global public health final
what is the WHO's mhGAP
"Intervention Guide (mhGAP-IG) for mental, neurological and substance use (MNS) disorders in non-specialist health settings. It is for use by doctors, nurses, other health workers as well as health planners and managers. The Intervention Guide presents the integrated management of priority MNS conditions using algorithms for clinical decision making."
health care in Rwanda
Health reform in 2000 with political commitment to equity and to service delivery Health systems approach by harnessing funding for disease specific programs to build platforms for integrated service delivery Community-based health insurance Community-based care using community health workers Cross-sector collaboration
what are the long term health and economic impacts of poor nutrition
Impacts maternal health, which affects household income and survival and health status of children Affects children's ability to grow or achieve full intellectual capacity, impacting future prospects Leads to lower productivity in adult workers Impacts life expectancy
global nutritional trends
In 2013, about 22 million newborns had low birthweight i.e. estimated as 16 percent of all babies born globally that year. The rate of <5 children underweight in low- and middle-income countries fell from about 28% in 1990 to about 17% in 2011.However, still about 100 million children globally suffer from moderate or severe underweight, about 165 million are stunted, and more than 50 million are wasted
Refugees around the world
In 2018, 25 people were newly displaced every minute of the day Women and girls make up 49% of refugees; children under 18 make up 50% of refugees About one-third live in camps, which are usually funded by the UNHCR or NGOs Some refugees have lived in camps for over two decades
being a refugee and its impact on women and girls
In urban areas •Lack of resources, education, health access •Loss of support provided by family •Vulnerable to sexual exploitation In refugee camps •Vulnerable to sexual and gender-based violence •Married off earlier In other areas •Restricted travel •Dependent on male escort •Vulnerable to sexual and gender-based violence
what is undernutrition
Inadequate dietary intake or infections of intestine that cause inadequate dietary absorption of nutrients Weakens the body and opens it up to infection, Difficulty in eating, and increased risk of diseases caused by micronutrient deficiencies Relationship creates a cycle of illness and infection
Per Capita Expenditure on Health in India & Rwanda
India= •58% of health expenditures come from household Rwanda=•18% of health expenditures come from household
Malnutrition in Children and Pregnant Women
Large share of nutritional deficits are mild, but still have negative consequences on development Malnutrition raises the risk of illness, decreased intellectual capacity ¡Malnourished children who rapidly gain weight are at high risk of nutrition-related chronic diseases as adults Malnourished pregnant women have greatly increased risks of dying of pregnancy-related causes, having preterm or low birth weight infant
what is the psychological impact of being a refugee
Loss of home, occupation, belongings, security, safety Disrupted social support systems Loss of independence and self-determination Many refugees have witnessed or been victims of war and violence, including sexual violence Depression, anxiety, and post-traumatic stress disorder (PTSD) found among refugees
Other Critical Services & Considerations
Mental Health & Psycho-social Support Severe and moderate mental health disorders may double in emergencies Water, Sanitation and Hygiene Essential for quality medical care and to prevent transmission of communicable diseases Safety and Security
what is a migrant
Migrant is an umbrella term for people leaving their homes and often crossing international borders, whether to seek economic opportunity or escape persecution
how do you categorize health services
Most low-income countries have fragmented health systems that include both public and private providers Many middle-income countries have a system organized around a national insurance scheme Almost all high-income countries have a national health insurance system
comparison of SARS and COVID-19
Multiple locations/events evidence that this has happened with SARS-2 CoV as well
what was the response to the rohingya militants attack
Myanmar military led a crackdown against Rohingyas in northern Rakhine state. Rohingya refugees quickly began fleeing Myanmar by the thousands, then, within weeks, by the hundreds of thousands.
____ is another term for a heart attack.
Myocardial infarction
Laws that govern how we respond to national emergencies
National Emergencies Act Public Health Service Act (1944) Stafford Act (1988) National Security and Homeland Security Presidential Directive
nutritional state of the world: overweight and obesity
Nearly 30% of the world's population, 2.1 billion people, are obese or overweight Obesity has nearly doubled worldwide since 1980 Childhood obesity has emerged as one of the most serious public health challenges of the 21st century
Gauging Nutritional Status
Nutritional status of infants and children is gauged by measuring and weighing them, then plotting weight and height on a growth chart Child's position on growth curve indicates whether growth is normal
resettlement to the US
Only about 1% of all refugees resettle to a third country •The process is long and selective—can take years •Those who make it to the U.S. are unique and resilient The U.S. determines yearly allotments for its resettlement program •Capped at 18,000 in 2020 (the lowest number in the history of the modern refugee program) •Specific caps for each region around the world •85,000 refugees were resettled under Obama in 2016
Role of CEID/Petersen group in COVID19 pandemic
Past One health work laying essential connection between SH:/ ISU VDL to allow donation of diagnostic reagents Collaboration with Nigerian groups to help with statistical analyses/modeling as needed as their caseload grows Donation of equipment and PPE to UIHC emergency department and elsewhere Provide education and awareness to local, state, national and international media
nutritional needs:pregnancy and birthweight
Pregnant women need an extra 300 more calories a day for sufficient protein and energy Iron, iodine, folate, zinc, and calcium are also important to the health of the woman and child The birthweight of a baby is an extremely important determinant of the extent to which a child will thrive and become a healthy adult
What is an "essential service"?
