GLOBAL HEALTH 20

gender empowerment

"an iterative process with key components including an enabling enviornment that encourages popular participation in decision-making that affects the achievements of goals like poverty eradication, social integration and decent work for all as well as sustainable development" (UNSDN 2012)

Child health

- 5.4 million children under 5 years of age die each year - almost all of these deaths are preventable -children are a particularly vulnerable population - child health closely linked with poverty

Global Child Mortality and Burden of disease

- 99% of childhood deaths are in low and middle income countries - half of these deaths occur in India, Nigeria, Democratic Republic of the Congo, Pakistan, and China -46% of under-5 child deaths occur among neonates - General trend is decline, but rates of decline vary considerably by region

significance of Bangladesh (Reducing Fertility)

- More than half the women have been illiterate until recently and where cultural traditions favor large families, each women had, on average, almost seven children in the mid-1970s, thereby jeopardizing her health and that of her children. Intervention - 1975 the government launched a program to reduce the national birth rate. Had four major components. - 1) young married women were trained as outreach workers to visit women at home and offer information and contraceptive. Family welfare assistants (FWAs) eventually exceeded 40,000. Their outreach surpassed all expectations, all bangladeshi women having been contacted at least once by an FWA, including many women isolated by cultural practices, geographical location, or poor transportation. -2) provision of a wide range of family planning methods through a well-managed distribution system -3) the establishment of thousands of family planning clinics in rural areas to which outreach workers could refer clients for long-term family planning methods such as sterilization. -4) the information, education, and communication (IEC) campaign. The IEC program successfully tailored its message to achieve different aims, such as persuading men to talk to their wives about contraception and winning social acceptance for FWAs by creating a story about a compelling soap opera heroine who eventually becomes an FWA remarkable success has inspired similar mass media initiatives in Kenya, Tanzania, and Brazil. The government program evolved substantially over time, benefiting greatly from the existence of the Matlab Health Research Center that has operated for more than 40 years as a site for large scale research on the operation of health, nutrition, and family planning programs. Impact - all women in Bangladesh became aware of family planning options - Contraceptive use increased 8% in the mid 1970s to 50% in 2007 and fertility declined from 6.3 births per woman in the early 1970s to about 3.3 in the mid 1990s. -other factors as increased education and employment opportunities for women also increased demand for contraception, the family planning program has been shown to have had an independent effect on attitudes and behaviors Cost and benefits - cost about 100 million to 150 million per year with more than half of the funding coming from the United states agency for international development (USAID), the United Nations Develop Programme (UNDP), the World Bank, and other agencies. - the most expensive program component is that of FWAs, who were once critical to program success but are now valued by clients more as convenience than as an essential source of information. - research suggest a fixed site approach that provides health and family planning services from clinics, complemented with targeted outreach to hard-to-reach clients. - some of those involved in women's health believe that "doorstep delivery" by FWAs would continue to be cost-effective if the FWAs delivered not only family planning but also other messages on sexual and reproductive health, such as safe mother hood, STIs, and HIV/AIDS Lessons learned - The success of the program can be attributed to four main factors. The first was political commitment on the part of Bangladesh and the international agencies involved. The second was the broad use of FWAs, who carried the program's message into almost every home, however isolated. The third was the excellent use of mass media strategies to target audiences and change behavior. The fourth was the research and data provided by the Matlab Center that helped to constantly identify problems and improve the program. Although the program still faces a number of challenges, Bangladesh is one of the few low-income countries to have reduced fertility rapidly without resorting to coercive measures.

