Global Health - Exam 1

According to the four basic ethical principles of scarce resource allocation, which patient would you prioritize for treatment? A. 20-year-old pregnant teacher with HIV living below the poverty line: for ART B. 25-year-old IV drug abuser with HIV living below the poverty line who has not enrolled in de-addiction programs for the past three years despite physician advice: for ART C. 70-year-old man with liver cancer, relapsing into alcohol abuse for the fifth time in the past two years: for liver transplant D. 90-year-old ex-President of a developed country with severe heart failure: for heart transplant

A. 20-year-old pregnant teacher with HIV living below the poverty line: for ART

Which statement about the present status of global health is true? A. About 146,000 deaths occurred from measles globally in 2013. B. Dengue fever is a significant public health problem but is confined to Southeast Asia. C. Large investments have been made in the last 20 years by the private sector in the development of new TB drugs. D. West Nile virus is not yet present in the United States.

A. About 146,000 deaths occurred from measles globally in 2013.

Assessing risks and benefits fulfills which ethical principle, as listed in the Belmont report? A. Beneficence B. Respect for persons C. Justice D. None of these are correct.

A. Beneficence

Which one of the following nations is unique in its epidemiologic transition because it achieved the transition by addressing infectious diseases without improving the nutritional status of its population? A. China B. Chile C. Kerala, India D. Cuba

A. China

Which two countries account for more than one-third of the world's total population? A. China and India B. US and China C. US and India D. US and Russia

A. China and India

What is the most important milestone achieved in global health over the last 50 years? A. Decrease in the under-5 mortality rate to 65 per 1,000 children B. Elimination of polio C. Eradication of guinea worm disease D. Elimination of malaria

A. Decrease in the under-5 mortality rate to 65 per 1,000 children

Which service can be provided at a health center level? A. Emergency obstetric care B. Directly observed therapy, short-course for tuberculosis C. Treatment for complicated mental illness D. Treatment of complicated malaria

A. Emergency obstetric care

Which intervention is most critical for preventing maternal mortality? A. Establishing emergency obstetric services B. Providing skilled birth attendance C. Providing prenatal care D. Training of traditional birth attendants

A. Establishing emergency obstetric services

Which country's health system was not profiled in Frontline's Sick Around the World? A. France B. Germany C. United Kingdom D. Switzerland

A. France

Which statement about global health is false? A. Global health focuses on individual level clinical care. B. Global health involves many disciplines within and beyond the health sciences. C. Global health refers to an area of study, research, and practice that aims to improve health in low-, middle-, and high-income countries. D. Global health concerns health problems, issues, and concerns that transcend national boundaries.

A. Global health focuses on individual level clinical care.

What is overwhelmingly true about Cuba? A. Health care is financed and delivered by the public sector. B. Health care is financed and delivered by the private sector. C. Health care is financed by the private sector and delivered by the public sector. D. Health care is financed by the public sector and delivered by the private sector.

A. Health care is financed and delivered by the public sector.

he top three direct causes of maternal mortality in low- and middle-income countries are: A. Hemorrhage, sepsis, and hypertensive disorders B. Hemorrhage, hypertensive disorders, and obstructed labor C. Unsafe abortion, obstructed labor, and sepsis D. Hemorrhage, sepsis, and obstructed labor

A. Hemorrhage, sepsis, and hypertensive disorders

Which statement about WHO is false? A. It is a major financing agency for global health projects. B. It is primarily a technical agency involved in advocacy, and generating and sharing knowledge C. It is governed through the annual World Health Assembly. D. It leads the development of international agreements and conventions.