Recommended by the US Department of Homeland Security
refugees entering the US experience
Refugees entering the U.S. find themselves at the intersection of several forms of oppression •Racism •Classism •Sexism •Xenophobia They may not necessarily recognize they are subject to these forms of oppression initially
what kind of barriers do resettled refugees experience
Schools may be unprepared to provide specialized services to refugee children •Mental health services •Language support Refugees often arrive with little or no money Degrees and work experience from most other countries are not honored in the U.S. Only lowest paid, least desirable jobs open to non-English speakers
what are limitations of resettlement services
Services cover only basic needs and are time-limited Limitations include: •No comprehensive mental health assessment •No long-term case management and cultural orientation •No orientation to U.S. health care system and norms •Geographic areas without ethnicity-specific local support face greater challenges of integration
Discussions at the country level
Sheltering-in-Place (SIP) versus Safer at Home Recommendations vs mandates Need for targeted measuring Legal authority at the state, county and city levels
what is humanitarian assistance
aid that seeks, to save lives and alleviate suffering of a crisis- affected population (WHO) humanitarian action should be governed by the key humanitarian principles of humanity, impariality, neutrality and independence
the _____ model creates a multiplying effect for behaviors such as immunization.
care group
what is the cost of packaged nutritional interventions for undernutrition in <5 children
cost per DALY averted of about $179
Over the last three years, the number of refugees being resettled in the U.S. is:
decreasing
Which mental disorder is higher among women in all countries all over the world?
depression
what is overweight
excess weight relative to height; commonly measured by BMI among adults. The international reference for adults is as follows -25-29.99 for grade I (overweight) - 30-39.99 for grade II (obese) - > 40 for grade III
what are problems with health systems
exploding costs inequality inefficiencies •Location of facilities •Deployment of providers •Generic vs. brand names products •Adoption of newest technology political pressures
True or False? Donors are the primary entities that define successful implementation.
false
True or False? Drinking coffee is a major risk factor for cardiovascular disease.
false
True or False? Higher health expenditures lead to better health.
false
True or False? In 2018, the largest number of refugees arriving in Iowa were coming from Sudan.
false
True or False? Iodine deficiency leads to anemia.
false
True or False? Most of the global population affected by diabetes are living in high-income countries.
false
True or False? The Centers for Disease Control and Prevention (CDC) is a regulatory agency.
false
True or False? The impact of war and displacement is the same for boys and for girls.
false
True or False? The majority of violence-related deaths occur in high-income countries.
false
True or False? This study provides evidence that employee-only use of face masks significantly reduces daily county-level growth rates of COVID-19.
false
Which of the following is the process of adding micronutrients not naturally present in a food's ingredients to a food product?
fortification
What is the typical role of a local nonprofit organization in public health?
implementor
Change in risk of type 2 diabetes associated with TV viewing, other sedentary behaviors, and walking
increase in % change by 14%= TV watching increase in 7% for sitting at work vs 9% for standing
The large spike in deaths in 2004 was due to:
indian ocean tsunami
Which of the following is NOT a common cause of child mortality during a complex emergency?
injury
what is universal health coverage (UHC)?
is present when everyone in a country has access to high-quality health services (including preventive care, diagnosis, treatment, and rehabilitation) and everyone is protected from major health-associated financial shocks via a tax-based financing system or a health insurance plan.
the three most commonly used indexes for child undernutrition are
length or height-for-age, weight-for-age, and weight-for-height
Mental, neurological, and substance use disorders account for what proportion of years of life lost globally?
less than 5%
pertaining to diabetes: do lifestyle intervention or drugs have more of an affect.
lifestyle intervention continues to have an effect; most drugs do not
What has the greatest and most sustained risk reduction impact for the management of Type 2 diabetes?
lifestyle interventions
for children, how is overweight measured
measured as weight-for-height two z-scores above the international reference
MHPSS interventions
mental health and psychosocial support is used in this document to describe any type of local or outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder." - WHO PM+
The significance of the International Conference on Primary Health Care in Alma-Ata, Kazakhstan is that it:
reaffirmed health as a human right
What is malnutrition?