HIV/AIDS Risk Factors

- uncircumcised males - being female (greater biological AND social risk) - receptive anal sex - needle sharing for intravenous drug use -certain sex behaviors (e.g. engaging in sex work unprotected; unprotected sex with partners of unknown sero-status) *THE MAIN RISK FACTORS FOR HIV CONTRACTION VARY BY POPULATION AND GEOGRAPHIC LOCATION *

Case study for technology and global health :mHealth

-(mobile health): medical and public health practice supported by mobile devices -90% of the world is now covered by mobile networks

HIV/AIDS treatment

-Antiretroviral Therapy (ART) is the use of HIV medicines to treat HIV infections -UNAIDS estimated that in 2017, 75% of HIV-positive people knew their status and 79% of them were on anti-retroviral therapy -GOAL: that all HIV + persons are placed on treatment - previous goal was for those considered clinically eligible: CD4 cell count below 500 (as of 2013)

Transmission paths for communicable diseases:

-Foodborne: Salmonella, E. coli -Waterborne: Cholera, rotavirus -Sexual or bloodborne: Hepatitis, HIV -Vector-borne: Malaria -Inhalation: Tuberculosis, influenza, meningitis -Non-traumatic contact: Anthrax -Traumatic contact: Rabies

Key Risk factors for adolescent Death

-alcohol use -unsafe sex -lack of contraception -iron deficiency -illicit drug use - unsafe water, sanitation, hygiene

Types of needed technology in Global Health

1) diagnostics 2) Vaccines 3) drugs 4) delivery devices Characteristics 1) they must address the needs of the poor, not only the financially well-off 2) The context for the new technology must be considered 3) The state of the overall health system (e.g. needle sanitation) must be considered 4) The logistics of new technologies in various settings (e.g. HIC health systems vs. LMIC health systems) must be considered

Mhealth Scope and Benefits

1) improve communication between healthcare provide and individuals 2) improve access to care for hard-to-reach populations (i.e, rual) 3) increase emergency communication 4) improve monitoring and surveillance 5) equalize health information access

Definition of adolescence

Adolescent: a person between the ages of 10 and 19 Early adolescence: 10-14 Older adolescence: 15-19 Youth: a 15-24 years old Young adult: 20-24

Which of the following is an example of a Millennium Development Goal (MDG) ?

All of the listed answers are examples of Millennium Development Goals, Global partnership for development, Improve maternal health, Achieve universal primary education

What are the Social Determinants of Communicable Diseases?

Disproportionately affect the poor -Enormous economic consequences -Individual level: development and productivity -National level: impede investment Relevance to MDGs in particular -Much of the burden of communicable diseases is avoidable, many can be prevented or treated BUT this relies on addressing the social determinants of CDs Hunger/poverty Income Primary education Maternal Health

According to the McKeown hypothesis, which of the following variables made the most significant contribution to reduced mortality?

Improved standards of living

Which health field is defined in part by its focus on the control of epidemics across the boundaries between nations?

International Health

sickness and in health

Main themes from "In Sickness and in Wealth" - People in poverty have higher cortisol because they are in they are places of stress, - Movie talks about control in regards to moving up socioeconomic ladder- as you move up you have more control. Sliding scale of socioeconomic status. - Sliding scale - Chronic stress: People at top have more control over schedule, whereas people at bottom don't because they are hourly paid, as opposed to salary paid. - Sliding Scale- lower can be more stressed. - Study of effects of stress on the immune system: more stressed get more sick easily, as oppose to those who are less stressed. - Recovery time also plays apart in this.

_ is defined as the number of deaths per 1,000 populations in a given year

Mortality rate

Two identical twins are raised together until the age of 18. One becomes a grocery store clerk, and the other becomes a physician, Which of the following is true?

On average, the grocery store clear will have worse health outcomes

Key points of our guest lecture Bonnie Kaiser

Review the slides and recording/ The greatest burden is in low and middle income countries What population is typically investigated for psychological, (european/american/male college students) on mental illness task shifting () goals for achieving mental health globally

Smallpox is the only human disease that has been successfully eradicated. Why was smallpox easier to eradicate than malaria?