A. It is a major financing agency for global health projects.

What does not represent ethical principles for allocation of scarce resources? A. Priority to the better off B. Personal responsibility C. Health maximization D. Equality

A. Priority to the better off

If you become sick but are able to quickly see a specialist, take time off from work, and have meals prepared for you because of the efforts and connections of your friends, colleagues, and neighbors, you have a high level of ______. A. Social capital B. Wealth-health gradient C. Sustainable development D. Herd immunity

A. Social capital

Which one of the following is the type of development that meets the needs of the present without compromising the ability of future generations to meet their own needs? A. Sustainable development B. Structural adjustment development C. Human capital development D. Economic development

A. Sustainable development

The proponent of the short-course AZT trials defended the study design by stating all the following except: A. That using the 076 regimen as active control would most likely show that the short-course regimen was superior B. The background rate of mother-to-child transmission of HIV varied between populations, because a comparison to placebo was necessary C. The trial was likely valuable to the communities from which the participants were drawn D. The 076 regimen was not available to the women enrolling in the trials, so they were not being deprived of treatment

A. That using the 076 regimen as active control would most likely show that the short-course regimen was superior

Which statement about measles vaccination by income quintile is true? A. The gaps in vaccine coverage between income groups is greater in West and Central Africa than among the same groups in South Asia. B. The rates of immunization in West and Central Africa is higher for each income group than for the same groups in South Asia. C. In South Asia, the children of the richest 20% of families are immunized more than two times the rate of children from the poorest 20% of families. D. In West and Central Africa, the children of the richest 20% of families are immunized at about two times the rate of children from the poorest 20% of families.

A. The gaps in vaccine coverage between income groups is greater in West and Central Africa than among the same groups in South Asia.

What is the best strategy in the short to medium term to combat the acute shortage of doctors who can perform cesarean sections in a low-income country? A. Train nursing staff to perform cesarean sections B. Train more doctors C. Seek international help D. Contract out services to doctors in neighboring countries

A. Train nursing staff to perform cesarean sections

Which United Nations agency is primarily involved in the prevention and control of HIV/AIDS? A. UNAIDS B. USAID C. UNICEF D. UNITAID

A. UNAIDS

What is the name given to the phenomenon that, either on a national or individual level, as income increases so does life expectancy? A. Wealth-health gradient B. Absorptive capacity C. Demographic transition D. Epidemiologic transition

A. Wealth-health gradient

In which one of the following countries was a high life expectancy achieved in spite of several decades of rule by a dictator intermixed with modest investments in health programs? A. Kerala, India B. Chile C. Cuba D. China

B. Chile

Which one of the following statements best summarizes our current understanding of the impact of stress on human health? A. Stress that results from highly volatile jobs like stock trading have the most negative impacts on health while other types of stress do not seem to negatively affect health. B. Chronic stress from poverty or other poor living conditions are more strongly associated with poor health outcomes than acute or short-term stressors. C. All types of stress are the same and have the same biological impact on health, regardless of the source of the stress or the duration. D. Stress has been shown to negatively affect health in animal studies but in humans we have no clear evidence that stress causes poor health.

B. Chronic stress from poverty or other poor living conditions are more strongly associated with poor health outcomes than acute or short-term stressors.

What does not represent international research ethics guidelines? A. Nuremberg Code B. Declaration of Alma Ata C. The Belmont Report D. Declaration of Helsinki

B. Declaration of Alma Ata

If a country prints additional currency in order to pay off debts, what is likely to be the economic outcome? A. Lower prices on imported goods B. Inflation C. Economic stability D. Decreased spending

B. Inflation

Which statement about social assessment is false? A. It develops coping strategies for dealing with residual and nonmitigatable impacts. B. It focuses on the impact of the intervention and is not important in the implementation of monitoring and management programs. C. It looks at a variety of domains and is not limited to health. D. It gives a picture of the local cultural context and how it relates to the intervention.

B. It focuses on the impact of the intervention and is not important in the implementation of monitoring and management programs.

Which statement about health equity is true? A. It only refers to differences in health across countries B. It is a multidimensional concept that includes issues of fairness within and across countries C. It does not include justice issues D. It only refers to difference in health within countries

B. It is a multidimensional concept that includes issues of fairness within and across countries

Which one of the following is not considered private health spending? A. Employee insurance by private firms B. Social security system C. Out-of-pocket expenditure D. Health expenditure by non-governmental organizations

B. Social security system

Which statement about maternal mortality is false? A. Over 50% of all maternal deaths in the world occur in only six countries. B. The lifetime risk of dying a maternal death is the highest in South Asia. C. Between 50 and 71 percent of maternal deaths occur in the postpartum period. D. About 42% of maternal deaths occur during birth or the first day after birth.