refers to those who do not get proper nutrition, whether too little, too much, or the wrong kind
Major causes of war and terrorism are:
revocation of human rights, poverty and despair, personal and national humiliation
The top cause of injury and violence-related deaths is:
road traffic injuries
what is an internally displaced person (IDP)
someone who has been displaced for the same reasons as a refugee but has not crossed a national border
57% of UNHCR refugees came from 3 countires
syria= 6.7 million afganistan= 2.7 million south sudan= 2.3 million
What type of prevention strategy is acute trauma care?
tertiary
what is the primary health care?
the first level contact of individuals, the family, and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process
what is an asylee>
the request for protection and the right to remain in the country as a legal immigrant is approved
what is the enabling environment for nutrition and an example
this concerns laws, policies, resources, and institutional issues that relate to the approach countries take to nutrition and how effective they are at formulating, implementing, and monitoring nutrition interventions -Examples: taxing sweetened beverages or foods high in fat
what are nutrition sensitive interventions and an example
those interventions that address the underlying determinants of malnutrition -Examples: vaccination program that prevents intestinal infections, or nutrition programs to enable farmers to increase the yield of crops that they consume
what are nutrition specific interventions and what is an example
those interventions that can have a direct impact on nutrition -Examples: promotion of exclusive breastfeeding, micronutrient supplementation, and food fortification
what is a z score used for
tool for assessing child growth relative to optimal health
True or False? Noncommunicable diseases are the primary cause of disease burden in adult populations globally, regardless of the nation's income level.
true
True or False? The best way to reduce the costs of ischemic heart disease for individuals and for health systems is to invest in prevention.
true
True or False? There are currently more armed conflicts in the world than at any point since World War II.
true
what type of diabetes is more common
type 2
_____ is present when everyone in a country has access to high-quality health services and everyone is protect from health-related financial shocks.
universal health coverage, UHC
what are Basic components to a healthy diet
vegetables, fruits, whole grains, legumes, and nuts, with limited amounts of red and processed meat
According to the causal model of injuries, a ______ is an inanimate object, such as a motor vehicle; whereas, a ____
vehicle, vector
A child with low weight-for-height is classified as having:
wasting
What type of expertise was needed to set up a clinic in the Kutupalong refugee camp?
water and sanitation infrastructure construction pharmaceutical supply chain
what is psychological first aid
which involves humane, supportive and practical help to fellow human beings suffering serious crisis events.
Which dietary factor is protective against diabetes?
whole grains
did more people die from diabetes than HIV/AIDS
yes! 5 million died from diabtes 1.5 million died from HIV/AIDS 1.5 million from tuberculosis .6 million died from malaria
what is BMI
¡the measure of body composition calculated by taking weight in kilograms and dividing it by the square of the person's height in meters. BMI = weight (kg)/Height2 (m2)
Social Determinants of Mental, Neurological, and Substance Use Disorders
´"Demographic factors, such as age, gender, and ethnicity ´Socioeconomic status: low income, unemployment, income inequality, low education, and low social support ´Neighborhood factors: inadequate housing, overcrowding, neighborhood violence ´Environmental events: natural disasters, war, conflict, climate change, and migration. ´Social change associated with changes in income, urbanization, and environmental degradation"
what is the treatment gap and why is it an issue of mental health and global health
´"More than 75% of those identified with serious anxiety, mood, impulse control or substance use disorders in the World Mental Health surveys in LMICs received no care at all, despite substantial role disability.
more specific data over mental health
´"Schizophrenia, depression, epilepsy, dementia, alcohol dependence and other mental, neurological and substance-use (MNS) disorders constitute 13% of the global burden of disease, surpassing both cardiovascular disease and cancer. ´Depression is the third leading contributor to the global disease burden. ´Every seven seconds, someone develops dementia. ´By 2020, an estimated 1.5 million people will die each year by suicide, and between 15 and 30 million will make the attempt."
specific data
´"Schizophrenia, depression, epilepsy, dementia, alcohol dependence and other mental, neurological and substance-use (MNS) disorders constitute 13% of the global burden of disease, surpassing both cardiovascular disease and cancer. ´Depression is the third leading contributor to the global disease burden. ´Every seven seconds, someone develops dementia. ´By 2020, an estimated 1.5 million people will die each year by suicide, and between 15 and 30 million will make the attempt."
