO is primarily a technical agency that engages in advocacy and the generation and sharing of knowledge

The World Health Organization (WHO) developed a framework for considering the different parts of health systems and roles they play in health system performance. Select all building blocks of the health systems, as defined by WHO:

- An effective health financing system - Leadership and governance - A Health workforce ​​Health information system - Good health service - Equitable access to medical products, vaccines, and technologies

Research in low- and middle-income countries is frequently sponsored by institutions or companies based in high-income countries and it draws on a pool of potential participants who are likely to be poor, undereducated, and without access to good quality medical care outside of research participation. Select all the ethical issues that might arise in these types of research:

- Ancillary care - Post-trial benefits - The standard of care

Applying Human Rights concept to Global Health would mean, among other things that we would:

- Assess the impact of health policies, programs, and practices on human rights - Take account of the health impacts resulting from violations of human rights - See health and human rights as inextricably linked and bring this notion to consideration of the determinants of health and ways in which health issues may be addressed

Culture is an important determinant of health in a number of ways: (Select all that apply)

- Different cultures have different practices concerning health and medical treatment - Culture is an important determinant of people's perceptions of illness - Access to health services is also closely linked with culture - Culture is related to health behaviors

Success in controlling onchocerciasis was possible due to: (Case Studies)

- Due to commitment among the African governments to coordinating a regional effort across national borders. - The onchocerciasis program proved that effective aid program, implemented with transparency and accountability, can deliver lasting results. - The participation of a wide range of organizations, such as multilateral institutions, private companies, and local NGOs, allowed for cost-effective and efficient intervention

Select all correct statements about population aging:

- Elderly support ratio is the ratio between the number of people that are 15 to 64 years of age, compared with the number that are 65 years of age or older - The large numbers of older adults for every working person will make it difficult for countries to finance health care

Select all tertiary level health services in a low-income country:

- Emergency Obstetric care - Treatment of pediatric cases - Specialist surgical services - Treatment of complicated adult cases - Basic surgical services ​​- Diagnosis and treatment of sick children - Advanced emergency care

The objective of World Health Organization (WHO) is to promote "the attainment by all peoples of the highest possible level of health." In pursuit of this goal, WHO largely focuses its attention on the:

- Generating and sharing health knowledge across countries, through studies, reports, conferences, and other forums. - Advocacy and consensus building for various health causes, such as HIV/AIDS and TB - Carrying out selected critical public health functions within an international forum, such as the surveillance of epidemics, including influenza, or the outbreak of other potentially dangerous diseases, such as Ebola - The provision of technical assistance to its member states, such as helping China to contain the outbreak of SARS or assistance to countries in managing their child vaccines programs.

Select all true statement/s about the epidemiologic transition

- Historically, there have been shifts in the patterns of disease; and in the first stage, there is high and fluctuating mortality, related to very poor health conditions, epidemics, and famine. - The pace of epidemiological transition in different societies depends on a number of factors related to the determinants of health and in its early stages, the transition appears to depend primarily on improvements in hygiene, nutrition, education, and socio-economic status. - Most low-income countries are in an ongoing epidemiological transition and many of them, therefore, face significant burdens of communicable and noncommunicable diseases and injuries at the same time

Select all examples that are linked to cultural practices around the globe and health:

- In some cultures in India it is believed that frequent sexual relations to weaken men by taking away their blood. - The body being "out of balance" brings illness - the most important concept is the notion of "hot" and 'cold" . In certain cultures, some foods are regarded as "hot" and some foods are regarded as "cold" and people are supposed to achieve a balance between these foods to avoid illness. - In some parts of Nigeria there is a belief concerning eating in pregnancy and that pregnant women should avoid some foods - like - eggs - so the baby would not grow up to be a thief - Some First Nations People in Canada have a belief that "illness is not necessarily a bad thing, but instead a sign sent by the Creator to help people re-evaluate their lives".