B. The lifetime risk of dying a maternal death is the highest in South Asia.

Which statement about female genital mutilation is false? A. It can lead to infertility and obstructed labor. B. The practice has shown increasing prevalence over time. C. It is highly prevalent in sub-Saharan Africa and Egypt. D. It is very closely related to ethnicity.

B. The practice has shown increasing prevalence over time.

Which of the following has a pluralistic health system? A. United Kingdom B. United States C. Canada D. Germany

B. United States

In which area would you expect to have the highest rates of contraception use among women aged 15-49? A. Urban Pakistan B. Urban East Asia and the Pacific C. Rural Latin America and Caribbean D. Rural Middle East and North Africa

B. Urban East Asia and the Pacific

A developing country's historically "well-performing" health system which has stood out in it's early adoption of conditional cash transfer strategies and development of infrastructure for domestic production of generic ARV medications

Brazil

What best represents a culturally-appropriate targeted intervention to promote exclusive breastfeeding in the Burundi case study context? A. Radio broadcasts to promote exclusive breastfeeding B. Mobilization of community-based spiritual leaders to show support for exclusive breastfeeding among the people in their community C. Advertisements for high-protein baby formula D. Research study to identify the barriers to exclusive breastfeeding

C. Advertisements for high-protein baby formula

What is least likely to be included in a primary healthcare package? A. Childhood vaccination B. Tuberculosis treatment C. Cardiac catheterization D. Basic obstetric care

C. Cardiac catheterization

What would buy you the most health gained for the least cost? A. Treatment of blocked arteries with surgery B. Emergency obstetric care C. Childhood vaccination D. TB treatment

C. Childhood vaccination

Paying women for three prenatal checks represents which RBF scheme? A. Contracting out B. Cash on delivery C. Conditional cash transfer D. Supply-side results based financing

C. Conditional cash transfer

Which statement about health expenditure and outcomes is false? A. Sri Lanka spends relatively little on health and has a relatively higher life expectancy than many countries that spend a higher share of GDP on health. B. The U.S. spends a relatively high share of its GDP on health and has lower life expectancy than many countries that spend a lower share of GDP on health. C. Cuba spends a relatively high share of its GDP on health and has a low life expectancy. D. Kenya spends a relatively low share of its GDP on health and has low life expectancy.

C. Cuba spends a relatively high share of its GDP on health and has a low life expectancy.

Which of the following was not a feature of smallpox? A. The disease was severe, which made patients take to their beds and infect few others B. There were no reservoirs of infection C. Diagnosis was made by laboratory testing since the rash was not distinct D. Survivors gained lifetime immunity

C. Diagnosis was made by laboratory testing since the rash was not distinct

Which statement about the French healthcare system is false? A. Insurance is largely via a government single payer system and firms working with government schemes B. Employing providers is largely through the private sector C. Health is regarded as a personal good D. Financing insurance takes place through premiums and taxation

C. Health is regarded as a personal good

Which country is considered low income, according to the World Bank definition? A. Swaziland B. Botswana C. Liberia D. Iraq

C. Liberia

If you wanted to describe a country as having a low per capita gross national income, which one of the following terms would be best to use? A. Third world country B. Global South country C. Low income country D. Industrializing country

C. Low income country

Which statement about informed consent is false? A. In some cultures, it is "normal" for a husband to make decisions on behalf of his wife, and the wife can be enrolled in the study as long as it is not against her will. B. Potential participants are allowed to ask questions regarding the study and seek clarification on matters they do not comprehend. C. Minors can provide consent as long as they completely understand the risks and benefits of the study. D. All of these are correct.

C. Minors can provide consent as long as they completely understand the risks and benefits of the study.

Which statement about NTDs is false? A. NTDs continue to compete with diseases with higher mortality rates for attention and financing. B. Many of the drugs for NTD control are donated. C. NTD control is not a best buy in global health, causing additional challenges. D. There remains a high burden of NTDs despite continued efforts by countries and the Global Network.