what many health challenges may refugees face
•Post-arrival health screenings are very basic •Refugees must navigate health systems with little help after the first visit •Refugees are more likely to use the emergency room for primary care, which is costly and ineffective •Cultural norms may prevent women from seeking medical care •Change in diet and availability of traditional foods
what are the interventions for pregnant women and undernutrition
-Multiple micronutrient fortification -Promotion of appropriate breastfeeding practices -Appropriate complementary feeding
how to address future nutrition challenges
-Policy makers need to understand the exceptional importance of nutrition to good health and human productivity and act accordingly -Governments need to work with the food industry to improve the way in which foods are fortified and to be sure that processed foods are healthy -Further research on what works -Create partnerships of civil society, government, and the private sector
determinants of obesity, what determines if someone is obese
-Various dietary components are playing a large role in the growth of global obesity and overweight -Most immediate cause is an increase in total energy intake coupled with a decrease in energy expenditure -Genetic and cultural factors are important -Rising global rate of obesity is being driven by global financial and trade liberalization, increased income and socioeconomic status, and urbanization
what is the length for age used for
0 to 24 months
how are health services organized
1)Financing •Public: taxes, social insurance funds •Private: private insurance or user fees 2)Delivery •Public: Hospitals/clinics owned by state; practitioners employed by government •Private: Clinics and practitioners operate as businesses
Rohingya militants attack 30 police posts in Rakhine state
At least 59 insurgents and 12 members of the security forces killed.
what are packaged nutritional interventions for undernutrition in <5 children
-Supplementation with vitamin A and zinc for children aged 6 to 59 months -Appropriate management of severe acute malnutrition -Appropriate management of moderate acute malnutrition
how are obesity and overweight addressed internationally, within governments, schools, etc.,
-International organizations can set global nutrition and physical activity standards -Governments can promote campaigns and align national dietary goals with nutritional and agricultural policies -Legislation can be used to restrict unhealthy food marketing aimed at children -Schools can encourage healthy eating
Direct Service Provision (if necessary)
-Mobile teams or temporary static clinics - staffed locally or nationally -Supplied with locally procured or internationally deployed kits - -All logistics through NGO systems - -Sometimes working in parallel to systems, sometimes supporting
Which of the following diseases is NOT caused by a coronavirus?
Avian influenza
The largest refugee settlement in the world is in:
Bangladesh
stigma and mental health
"So ground zero in global mental health is not the 15% of the global burden of disease accounted for by the cost of mental disorders; nor is it the under 2% (and often less than 1%) of expenditure on health that is estimated to go to services for psychiatric conditions in countries in Africa, Latin America, and south and southeast Asia (compared to over 10% in the USA). Nor is it the absence, or extremely small numbers, of psychiatrists, psychiatric nurses, psychologists, and psychiatric social workers in these impoverished nation states. No, bad as these indices of the deficiencies of care are, they are not ground zero. Ground zero is the routine local condition of people with mental illness in communities, networks, and families. It is their pain and suffering. The fundamental truth of global mental health is moral: individuals with mental illness exist under the worst of moral conditions." Arthur Kleinman (2009), Global MH: A failure of humanity. The Lancet, 374.
what did - Bill Frelick, Refugee Rights Director at Human Rights Watch say about resettlement to the US
"This action not only cuts a lifeline for thousands of refugees, but sends a message to countries on the front line of the crisis, from Bangladesh to Lebanon to Kenya, that U.S. pledges of support can no longer be trusted."
Nutritional needs:Infancy and Young Childhood
"Window of opportunity" is conception to 2 years of age Nutritional gaps during this time can cause problems with stature and mental development, and frequent infection Children need sufficient protein, energy, and fats as well as iodine, iron, vitamin A, and zinc Grow best and stay healthiest if exclusively breastfed for first 6 months
death and diabetes
-Approximately 4.2 million adults aged 20-79 years are estimated to die as a result of diabetes and its complications in 2019. -Diabetes is estimated to be associated with 11.3% of global deaths from all causes among people in this age group. -every eight seconds, one dies from diabetes
during complex emergencies, the most common reported causes of under 5 deaths are the same as the major causes of death in countries with the highest child mortality rates:
-Diarrheal Diseases -Acute Respiratory Infections -Measles -Malaria -Severe Malnutrition -Neonatal Causes
Childhood underweight is the leading risk factor for death of under-5 children globally
-Forty-five percent of all deaths in children under 5 are attributable to nutrition-related causes -About 3 million under-5 child deaths a year -An important risk factor for death from other causes including diarrhea, pneumonia, measles, and other communicable diseases
humanitarian health factors include
-Government Ministry of Health National Disaster Agency Lab Service -UN WHO UNICEF IOM UNHCR -red cross ICRC IFRC -emergency medial teams UK EMT AusMAT Mercy Malaysia -(I)NGO's BRAC & many National or community-based NGOs Doctors Without Borders (MSF) Save the Children International Medical Corps International Rescue Committee Medecins du Monde
COVID-19 Mitigation Measures: Health facilities
1.Triage and screening established at the entrances to all health facilities. This must include redesigning patient flow and waiting areas to minimize congestion and risk of COVID-19 infections. 2.Standard and transmission-based IPC precautions implemented at health facilities. 3.Isolation area identified. 4.Provision of PPE and conservation strategies 5.Strict staff sickness policy implemented - staff to not attend work if sick. 6.Implementation of home based treatment protocols for mildly unwell patients 7.Cancellation of routine/non-urgent services and procedures (includes cancellation of mass gatherings for health education sessions) - PC3 and PC4 activities. 8.Prepare for disruptions in patient access - consider distributing supply of contraceptives, emergency medications to patients with chronic conditions, etc. 9.Surge capacity to cope with increased staffing needs and reduced numbers of staff.