Select all the themes related to the World Health Organization Commission on the Social Determinants of Health

- In the end, people's life circumstances, and therefore their health, are profoundly related to political, social, and economic forces - The health differences within countries are closely linked with social disadvantage - Health status is improving in some places in the world but not in others

Select all that is/are true about USAID

- In the health field, USAID engages in a wide variety of activities, including advocacy for global health, the generation and sharing of knowledge, and the financing of health investments. - USAID is the development assistance agency of the U.S. federal government. ​​- USAID promotes U.S. foreign policy goals by advancing economic and social development all over the world. - Traditionally, USAID has also been very involved in supporting family planning

Select all that apply about the leading causes of deaths and DALYs

- Injuries make up between 8 percent and 11 percent of total DALYs, depending on the region. - In lower middle-income countries about 36 percent of total DALYs were associated with causes of communicable, maternal, perinatal conditions and nutritional disorders, compared to 61 percent in low-income countries and 11 percent in upper middle-income countries. ​​- While about 61 percent of the total DALYs were associated with Communicable, maternal, and perinatal conditions and nutritional disorders in low-income countries, about 86 percent of total DALYs were associated with non-communicable diseases in high-income countries.

Select all that apply about the concept of culture:

- It should be noted that there is a heterogeneity within all cultures - It is important to consider that cultural practices may be well adapted to some settings but poorly adapted to others. - Culture may be termed as "behavior and beliefs that are learned and shared"

When engaging in global health activities, it is critical to:

- Keep equity, inequality, and disparities in mind at all time - Be careful when using numbers that reflect averages for health indicators, because they may hide variation across and within groups - Examine how each piece of key data on health status, access, coverage, and financing relates to different population groups, especially the poor and marginalized

Which of the following is/are a leading cause of death (top 10) in high-income countries;

- Lower respiratory infections - Ischemic heart disease - Chronic kidney disease - Colorectal cancer - Alzheimer's disease and other dementias

Which of the following is/are leading (Number 1- 10) causes of death in children under 5 in low-income countries

- Malaria - Diarrheal diseases - Protein-energy malnutrition - Meningitis

Which of the following are true about Disability adjusted life year (DALY):

- One of the goals of health policy is to avert DALYs in the most cost efficient manner possible. - The DALY is a summary measure of losses due to premature death and years live with disability in a given population - The value of years live with disability is calculated by weighting these years by a disability index

To examine the key data on the burden of disease, it is critical to understand a number of points. Select all such possible points:

- People in much of the world are living longer than before - The burden of disease is predominantly noncommunicable in all World Bank regions, except sub-Saharan Africa and low-income countries. - People in much of the world are dying at lower rates than earlier

Select all that are important to understand health problems in low- and middle-income countries:

- Perceptions of disease - Folk illness - Perceptions of illness - The prevention of illness

The World Health Report 2000 suggests each health system has some functions. Select all such functions:

- Provide health services - Resource generation - Stewardship - Financing

Select all true statement/s about Bill and Melinda Gates Foundation

- The Global Health division aims to reduce health inequities - At the end of 2017, the foundation had an endowment of almost 51 billion. - The foundation has paid particular attention to supporting the spread of known technologies for improving health, such as immunization, to the places where they are most needed

(Case study: The challenge of Guinea worm in Asia and Sub-Saharan Africa). Select all that are true about Guinea worms:

- The Guinea Worm Eradication campaign has continued to be successful and the world is nearing eradication of Guinea Worm. - Guinea worm is contracted by drinking stagnant water from a well or pond that is contaminated with tiny fleas that carry Guinea worm larvae - Although Guinea worm disease afflicts all age groups, it particularly harms children

Select all that is/are true about BRAC:

- The core of BRAC's health programs in Bangladesh is a community-based approach to primary health care, called "Essential Health Care (EHC)." - BRAC is the largest Nongovernmental Organization in the world that is involved in international development work. - BRAC's business model is largely based on raising money from earnings in a variety of social enterprises to help cover the costs of its programs that do not earn revenue

The burden of disease in the future will be influenced by:

- The impact of scientific and technological change on the low-income countries of today will depend to a large extent on the pace at which they are able to effectively adopt any improvements when they are developed. ​​- Although the full impact of climate change on health is not clear, it is anticipated that climate change and its attendant impact on weather and rising sea levels could directly and indirectly have an important impact on health. - The impact of economic development on health will depend partly on the extent to which economic growth is equitable across population groups.