C. NTD control is not a best buy in global health, causing additional challenges.

According to the diffusion of innovations model, what is least likely to influence adopting behavioral change? A. Perceived cost efficiency of the innovation B. How easy it is to try the innovation C. Perceived ecological impact of the innovation D. How the innovation fits with the culture and values of the people considering its adoption

C. Perceived ecological impact of the innovation

What is least likely to represent social and cultural barriers to polio vaccination in India? A. Misinformation about the effectiveness or side effects of the vaccine in some communities B. Communal tension between Hindus and Muslims C. Poor sanitation D. Large number of migrant workers in many communities

C. Poor sanitation

What is the correct progression of behavioral change, according to the stages of change model? A. Contemplation, maintenance, decision, action, precontemplation B. Action, maintenance, contemplation, decision, precontemplation C. Precontemplation, contemplation, decision, action, maintenance D. Precontemplation, contemplation, maintenance, decision, action

C. Precontemplation, contemplation, decision, action, maintenance

In which World Bank region would you expect females to be the least healthy compared to males? A. East Asia and Pacific B. South and Central America C. South Asia D. Europe and Central Asia

C. South Asia

What is likely to be least related to the social determinants of health? A. Dowry death B. Sexual abuse C. Female infanticide D. Breast cancer

D. Breast cancer

The Tamil Nadu Nutrition Project best represents: A. Conditional cash transfers B. Social marketing C. Mass media approach to health behavior change D. Community mobilization

D. Community mobilization

What was not a feature of the Oportunidades program in Mexico? A. Promotion of gender equality by creating social and economic opportunities specifically for women. B. Full immunization and participation in growth monitoring of children less than 2 years of age. C. First national, government-run CCT program in Mexico. D. Conditional cash transfers to all households in Mexico to improve nutritional status and health.

D. Conditional cash transfers to all households in Mexico to improve nutritional status and health.

What does not fall under "the three delays" of childbirth? A. Delay transporting a woman to the hospital B. Delay identifying complications and seeking care C. Delay providing emergency obstetric care D. Delay obtaining the services of a traditional birth attendant

D. Delay obtaining the services of a traditional birth attendant

Which of the following is not a model of behavioral change? A. Diffusion of innovations model B. Stages of change model C. Health belief model D. Environmental model

D. Environmental model

What is the most important factor in the spread of TB from lower-income countries to higher-income countries? A. Spread of pathogens through the atmosphere B. Bioterrorism C. Travel and tourism D. Immigration

D. Immigration

Which statement about the Global Fund is false? A. It is a partnership of the public and private sectors. B. It tries to operate in a performance-based manner. C. It primarily works to fight AIDS, TB, and malaria D. It is primarily a technical agency.

D. It is primarily a technical agency.

Which statement about sex-selective abortion is true? A. Higher income and education has consistently been associated with decreased male preference in India. B. The one-child policy in China has helped reduce this practice. C. It is most prevalent in sub-Saharan Africa. D. It results in a skewed sex ratio.

D. It results in a skewed sex ratio.

In which one of the following places is there a democratic political system that has enacted "socialist" or "communist" policies and has very favorable public health outcomes, similar to a Scandinavian country? A. Cuba B. Chile C. China D. Kerala, India

D. Kerala, India

A country with gross national income per capita of $1,000 is classified by the World Bank as a(n): A. High-income country B. Low-middle-income country C. Upper-middle-income country D. Low-income country

D. Low-income country

Which group is most likely to have the lowest measles immunization rate? A. Richest 20% population of West and Central Africa B. Richest 20% population of South Asia C. Poorest 20% population of South Asia D. Poorest 20% population of West and Central Africa

D. Poorest 20% population of West and Central Africa

What does not represent one of the four Ps of social marketing? A. Persuasive promotion B. Affordable price C. Convenient places to buy the product D. Presence of patent

D. Presence of patent

Which approach is the most culturally appropriate and acceptable by the population in an indigenous village in the Andes? A. Require payment in cash for all services at the time they are rendered B. Have nurses for these villages who come from the lowlands C. Provide services for these villages in non-indigenous languages D. Provide services in local languages by providers from these villages

D. Provide services in local languages by providers from these villages

Among which of the following would you expect to have the greatest disparity in the rate of stunting in under-5 children? A. Rural South Asia vs. rural sub-Saharan Africa B. Rural vs. urban South Asia C. Rural vs. urban sub-Saharan Africa D. Rural vs. urban Latin America and the Caribbean

D. Rural vs. urban Latin America and the Caribbean

What is not a health system building block according to WHO framework? A. Financing B. Information C. Service delivery D. Social and financial risk protection

D. Social and financial risk protection

Which statement about the Tuskegee study is false? A. The participants were not treated, although they had been told they were treated for "bad blood." B. The study lasted for 40 years. C. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was created following the hearings. D. The Public Health Service allowed the participants to receive effective treatment when penicillin became widely available after World War II.