diabetes is in how many people globally how many people are affected by diabetes globally
1/11 463 million adults
Primary Health Care, from Alma-Ata to the Present
1978: International Conference on Primary Health Care in Alma-Ata, Kazakhstan A call to action by UN agencies, health ministers, and global health workers around the world to achieve "Health for All" Shift from viewing health as a result of biomedical interventions to an outcome of social determinants Reaffirmed health as a human right Attainment of good health requires the action of many other social and economic sectors in addition to the health sector Health inequality is politically, socially, and economically unacceptable Right to participate individually and collectively in the planning and implementation of health care Primary health care is essential
how many refugees are there in the world
25.9 million
how many asylum seekers are there
3.5 million
how many new asylum seekers are there
341,800 people
how many people are forcibly displaced worldwide
70.8 million
Of the 10 countries with the highest under-five mortality rates, ____ are affected by conflict
8
where in the world displaced people are being hosted
80% of refugees live in countries neighboring their countries of origin
what are examples of refugees
A Congolese civilian who fled to neighboring countries during the rebel conflict that started in 1996 Political dissidents who fled Vietnam during and after the Vietnam War Syrian families who have fled their homes since the outbreak of the civil war in March 2011
how to prevent obesity and noncommunicable diseases
A balanced, healthy diet is crucial for the prevention of obesity and noncommunicable diseases
what is a refugee
A refugee is a person who cannot return to his/her country of nationality or former residence due to a well-founded fear of persecution on account of: •race •religion •nationality •membership in a particular social group political opinion
public health in emergencies- primary health care
Access to quality health services is limited - increased burden on systems, shortages of medical professionals and essential medicines and supplies Limited basic healthcare, breakdowns in water and sanitation, and overcrowding increase risk of communicable diseases and disease outbreaks Standard health responses are aligned to SPHERE minimum standards and include: •Management of common illnesses (ORS for diarrhea, antibiotics for ARIs, antimalarials, etc.) • •The Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations • •Preventative interventions including vaccinations and health and hygiene promotion
Which of the following is the complex process of adopting practices, traditions, values, and identity of a new community after migrating?
Acculturation
nutrition needs: adolescence
Adolescents need protein and energy to grow, as well as iron, iodine, folic acid, and calcium Adolescent girls who are poorly nourished are much more likely to give birth to an underweight child and experience complications during pregnancy than well-nourished girls Children who are stunted are generally unable to make up later for their retarded growth
nutritional needs: adulthood and old age
Adults need a well-balanced diet with protein, energy, and iron in order to stay productive Foods that contain too much fat, cholesterol, sugar, or salt can be harmful The ability of older people to live on their own can depend on their nutritional status Older adults need calcium to reduce risk of osteoporosis
In which region are adolescent girls more obese than adolescent boys?
Africa
what are non-modifiable factors for type 2 diabetes
Age Sex Ethnicity Genetic background Family history of diabetes History of gestational diabetes Birth weight
according to the WHO, what is a health system
All actors, institutions, and resources that undertake health actions—where a health action is one where the primary intent is to improve health
what are the Long-term Health and Economic Impacts of overweight and obesity
Associated comorbidities have high medical costs that can trap poor households in cycles of debt and illness Affect worker productivity Affect mental health, especially harmful to the academic achievement of children and adolescents
what is the role of the CDC, FDA, and CMS in public health
CDC is developing a set of assays to detect antibodies, HOWEVER CDC does not intend to pursue as Emergency Use Authorization (EUA) since they do not intend to use the test for diagnostic purposes CDC is developing guidance on decontamination on re-use of PPE FDA is reviewing some assays for diagnostic serology antibody tests and hope to have some approved within the week CMS has issued a new guidance that is only applicable during the COVID-109 state of emergency, that includes:Expedited CLIA certification Allowable remote review of laboratory data and slides
Congolese Refugees in Johnson County
Close to 3,000 Congolese refugees and immigrants live in Johnson County Health care providers mentioned the following gaps in service delivery for the Congolese: •Interpretation Services •Transportation •Clinic structure •Physician Training/Education •Insurance •Cultural differences
what does the United States health insurance look like (PLURALISTIC)
Complex and fragmented Health care primarily as a consumer good No universal health insurance •43.4% of U.S. adults are uninsured or underinsured Private employer-based health insurance Public health plans for military, elderly, children, low-income Mix of public and private financing and delivery
Congolese Health Partnership
Congolese Health Partnership formed in June 2017 The overall objectives of this partnership are to work together to: •Improve knowledge about health care during pregnancy and childbirth •Build trust between Congolese families and health care providers
Congolese Refugees