Select all that apply about the leading causes of deaths and DALYs:

- The leading (number 1) cause of deaths for females in lower middle-income countries is ischemic heart disease. - The leading (number 1) cause of DALYs for females in upper-middle-income countries is ischemic heart disease. - The leading (Number 1) cause of deaths for females in low-income countries is lower respiratory infections.

Select all true statement/s about life expectancy and percentage gain in life expectancy by World Bank Regions

- The percentage gain in life expectancy from 1960 -2016 was highest in South Asia. - Among the World Bank Regions, the lowest life expectancy is in Sub-Saharan Africa - The percentage gain in life expectancy from 1990 - 2016 was highest in Sub-Saharan Africa.

Select all that apply to Multilateral Development Banks:

- There are a number of development banks that lend or grant money to low- and middle-income countries and economies in transition to help promote their economic and social development and these banks are owned by all of their member countries and are referred to as "multilateral." - Multilateral development banks channel financial resources from high-income countries, through bond sales and grants, to help finance development activities in low- and middle-income countries, through bond sales and grants, to help finance development activities in low- and middle income countries and countries that are making the transition to more open, market based economies

Select all the links that health and education are connected (generally):

- There are intergenerational links: the health and education of parents affect the health and education of their children - Malnutrition and disease affect the cognitive development and school performance of children - Education enables people to better prevent and manage illness

Select all that are true about UNAIDS

- UNAIDS is the global agency with primary responsibility for dealing with HIV/AIDS - UNAIDS focuses its attention on the regions of the world most affected by HIV/AIDS, particularly Sub-Saharan Africa - UNAIDS generates and shares knowledge, sets standards, and mobilizes resources - Currently, UNAIDS has 11 cosponsors

Select all the Organizational Actors in Global Health (type of organizations):

- United Nations Agencies - National Scientific Organizations - International Health programs - Nongovernmental Organizations - Multilateral Development Banks - Human Rights Organizations - Think Tanks - University Affiliated Programs

A number of organizations work together to help address some of the most important burdens of disease. Select all the partnerships related to WHO and other partnerships and special programs

-Gavi - Roll Back Malaria - Stop TB

The basic ethical principles of the Belmont Report include:

All of the above (respect for persons, beneficence, justice)

A health system is:

All of the above (all actors, institutions, and resources that undertake health actions-- where a health action is one where primary intent is to improve health- combination of resources, organizations, and management that culminate in delivery of health services to population)

Human rights for health might be suspended, for example:

During a disease outbreak

Which of the following does NOT describe a link between health and education?

Education contributes to the spread of illness

Which of the following in NOT a model of behavioral change?

Environmental model

The convention on the Rights of the Child (CRC), agreed in 1989, is the first document which focuses specifically on the rights of children. The document defines a child as:

Every human being below the age of 18

Diabetes is the leading cause of DALY (disability adjusted life year) in high-income counties

False

Maternal mortality ratio is the number of women who die as a result of pregnancy and childbirth related causes per 1,000 live births in a given year

False

Neonatal mortality rate is the number of deaths to infants under 28 months of age in a given year per 1000 live births in that year.

False

The TB Alliance is a partnership among governments and foundations only

False

The majority of the population growth in the future will occur in high-income countries

False

Under-5 mortality rates is highest in South Asia

False

How does a Health Adjusted Life Expectancy (HALE) differ from measuring life expectancy at birth?`

HALE's summarize the expected number of years to be lived in full health whereas life expectancy at birth just measure the number of years a newborn is expected to live

The leading cause (number 1 cause) of death in adults 15 - 49 years old in Low-income countries is:

HIV/AIDS

What is overwhelmingly true about Cuba?

Health care is financed and delivered by the public sector

As a country's expenditure on health as a share of national income increases, its health status generally:

Increases

The number of deaths of children under one year of age for every 1,000 live births in a given year is the

Infant mortality rate

Which of the following is/are a leading cause/s of death (top 10) in low-income countries

Malaria, Stroke, Diarrheal diseases

A type of health care provided by the government through overwhelmingly tax-based approach is known as:

National Health Service

What is the leading (number 1 ) cause of DALY (Disability Adjusted Life Year) in South Asia (regions as defined by World Bank)

Neonatal disorders

The history of ethical regulations in human subjects research began with the:

Nuremburg Code

What is the correct progression of behavioral change, according to the stages of change model?