Smallpox can be easily diagnosed with distinctive sores on the body which allow for easier case-finding, while diagnosing malaria can be challenging

significance sri lanka case on women's health

Sri Lanka - The female literacy rate in Sri Lanka for many years was more than double the South Asian average and free health services have been available in rural areas since the 1930s - Sri Lanka improved access to health services. In the 1930s Sri Lanka established health facilities throughout the country that were staffed by medical officers. They also expanded secondary and tertiary facilities in the 1950s and around the same time established a working ambulance service. - 2nd in 1940s introduced policies to expand the number of midwives, who were the frontline workers dealing with pregnant women and childbirth. The focus on midwifery and on promoting easy access to higher-level health services in Sri Lanka has contributed to a wide acceptance by women and their families of giving birth with the assistance of a trained midwife at home or in a hospital. Midwives serve a population of 3,000 to 5,000 people and they provide an invaluable link between the local community and the health system. - Sri Lanka made use of its civil registration data to identify what areas of the country had the most significant problems with maternal mortality = reduced maternal deaths The government was able to target its effort to vulnerable groups, including women who were isolated physically and socially starting in 1960s to ensure the quality of maternal health services was always appropriate. At the same time, the government made considerable progress in other health areas. This included efforts to improve health by improving sanitation and by measures to combat malaria and hookworm -Sri lanka halved maternal deaths every 6 to 12 years between 1935 and 2008. Decline in the maternal mortality ratio from between 500 and 600 maternal deaths per 100,000 live births in 1950 to 29 per 100,000 more recently -skilled medical practitioners now attend 97 percent of the births in Sri Lanka, compared with 30 % in 1940. It has also achieved better maternal health outcomes than many countries that have higher per capita incomes or spend more on health than Sri Lanka. Low-cost, but dedicated and well-trained health personnel, including midwives. helped make the expansion of access to health care and made it affordable Sri Lanka's success in reducing maternal deaths can be attributed to widespread access to maternal health care, including emergency obstretic care, built upon a strong health system that provides free services to the entire population. The professionalism and broad use of midwives, the systematic use of health information to identify problems and guide decision making, and targeted quality improvements for vulnerable groups WERE INGREDIENT FOR SUCCESS Public-sector commitment to human development created conditions where gains were reinforced by good education, and emphasis on gender equity, the promotion of family planning, and a coordinated network of health care services. it was the step-by-step actions of the government rather than better living conditions alone that led to most of the improvements in maternal health.

emerging infectious diseases

a newly discovered disease

Communicable disease (CD, infectious disease):

illnesses caused by a particular infectious agent or parasite that spreads directly or indirectly from people to people, animals to people, or people to animals

Factors contributing to development of drug resistance include:

increasing use of drugs poor prescribing and dispensing practices inappropriate use of treatments failure of patients to take correct dosages counterfeit drugs examples of drug resistance: HIV, any first-line drug MRSA, beta-lactams Malaria, all medication Contribution to Resistance : poor laboratory capacity for diagnostic testing lack of surveillance = late detection of infections Poor sanitation and hygiene in healthcare settings Decreased attention to CDs

What do allen and feigl suggest the name "noncommunicable disease" connotes? What are the effects on research and national health funding?

it implies that it is less important, a negative category Tabaco advertisement can lead to someone getting lung cancer It effect research and national health funding by creating less attention for these diseases and funding for low and high income countries

life course approach to child health

life course interventions would be specific to - prepregnancy - during pregnancy - during labor, birth, and the first week after birth - the post-natal period of infancy - during ages 1-5

Elimination (of disease):

reducing the incidence of a disease in a specific area to zero

Eradication (of disease):

termination of all cases of a disease and its transmission globally

Women's Health

the branch of medicine that focuses on the treatment and diagnoses of diseases and conditions that affect women's physical and emotional well-being

drug resistance

the extent to which infectious or parasitic agents develop the ability to resist drug treatment

Cardiovascular disease (CVD)

disease of the heart or blood vessels Ischemic heart disease: a disturbance of the heart function due to inadequate supply of oxygen to the heart muscle Stroke: sudden loss of function of the brain due to clotting or hemorrhaging BURDEN of CVDs - CVDs make up 27% of all global deaths - Ischemic heart disease is leading specific cause of death globally for all age groups and both sexes ( 10 million in 2016) *except East Asia and the Pacific where STROKE is most common - Ischemic heart disease was the second leading cause of DALYs globally among all age groups and both sexes - stroke is the 3rd leading cause of DALYs * limited access to care in LMICs for CVDs* RISK FACTORS for CVDs Non modifiable risk factors: sex, family history, ethnicity, age Modifiable risk factors: Hypertension and/or high cholesterol, Tobacco use, Poverty, Stress, social isolation FUTURE directions for CVD research & interventions Focus on prevention: healthy eating, regular exercise, taxes on less healthy foods and tobacco, tax breaks on healthy foods, promote alternative forms of transportation Treatment: cholesterol medication, hypertension medication, widening and clearing arteries