D. The Public Health Service allowed the participants to receive effective treatment when penicillin became widely available after World War II.

Which of the following represents an upper-middle-income country according to the World Bank classification? A. Bolivia B. Yemen C. Bangladesh D. Turkey

D. Turkey

All of the following fall under the six conditions that a clinical research protocol must satisfy to be ethical, except: A. Scientific validity B. Fair subject selection C. Social value D. Written consent

D. Written consent

Which statement about sexually transmitted infections in women is true? A. Chlamydia is nine times more prevalent in women than in men, and sub-Saharan Africa faces a disproportionately high share of morbidity and mortality from STIs. B. They can lead to still birth, and sub-Saharan Africa faces a disproportionately high share of morbidity and mortality from STIs. C. They can lead to still birth. D. Sub-Saharan Africa faces a disproportionately high share of morbidity and mortality from STIs. E. They can lead to still birth, chlamydia is nine times more prevalent in women than in men, and sub-Saharan Africa faces a disproportionately high share of morbidity and mortality from STIs. F. Chlamydia is nine times more prevalent in women than in men.

E. They can lead to still birth, chlamydia is nine times more prevalent in women than in men, and sub-Saharan Africa faces a disproportionately high share of morbidity and mortality from STIs.

In this capitalist democracy, health is regarded as a public good; insurance is largely via a government single payer system and firms working with government schemes; financing insurance takes place through premiums and taxation, while employing providers is largely through the private sector.

France

A single-payor system and the birthplace of social insurance, people buy their insurance from one of more than 200 private, nonprofit "sickness funds." Premiums are pegged to patients' income, and the poor receive public assistance to pay their premiums. Although doctors pay much less than U.S. physicians in malpractice premiums, they feel underpaid in this system.

Germany

One of the most privatized systems in the world, there has historically been minimal access to public health services and resources in "rural" (less developed) areas; in 2005, this country introduced National Rural Health Missions and increased government financing of social health insurance in 2007, which ultimately is applied to pay for private health service delivery

India

This Asian capitalist democracy has some of the best health statistics in the world and uses a social insurance system; all citizens are required to have health insurance, either through their work or purchased from a nonprofit, community-based plan. Those who can't afford the premiums receive public assistance. Most health insurance is private; doctors and almost all hospitals are in the private sector. Concerns include the fact that the system has been so successful at keeping costs down, too little is spent on health care, and hospitals are operating at a deficit.

Japan

Beyond its tiered social security-based public health system, this country has been pioneering in using a social development intervention--conditional cash transfer--to motivate health education and behaviors.

Mexico

Historically, a "welfare state" of a poor country with a "well-functioning" health system; the health system has managed to withstand the onslaught of neoliberal economics and continues to be the major provider of health services; in the past two decades, the system has been moving towards privatization due to the structural adjustment demands of the World Bank, with services increasingly provided much less efficiently by the private sector, often subsidized (at the expense of) the public sector. There are indications that this shift has negatively impacted the cost-effectiveness and quality of health care.

Sri Lanka

This highly capitalist democracy shows that universal coverage is possible, even in a nation with powerful insurance and pharmaceutical industries. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. They can make money on supplemental insurance, however. It is the second most expensive health system in the world, yet far cheaper than the most expensive one.

Switzerland

Implementation of new health system in 1995 extended insurance to the 40 percent of the population that lacked it, while actually decreasing the growth of health care spending. Every citizen has a smart card, which is used to store his or her medical history and bill the national insurer, and can see a doctor any time without a referral. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country's single insurer, this health care system has the lowest administrative costs in the world.