Congolese refugee crisis is the product of nearly 16 years of armed conflict and unrest Started in 1996 when Rwanda invaded the DRC in pursuit of the perpetrators of the 1994 genocide Although a peace accord was signed in 2003, unrest still plagues eastern DRC More than 4.1 million Congolese are displaced, with 620,000 seeking refuge in neighboring countries
what are key health sector issues
Demographic and Epidemiologic Change Stewardship Human Resource Issues Quality of Care Financing of Health Systems Financial Protection and Provision of Universal Coverage Access and Equity Integrated vs. Disease-Specific Approach
Since 9/11 and the Anthrax Letters, public health and our partners have:
Developed Emergency Response Plans, and the Continuity of Operation Plans Continuously trained, exercised and drilled for disasters and infectious disease outbreaks. This is a requirement of the Public Health Emergency Cooperative Agreement (PHEP) Program
summary of diabetes
Diabetes is on the rise everywhere around the world, regardless of income and regions. Type 2 diabetes is the most prevalent form. Obesity, unhealthy diet, and physical inactivity are major risk factors for type 2 diabetes. Effective approaches are available to prevent type 2 diabetes.
being a refugee and its impact on children
Disease disparately impacts refugee children
Who are the Rohingya?
Distinct Muslim ethnic group from Rakhine state in Myanmar Estimated global population: 1.5 - 2 million people Prior to August 2017 there was an estimated 1 million in Myanmar, with large diasporas in Bangladesh, Pakistan and Saudi Arabia. One of the world's most persecuted peoples.
Why Don't Higher Expenditures Lead to Better Health?
Distribution of health resources may not relate to need Access to other societal factors also relate to health Medical care (and spending) is unable to correct for wealth inequalities
what are the characteristics of primary health care
Essential and socially acceptable Based on evidence and universally available Addresses the needs of the community and is affordable Provides preventive, promotive, curative, and rehabilitative services Linked to health system through referral system
What region has the highest age-adjusted rates of cardiovascular disease (CVD) death?
Europe and Central Asia
health care in India
Federal system of tiered network of health services in the public sector The private sector treats almost 80% of outpatients and 60% of inpatients Only 30% of population covered by insurance Majority of people pay out of pocket (70%) Public health care is free for those in poverty, but services are inaccessible in rural areas •National Rural Health Mission
what does national health insurance look like in Germany
First country to have universal health insurance Health care as insured, guaranteed service Comprehensive package of benefits for members and families Insurance carriers for mandatory insurance are "sickness funds" financed by employers and employees and cover 90% of the population Services provided by public and private facilities
Which of the following countries is an example of National Health Insurance?
Germany
how do state and local entities respond to emergencies? to COVID specifically?
Governors are responsible for declaring their state of emergency in order to enable federal support or intervention. In the case of COVID-19, the President declared a national public health emergency prior to some states declaring a state of emergency. This allowed the release of federal funds to the states for response that can be used for all aspects of the response.
health sector expenditure
Health expenditures are a significant component of the global economy, accounting for more than 8% of the world's total gross domestic product (GDP). Total health expenditure as a share of GDP varies substantially across countries Some countries are around 3% to 4%, such as Indonesia, Pakistan, and Bangladesh Most of the higher-income countries spend between 7% and 12% The U.S. spends 18% of its GDP on health Some countries, such as Afghanistan, Costa Rica, Cuba, and Haiti, are outliers There is a wide range in the share of total expenditure on health that is private sector expenditure Private health expenditure, from total expenditure: Denmark and France, 15-25%; Ireland and Israel, 35-40%; Bangladesh, India, Kenya, and Pakistan, 60-70%
what are resettlement resources for refugees
The Office of Refugee Resettlement (ORR) and the U.S. Department of State oversee and fund refugee resettlement and assistance Refugees receive comprehensive assistance through a local refugee resettlement agency, which may include the following: •SNAP (Food Stamps) •Refugee Medicaid (first 8 months only) •Refugee Cash Assistance (first 8 months; not all qualify) •Case management services The voluntary agencies provide wrap-around case management, ensuring that refugees receive: •Housing •Community and cultural orientation •Basic health screening •Job development services •English language classes •School enrollment for children Most services completed in first 3 months
what country has the most obese people
The U.S. has the highest proportion of the world's obese people (13%)
what are the four functions of a health system
The World Health Report 2000 suggests that health systems have four functions: 1.Provide health services 2.Generate resources: raise money that can be spent on health 3.Financing: pay for health services 4.Stewardship: govern and regulate the health system
what are the three goals of a health system
The World Health Report 2000 suggests that there are three goals for every health system: 1.Good health 2.Responsiveness to the expectations of the population 3.Fairness of financial contribution
what is a health system
The agencies that plan, fund, and regulate health care The money that finances health care Those who provide preventive health services Those who provide clinical services Those who provide specialized inputs, such as the education of the healthcare profession The production of drugs and medical devices
why study refugees?