Finland Uses Labels to Reduce Salt Consumption

finnish salt intake was estimated to be approximately 12 grams per day (4,800 mg/day sodium) more than twice the amount recommended by WHO Finnish media aided the effort by releasing numerous reports on the harmful health effects of salt, which raised both public and government awareness of salt and lower-sodium alternatives.145 Health education of consumers and training programs for healthcare professionals, teachers, and caterers on how to -From 1979 to 1982 a community based intervention to reduce population wide sodium intake called the north Karelia project was conducted to reduce mortality associated with cardiovascular disease -service organizations, schools, nongovernmental organizations, media outlets, and the food industry -Labeling systems reduced the salty content of targeted foods by 20-25% -reduction in sodium intake, diastolic blood pressure, and reduction of overall mortality and mortality due to stroke or heart disease

Social determinants of women's health

- gender inequity drives poor outcomes for women's health globally: - unequal power relationships between men and women - social norms that decrease education and paid employment opportunities; - an exclusive focus on women's reproductive roles; -potential or actual experience of physical, sexual and emotional violence. - poor health of women can have enormous consequences on society

Key challenges to child health

- if child deaths are to be averted, then policies and interventions will have to focus on 1) when within the first 5 years child death occurs 2) where they take place 3) why they occur

Social inequities by Sex and Gender

- male preference is sometimes expressed through female abortion or infanticide - young female children often fed less nutritious food than male children, which can have long-term effects - poverty, lack or low levels of education, and low social status limit access to health care - unjust social norms that devalue women's personhood can lead to differential risk for physical, emotional, and sexual abuse

Examples of current needs

- stable and rapid diagnostics for different forms of TB - low-cost and effective malaria drugs beyond ACT - Vaccines for HIV, malaria, or any of the NTDs such as hookworm - non-injection based vaccines (e.g. oral or nasal administration)

Health Technology

- the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of live

Cancer

- the name given to range of diseases characterized by body cells that divide without stopping and spread to surrounding tissues BURDEN OF CANCER - all the different forms of cancer made up about 16% of all deaths and 9.2% of DALYs and for all age groups and both sexes in 2016 - breast cancer is the leading cause of cancer death in low and middle income countries and for women globally RISK FACTORS FOR CANCER - vary for each particular type of cancer -genetic -behavioral -environmental -infectious agents FUTURE DIRECTIONS - scaling up of healthcare systems to : provide screening & provide treatment

Adolescent Health

- there are 1.2 billion adolescents in the world (1 in every 6 people) as of 2013 - Important health behaviors are set during adolescence Essential to maintaining gains made in improving child health - burden of disease for adolescents is unique - future losses to adult productivity and potential - high costs associated with morbidity (e.g HIV and TB treatment)

Constraints on the development of Needed technologies

-costs of research or new health technologies is extremely high - for-profit sector does not believe it could make a sufficient profit from products for LMICs - 10/90 Gap: about 90% of expenditure and development on health has been oriented toward diseases affecting high-income countries, and only about 10% toward diseases affecting low-andmiddle- income countries -historically insufficient attention to health condition in LMICs from national research institutions - vaccine market is particularly difficult to enter - *THESE DEVELOPMENT GAPS REPRESENT A MARKET FAILURE*

Determinants of overnutrition

-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 malnourishment in the form of overnutrition is being driven by global financial and trade liberalization, urbanization, and socioeconomic barriers to accessing healthy foods

the importance of nutrition and health

-nutritional status has a profound relationship with health status - childhood underweight is the leading risk factor for death of under-5 children globally - 45% of all deaths in children under 5 are attributable to nutrition-related causes - low-cost, highly effective interventions are available to improve nutrition status