Taiwan

This country has been moving from a social health ("medical welfare") insurance scheme of the 1970's to Universal Coverage Scheme enacted in 2000, dubbed "30 baht treat all diseases"; the country has achieved near universal coverage, but leaves out 4.5% of the population, primarily migrants and indigenous. A challenge has been increased workload for public healthcare workers, which, in combination with the demand for private services by medical tourists, has resulted in an in-country "healthcare exodus" to the private sector.

Thailand

A capitalist democracy with "socialized medicine"; taxes fund government-run health services through NHS

United Kingdom

The most expensive health system in the world; medicine as capitalist politics and profiteering "at the largest scale"; a "dysfunctional," costly and privatized system; all levels of care are privatized, including "primary" care, which is not as profitable and therefore not as accessible as there is a shortage of primary care providers

United States

Which NGO is based in a low- and middle-income country? A. Doctors Without Borders B. Save the Children C. Oxfam D. BRAC

D. BRAC

Which of the following represents a human rights issue for patients with HIV/AIDS? A. Coercion of people to get tested for HIV B. Employment discrimination C. Disclosure of HIV status to spouses or sexual partners D. All of these are correct.

D. All of these are correct.

Which of the following represents public-private partnerships for public health? A. Aeras B. Medicines for Malaria Venture C. Human Hookworm Vaccine Initiative D. All of these are correct.

D. All of these are correct.

Which statement about ancillary care is true? A. If participants are harmed by research procedures, and do not have access to health care outside the trial, they should be treated for those harms. B. Researchers have a duty to provide life-saving medical care when they can do so at a relatively low cost. C. Ancillary care should be incorporated into the planning for research studies conducted in poor populations. D. All of these are correct.

D. All of these are correct.

Which of the following is most likely to have the lowest life expectancy at birth? A. A white Australian female B. A white American male C. A Canadian of East Asian descent D. An aboriginal Australian female

D. An aboriginal Australian female

Which statement about health and maternal education is false? A. Studies have demonstrated that each additional year of schooling for a woman is associated with a 7-9% reduction in under-5 mortality. B. Studies have shown that more than half of 8.2 million under-5 deaths that were averted between 1970 and 2009 were attributable to the higher education of women of reproductive age. C. Studies in Philippines have shown that even better educated mothers were unable to keep their children healthy in locations without safe water supply. D. Studies have shown that every 10% increase in the level of maternal education led to a reduction in the infant mortality rate by 4.1 deaths per 1,000 live births.

C. Studies in Philippines have shown that even better educated mothers were unable to keep their children healthy in locations without safe water supply.

Which country is most likely to have the highest private health expenditure as a percentage of the total health expenditure? A. Jordan B. Peru C. Sudan D. United States

C. Sudan

The largest charitable foundation in the world is: A. The Wellcome Trust B. The Clinton Foundation C. The Bill & Melinda Gates Foundation D. The Rockefeller Foundation

C. The Bill & Melinda Gates Foundation

All of the following are multilateral development agencies, except the: A. World Bank B. Inter-American Development Bank C. United States Agency for International Development D. Asian Development Bank

C. United States Agency for International Development

A "dysfunctional" system that reflects an economic transition from "all eating from the same bowl" to "smashing the iron bowl"; during the socialist planned economy, there was basic, albeit low-quality, universal coverage between labor and cooperative insurance schemes, i.e. enterprise-based welfare; however, "smashing the iron bowl" entailed the end of enterprise welfare and secure lifetime employment

China

A developing country's "well-performing" health system with universal coverage based on a social security system with employer and employee pay deductions, sliding fees for informal workers, and fees for the poorest covered by the government

Costa Rica

In this country that is not considered a "capitalist democracy," there is universal health care/coverage, and health care is directly financed and delivered by the public sector

Cuba

What is the approximate percentage of private out-of-pocket expenditure (of all health care expenditures) in India? A. 50% B. 60% C. 20% D. 80%

D. 80%

What is a risk factor for violence and sexual abuse against women? A.Low socioeconomic status of the woman and her abuser B. Proximity to drugs or alcohol by the woman and her abuser C. A post-conflict situation D. All of these are correct.

D. All of these are correct.