The number of refugees is increasing Refugees have been persecuted by no fault of their own Refugees have unique health concerns carried on from developing country of origin and displacement Women and children make up over half of the refugee population
The Importance of Nutrition in attaining the SDGs
The nutritional picture of the world has changed dramatically in the last few decades Nearly 30% of the world's population is overweight or obese; most of these people are in low- and middle-income countries Overweight and obesity are closely linked with many NCDs, and prevention is complex Nutrition is central to achievement of the SDGs
True or False? 9 out of 10 people with mental health problems experience some form of stigma.
True
Which country is receiving the greatest number of Syrian refugees?
Turkey
top refugee hosting country
Turkey
Gauging Adult Nutritional Status
Underweight: BMI is less than 18.5 Normal weight: BMI is 18.5 to 24.9 Overweight: BMI 25 - 29.9 Obese: BMI is greater than 30
The term "NGO" originated from the:
United Nations
what does national health service look like in the UK
Universal health coverage National Health Service (NHS) is responsible for health services and related insurance Comprehensive coverage for every resident 75% of NHS funding comes from general taxes and the rest mostly from a payroll tax About 11% of population opts to buy private insurance Services are generally government regulated
what are three current solutions for displaced persons
Voluntary repatriation •About 30% return to their country of origin Gain refugee status in a second country and integrate into society Resettle to a third country •From the second country, refugees may apply to be permanently resettled in a country with refugee resettlement programs, often referred to as the third country
Addressing Undernutrition in <5 Children
Young child deaths could be reduced by about 15% with a package of nutritional interventions for pregnant women that includes: -Folic acid supplementation or fortification -Balanced energy protein supplementation -Calcium supplementation
how to gauge birthweight
a child has a low birthweight if the child's weight at birth is below 2,500 grams
how to gauge height for age
a child is stunted if its height-for age is two z-scores below the international reference height-for-age
how to gauge weight for age
a child is underweight if its weight, measured in kilograms, is two z-scores below the international reference weight-for-age
how to gauge weight for height
a child is wasted if its weight divided by height in meters squared is two z-scores below the international reference
what is an asylum seeker?
a person who has already entered their country of choice and who fears persecution if sent back to his/her home country
what is mental health
a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community
The most likely reservoir for the virus that causes COVID-19 is a:
bat
Formerly called manic depression, ____, is characterized by alternating periods of depress mania or hypomania
bipolar disorder
children who are not ____, are 3-6 times more likely to do before they turn 6 months.
breastfed
issues with stigma and mental health
´90% people with mental health problems experience some form of stigma, whether from friends and family, at work, in education or during treatment." ´Stigma affects: ´Self esteem ´Interpersonal relationships: "65% of people with mental health problems experienced stigma in their friendships. Additionally, 57% reported stigma in their family life, and 38% said they had experienced it in dating and relationships." ´Employment and housing: "57% of young people stated that fear of stigma has stopped them from applying for a job." ´Mental health symptoms ´Mental health treatment and coping ´Physical health
self care
´Ideally, we all engage in regular self-care in which we do the things that make us feel taken care of mentally, physically, and emotionally. ´But this doesn't always happen, and we may need to stop and take the time to remind ourselves we are important, too. ´Self-care is important to maintaining a healthy relationship with yourself. ´It means doing things to take care of our minds, bodies, and souls by engaging in activities that promote well-being and reduce stress. ´Doing so enhances our ability to live fully, vibrantly, and effectively. ´The practice of self-care also reminds both you and others that your needs are valid and a priority."