Tamil Nadu State, India Nutrition Project

. This project began in 1980 in the South Indian state of Tamil Nadu. It aimed at improving the nutritional status of poor women and children in the rural areas of the state through a set of well-focused interventions. First, the levels of malnutrition among poor women and children in Tamil Nadu were very high at the time the project was conceived. Second, malnutrition persisted despite considerable investments that had already been undertaken to improve nutrition status. Third, studies that had been done on those investments showed that they were not working as planned and were not cost-effective. the children that needed help were not getting it food that was given to children at feeding centers that was meant to be supplementary to their regular diet often replaced their regular food or was taken home and consumed by family members other than the intended children. Moreover, little attention had been paid to nutrition education for families or to health investments that could complement the investments made in nutrition. The project focused considerable attention on nutrition education and efforts to improve care and feeding practices for young children. In addition, because deficits at an early age often produce irreversible damage to children's physical and mental development, project interventions focused on pregnant and lactating women and on children younger than 3 years of age. the project included a package of services that were delivered by health and nutrition workers that consisted of nutrition education, primary health care, supplementary on-site feeding for children who were not growing properly, vitamin A supplementation, periodic deworming, education of mothers for managing childhood diarrhea, and the supplementary feeding of a small number of women. Groups of mothers met regularly to weigh their young children. They then plotted their weight-for-age on a growth chart. Together with the community nutrition worker, they identified which children were not growing properly. A related innovation of great importance was that supplementary feeding was targeted only to the children identified as faltering. In addition, children received food supplements only while they were not growing well. The intent of this approach was to show that short-term feeding, combined with better childcare practices, could return the child to normal growth. This was a major change compared with previous practice in which supplementary feeding was more universal and longer term. the project was shown to have significantly reduced the levels of malnutrition of the targeted children. These improvements also continued over a substantial time, suggesting that the gains of the project were sustainable. The project was also more cost-effective than other investments that had tried to achieve similar aims in India. This project was pioneering and revealed some very important lessons: ■ Growth monitoring, coupled with short-term supplementary feeding of children who are faltering, can be a cost-effective way of improving nutritional status. ■ More universal and longer-term feeding of children is not necessary to achieve improvements in nutrition. ■ Women can be organized to participate actively in growth monitoring efforts. ■ Nutrition education can have a permanent and sustainable impact on child care and child feeding practices, even in the absence of other interventions.

BURDEN OF DISEASE FOR WOMEN

1) STIs and women - women are biologically more susceptible and have different symptoms - young women are more at risk for contacting yet less likely to access care - significant portion of DALYs for women 1% in LIC .5% in LMIC .2% in UMICs <.1% in UICs ADDRESING STI BURDEN FOR WOMEN - strengthen health system surveillance for STIs - Train healthcare workers to provide better STI care - increase sex education - create a system of intimate partner notification - increase access to safe prevention methods (e.g. free/affordable condoms) *gender empowerment is the key to any of these components* 2) Violence against women - UNAIDS estimaes 10-50% women worldwide have been abused physically by a partner - violence against women can lead to injuries, unwanted pregnancy, STIs, depression, disability, and death -Risk factors include: low socioeconomic status, young age of the male partner, and gender inequality addressing violence against women - legislation - ensure police, judge, and healthcare workers are trained in effective methods - change norms about intimate power violence - provide shelter for abused women - increase access to couples counselling and education 3) Maternal Morbidity and Mortality -300,000 maternal death were recorded in 2015 alone -99% of those deaths occured in LMICs Many direct and indirect risk factors as well as causes of disability and death addressing maternal mortality - enhance the nutritional status of adolescent girls - reduce the demand for abortion and the number of risky births through more accessible and good quality family planning service - ensure mothers are healthy, well-nourished, and receiving prenatal care that takes into account all health risks - provide skilled attendance at delivery - ensure access to good health system in care of emergency 4) Unsafe abortion - 1 per 100,000 women die from safe/legal abortion - only about 55% of abortions are safe/legal - unsafe abortions are associated with 13% of maternal deaths - There are about 25 million unsafe abortions each year - unsafe abortions have a death rate of 30-520 per 100,000 addressing unsafe abortion - studies show that women in regions like sub saharan africa would like to avoid pregnancy but do not have needed access to family planning - increase education on sex, fertility, and safe sex - provide access to free/affordable family planning : - information, education, and communication that promotes informed choices - good quality selection of family planning technologies - many points of services (private and public sector) - trained healthcare workers (esp. female) * Gender empowerment is the key to any of these components *