Precontemplation, contemplation, decision, action, maintenance

All of the following are ways we could carry out a "human rights approach" in global health efforts EXCEPT?

Reduce individual power over their own health decisions

The committees within various organizations that conduct research that review all proposed research on human subject is called:

Research Ethics Board, an Institutional Review Board, or an independent ethics committee

The quality of data on population and health depends in many ways on the extent to which countries maintain a system of vital registration that can accurately record births, deaths, and the causes of death. According to the UNICEF regions (2005-2012), which of the following world regions has the lowest births registered for children in the poorest 20% of the households under 5 years of age?

South Asia

Infant mortality rate is highest in which of the following World Bank regions?

Sub-Saharan Africa

Life expectancy at birth is lowest in which of the following World Bank region?

Sub-Saharan Africa

Percentage of women 15-49 years of age, married or in union, who are using contraceptives is lowest in which of the following regions (both in urban and rural areas)

Sub-Saharan Africa

Which country spends the highest total health expenditure as a percentage of GDP?

The U.S.

The MOST important multilateral organization providing development assistance for health is:

The World Bank

Life expectancy at birth is

The average number of additional years a newborn baby can be expected to live if current mortality trends were to continue for the rest of that person's life

The basic ethical principles of human subjects research include all of the following EXCEPT:

The benefits and risks of research can be distributed as the researchers choose

Human subjects' research must comply with all of the following standards, EXCEPT:

The human subject must participate to the end of the research

What is one reason why early efforts to control onchocerciasis were INEFFECTIVE? (Case Studies)

The vector carrying the parasite is able to travel large distances and spread the disease across national borders

As interest in global health has spread and the financing for global health has increased, many universities throughout the world have become more involved in teaching, research, and practice on global health issues

True

Cultural competence is the ability to interact effectively with people of different cultures

True

Cultural relativism is the idea that "because cultures are unique, they can be evaluated only according to their own standards and values"

True

Doctors Without Borders is best known for its work in humanitarian crises. MSF is also well known for its commitment to political independence, medical ethics, and human rights

True

Economic incentives can also encourage behavior change in health and help reduce poverty.

True

Ghana is among the first African countries to commit to universal coverage. Ghana established the National Health Insurance System (NHIS) which was financed by a value-added tax

True

High blood pressure is the leading (number 1) cause of risk for death in low-income, lower-middle income, upper middle-income, and high-income countries

True

In South Asia, the richest 20 percent of the population was 1.7 times more likely to have a birth attended by skilled personnel than the poorest 20 percent. (2011 - 2016)

True

India, Nigeria, and United States have health care systems organized by the private sector, with some of those services being paid for through public financing schemes and some through privately financed schemes

True

Low and middle income countries will see (projections to 2030) a substantial shift away from communicable diseases and toward noncommunicable disease and injuries

True

One important tool for setting priorities for public expenditure on health is cost-effectiveness analysis

True

One of the main goals of the Wellcome Trust has been to improve the capacity of low-income countries to do research and make informed health policy decisions.

True

Poorer (low-income countries) countries have the highest private health expenditure as a percentage of total health expenditure. But, rich (high-income countries) countries spend relatively less out-of-pocket cost as a percentage of total health expenditure

True

Research in global health is an integral part of the National Institute of Health (NIH) agenda and one of the five priorities for the institutes.

True

Rural children (0-5 years, 2011-2016) were about 50 percent more likely to be stunted in Latin America and the Caribbean than urban children

True

The Global Fund was established in 2002 to fight AIDS, TB, and Malaria

True

The Million Death Study in India (Case Study): The study has suggested that the top four causes of death in India are cardiovascular disease, chronic respiratory disease, TB, and cancer.

True

The Rockefeller Foundation was instrumental in establishing the first schools of public health in the United States and was also deeply involved int he development of a vaccine against yellow fever

True

The demographic transition is the shift from a pattern of high fertility and high mortality to low fertility and low mortality, with population growth occurring in between

True

The incidence rate in health measures how many people get a disease, for a specified number of people at risk, for a given period of time

True

United States spends a relatively high share of GDP on health but still has a lower life expectancy than countries that spend a lower share of GDP on health

True

Which is the specialized agency of the UN that focuses on promoting the well-being of children?

UNICEF