some solutions to the treatment gap
´Task shifting ´Disruptive innovations ´Interventions in everyday settings ´Best buy interventions ´Lifestyle changes ´Use of social media ´Entertainment education ´Use of technologies ´Community partnership models
initial rapid assessment
•Baseline: What was the health status before the crisis? •Vaccination coverage •Endemic diseases (malaria?) •Rates of malnutrition •Breastfeeding practices •What training do medical staff have? • •What impact has the crisis had on health services? •Have medical staff fled or been killed? •Are private or traditional providers available? •Are clinics still standing and functional? •Were medical stocks damaged? •Displaced populations: what exists in new location vs. previous locations? •What other health actors are responding? Where? What services? • •Local and national protocols and guidelines
CMAM, a widely-adopted approach to treat acute malnutrition in children 6-59 months on an outpatient basis, provides:
•Care in the community - early and close to home • •Community mobilization, nutrition education and screening • •Outpatient for severe cases (RUTF & routine medical care) • •Prevention of severe cases through supplementary feeding • •Inpatient therapy/stabilization for severe cases with complications
what do we do - post acute
•Decrease in mortality •Outbreaks controlled •Access to adequate diet stabilized •Population movements decreased Response is scaled back and strategy re-evaluated: •Less need for direct service provision •Increased support to national health systems •Provision of supplies and training to MOH centers •Supervision of quality services
folic acid and calcium
•Deficiencies of folic acid in pregnant women are associated with neural tube defects in their children, such as spina bifida
iodine
•Deficiency associated with a growth on the thyroid called a goiter and the failure to develop full intellectual potential
fiber and refined carbohydrates
•Dietary fiber helps prevent obesity, diabetes, cardiovascular diseases, and various cancers
what is coronavirus
•Enveloped + sense ss RNA viruses •Rapid mutation and recombination •Both a and b coronaviruses have gene sources from bats, g and d from birds •Novel 2019/20 strain is b coronavirus lineage B, or subgenus sarbecovirus, includes human SARS virus.
infant and young child feeding (IYCF)
•Exclusive breastfeeding practices through the age of 6 months could prevent 13% of child deaths, globally • •In emergencies, feeding practices can be undermined by displacement, insecurity, lack of privacy and poor access to adequate nutrition for both mother and child. • •In addition, mass distribution of breast milk substitutes, misconceptions about the relationship between stress and breast milk, and poor counseling threaten a mother's ability to breastfeed
sodium
•High sodium intake can lead to hypertension, which is a major risk factor for stroke and fatal coronary heart disease
vitamin a
•Important to growth and proper functioning of immune system; can impact severity of illness and chance of survival of pneumonia, diarrhea, and measles
provision of drugs and supplies
•Inter-agency Emergency Health Kit (IEHK): 10,000ppl for 3 months •Reproductive Health Kit (0-12) •Diarrhea Kit •Vaccination Kit •Newborn Kit (in pilot) •CMAM Kit
over the last 2 years, the Congolese health partner ship (CHP)
•Interviewed over 50 Congolese men and women in our community •Partnered with UIHC to organize 4 community dialogue sessions •Presented to over 30 providers on Congolese culture and health •Initiated a bill that will allow pregnant lawful permanent residents to access Medicaid without a 5 year waiting period •Leveraged partnership to procure resources to address mental health
what are the most common killers of refugee children under age 5
•Malaria •Diarrhea •Measles •Respiratory tract infections Malnutrition and hunger
Spending on health activities can be divided into two categories:
•Money spent on personal health •Money spent on public health
Community-based Management of Acute Malnutrition (CMAM)
•More than 1/3 of all child deaths are attributable to malnutrition •Severe acute malnutrition (SAM) kills 1 million children/year •In emergencies, increased illness and irregular access to nutritious foods dramatically increase the incidence of acute malnutrition
what are modifiable factors for type 2 diabetes
•Overweight or obesity •Unhealthy eating •Physical inactivity •Sedentary behavior •Smoking •Sleep insufficiency •Lactation
trends in natural disasters
•Population growth •Climate change •Increasing frequency and severity of climate-related events •Competition for resources Displacement
As populations are displaced and security is limited in crisis settings, a woman's need for access to reproductive health options becomes more important than ever, the Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations prioritizes activities designed to:
•Prevent & manage consequences of sexual violence •Reduce HIV transmission •Prevent excess maternal and neonatal mortality •Plan for provision of comprehensive RH services in early days/weeks of an emergency response •Increase mix of family planning methods, focusing on long-term methods and post-abortion care
supporting existing systems- acute phase
•Provision of drugs and supplies • •Support for, or supplementation of, staffing • •Training in clinical protocols, service provision, infection prevention/control, etc. • •Logistics support (vaccination campaigns, supply management, cold chain, fuel, etc.) • •Surveillance, data collection, reporting, supervision, when needed
zinc
•Severe deficiency is associated with growth retardation, impaired immune function, skin disorders, hypogonadism, and cognitive dysfunction •Deficiency is a risk factor for morbidity and mortality from infectious diseases
Emergency response must protect and support safe and appropriate feeding practices through:
•Widespread community breastfeeding promotion •Training, support and supervision of volunteer peer counselors •Community support sessions for women •Private and secure breastfeeding areas in temporary settlements •Capacity building of medical staff on optimal feeding practices
iron
•anemia, associated with fatigue and weakness •Iron-deficient pregnant women have an increased risk of giving birth to a premature or low birthweight baby, or hemorrhaging and dying in child birth