True or False: The world health organization defines "health" as "a state of being free from physical disease or pain

False

In the push to move from Primary Health Care to Selective Primary Health Care, what set of Interventions does the acronym GOBI stand for?

Growth Monitoring, Oral Rehydration, Breastfeeding, and Immunization

(re) emerging CDs (examples of emerging infectious diseases: )

Bubonic Plague (6th century) HIV/AIDS (1981) Ebola (1976) H5N1 influenza (bird flu) (2003) SARS-CoV-2 (2019) Reemerging CDs are perpetual, global challenges Zoonoses (animal to human ) case about 60% Key factors to (re)emergence include: microbial adaptation change climate change/ changing ecosystems International level Global commerce War

CD CASE STUDY OVERVIEW HIV/AIDS

Burden (2017) - Number of people living with HIV/AIDS: 36.9 million - Prevalence among adults aged 15-49: 0.8% - Number of new HIV infections: 1.8 million - Number of HIV-related deaths: 940,000 - Proportion of all adults living with HIV receiving ART: 59% Burden of disease: - highest prevalence rate of HIV/AIDS is sub-Saharan Africa: 4.7% of the adults aged 15-49 - in sub-Saharan Africa, women are twice as likely as men to be living with HIV The cost and consequences of HIV/AIDS Enormous impacts in high prevalence countries that go beyond morbidity and mortality: - a person with untreated AIDS may not be able to work, becoming dependent on others for care -Creates exceptional number of orphans - Highly stigmatized condition - Direct cost of treatment high for the poorest countries ADDRESSING the burden of HIV/AIDS - Need for vaccine -focus on prevention of new infections -achieving 90-90-90 by 2020: - 90 % of the people with HIV will know their HIV status - 90 % of those with HIV will be recieving ART - 90% of those being treated will have suppressed viral loads - successful efforts have included strong political leadership and open communication - approach to prevention must vary with nature of epidemic - efforts need to combine education, behavioral change, biomedical approaches, structual approaches. and early treatment SUCCESSFUL efforts - condom promotion - screening and treatment for STIs - Prevention of mother - to - child transmission - VOLUNTARY male medical circumcision - Interventions that targeted populations that transmit the virus from high risk to low-risk populations

BURDEN of CDs

CDs cause 31% of deaths and 40% of DALYs in low-and middle-income countries 50% of total DALYs in sub-Saharan Africa 22% of total DALYs in South ASIA

Types of NCDs

Cardiovascular disease Diabetes Cancer Mental and Behavioral illness

diarrheal disease (definition, burden, treatments and preventions)

Diarrhea: "the passage of three or more loose or liquid stools per days (or more frequent passage than is normal for the individual) Caused By : bacteria, viruses, parasites transmitted by : water, food, fecal-oral Burden of Diarrheal Disease - most significantly impacts the poor - 3rd leading cause of death low-and middle income countries - Third leading cause of DALYs among under-5 children * Mortality has decreased significantly in the past 30 years, from an estimated 4.6 million deaths in the 1980s to 760,000 deaths in 2013* Case management interventions: - oral rehydration therapy (ORT) - zinc supplementation - selective antibiotics (as appropriate) Disease prevention strategies for Diarrhea: 1. Promotion of exclusive breastfeeding for the first six months 2. Improved complementary feeding, after six months 3. Rotavirus immunization 4. Measles immunization 5. Improving access to clean water supply and sanitation

Which of the following does not reflect a link between health and education discussed in the reading and lecture?

Education leads to an average decrease in earnings and health due to the cost and stress of educational debt

The burden of health conditions for females

Heart disease is a major contributor to women's morbidity and mortality Burden of disease Group 1 (communicable. maternal, perinatal, and nutritional disorders) is a major consideration specifically for women's health

If we all give individuals in the class a size adult small t-shirt, what key course concept related to the distribution of resources is the representative of?

Equality

Which of the following statements about community Health workers (CHWs) is true: CHWs are:

Experts in the experiences and needs of the community

Malaria (definitions, burdens, treatments, and prevention)

Malaria: is a mosquito-borne disease caused by a parasite (cannot be spread from person to person) - people with malaria often experience fever, chills, and flu like illness - left untreated, they may develop severe complications and die BURDEN of malaria worldwide (2013) - Number of people at risk of infection : 3.2 billion - Number of new malaria cases; 198 million - Number of malaria -related deaths: 548,000 - Burden of malaria-related deaths: 90% in africa, 78% occurred in children under 5 years of age -proportion of households owning at least one insecticide-treated bednet: 67% Costs & consequences of Malaria: - Direct costs: individuals can contract malaria up to 5 times a year - Indirect costs: often as great or greater than direct costs due to lost days of work - economic costs: in countries with a high burden are equal to 1.3% of GDP per year Key interventions: - prompt treatment of those infected, based on confirmed diagnosis - WHO recommends: 1) chloroquine 2) artemisinin-based combination therapies (ACT) for treating uncomplicated malaria - intermittent preventive therapy for pregnant women - long-lasting insecticide-treated bednets for people living in malarial zones - indoor residual spraying in malarial zones Goals for treating malaria - reducing global malaria cases from 2000 levels by 75% in 2015 MDG Report 2015: new cases fell by 60% -Reducing global malaria deaths to 0 by 2015 - still 429,000 deaths in 2015 (but mortality rates are falling)

Significance of the Cash Transfer Program in Malawi

Malawi's attempt to reduce the health risks to young women by using incentives to keep them in school longer. Faces a high burden of HIV/AIDS. is over 10% and females especially adolescent girls, are particularly vulnerable. Women in Malawi are at highest risk of contracting HIV between ages 15 and 24 years. Interventions that reduce young women's risk of becoming infected with HIV have the potential to significantly reduce HIV prevalence in the general population. Low education attainment and economic dependence on men are important risk factors for HIV infection. In low-resource settings, adolescent girls often engage in transactional sex with older men to pay for school fees and other day-to-day expenses. Cash transfer programs have the potential to reduce the incentive for adolescent girls to engage in such risky transactional sex and ultimately reduce the number of new HIV infections among young women. rural Zomba district of Malawi, a randomized trial was conducted to assess the effect of a cash trasnfer program on HIV for young women. 1,000 young unmarried women (13 to 22 yo) participated. Half were random assigned to receive conditional cash transfers, with school attendance required to receive payments. The other half received unconditional cash transfers and did not have to attend school to receive payments. Those were going to get payments were randomly assigned by lottery to receive monthly payments ranging from $1 to $5. Participants completed behavioral risk assessments at baseline and 12 months later. Eighteen months after baseline, their HIV status was tested. after the 18-month program participant had a significantly lower HIV prevalence rate of 1.2 percent, compare to 3.0 percent in the control group who got no cash transfer payment. The study also showed that there was no significant difference in the effect between the condition and unconditional cash transfer programs. the program also found that the cash transfers significantly reduced the number of sexual encounters girls had, especially with older men. This evidence supports the notion that cash transfers can reduce HIV prevalence by reducing the need for young women to engage in transactional sex with older men. UNAIDS and the World Bank have pledged funds to help the malawian government expand its existing cash transfer program. Similar efforts are also being expanded in neighboring countries, South Africa, Botswana, and Kenya the program highlights the importance of helping to address the underlying causes of risk

Determinants of Nutrition and Health

Poverty, nutrition, education, health feedback loop: -Poverty leads to lack of purchasing power, leading to poor nutrition, affecting the potential to work and generate income, leading to further poverty. -Lack of education leads to poor feeding practices, causing poor childhood nutrition, leading to poor mental development, leading further to lack of educational opportunities -Malnutrition makes children susceptible to infections, which further decreases their nutritional intake, leading to further malnutrition

According to the course syllabus, readings for this class should be completed

before the corresponding lecture

Resistance forms of disease

can emerge or reemerge when bacteria, parasites, and viruses and altered through mutation, natural selection, or the exchange of genetic material among strains and species

what are the limitations of noncommunicable diseases

can get not regulated checked on, or studied, or the same amount of research as a communicable disease because people may not care for it too much.

difference between a noncommunicable vs communicable

communicable is something that is transmissible (you can get from someone else ) transmits to one another, non communicable can be like cancer, mental health contagious vs. non contagious

True or False: There is a relationship between the number of years your parents owned your home when you were a child and your likelihood of getting a cold when exposed to a cold virus as an adult

True

Which of the following statements about the differences and similarities between the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs) is true?

Unlike the MDGs, the SDGs were designed to be a guide for all countries to work toward sustainable development

Addressing Emerging & Reemerging CDs

strong health systems sensitive surveillance systems and public health laboratories global collaboration and willingness to share information with other countries rapid detection of new outbreaks mechanisms for effective containment

USA Infant mortality rate (IMR) and social determinants of health

- 2017 CDC report states that IMR decreased by 15% over the past 10 years -IMR for black infants decreased from 14.3 in 2005 to 11.6 in 2014, increased to 11.7 in 2015 -IMR for white infants decreased from 5.7 in 2005 to 4.8 in 2015 -Social determinants of health: access to pre- and peri-natal care, access to basic preventative health services, planned vs unplanned pregnancies

Problematic Perceptions of Technology in Global Health

- Health technology is NOT a panacea for Global Health - New technology will NOT be a quick fix - Not all health problems need NEW technologies - Focus for technology in Global health MUST remain on equity

Key terms for Nutrition and Health

- Malnutrition: refers to those who do not get proper nutrition, whether too little, too much, or the wrong kind - undernutrition: The insufficient intake of energy and nutrients to meet an individual's need to maintain good health. The three most commonly used indexes for child undernutrition are height-for-age, weight-for-age, and weight-for-height - underweight: low weight-for-age; that is, two z-scores below the international reference for weight-for-age - stunting: failure to reach linear growth potential because of inadequate nutrition or poor health. Stunting is measured as height-for-age two z-scores below the international reference - wasting: weight, measured in kilograms, divided by height in meters squared, that is two-z-scores below the international reference - 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 for children, overweight is measured as weight-for-height two z-scores above the international reference

How can we combat the market failures associated with health technology development gaps?

- Push Mechanisms : reduce risk and cost of investments - tax credits for research and development - pull mechanisms: assure a future return in the event that a product is produced Tiered drug pricing

Mental and Behavioral illness

- a wide range of illnesses and mental health conditions that affect mood, thinking, and behavior BURDEN OF MENTAL AND BEHAVIORAL ILLNESS - Mental and Behavioral illness cause 7.1% of DALYs in HICs and 4.6% in low and middle income countries in 2016 - burden varies by sex, gender, age, and social context among other things RISK FACTORS FOR MENTAL AND BEHAVIORAL ILLNESS - Genetics - Sex - Gender - Experiences of trauma or violence

diabetes

- an illness caused by poor control by the body of blood sugar - TYPE 1 diabetes: autoimmune disorder that attacks and destroys the cells in the pancreas which produce insulin - TYPE 2 diabetes: characterized by the inability to produce enough insulin or to efficiently use the insulin the body does make - Gestational Diabetes: Can develop during pregnancy due to the placenta's hormone production process BURDEN OF DIABETES - 425 million people and 8.8% of adults worldwide had diabetes in 2017 - about 80% of all deaths from diabetes are in low- and middle-income countries - costly complications: blindness, kidney failure, amputation of lower extremities, and stroke Risk Factors for Diabetes: type 1: Family history of diabetes, Environmental factors, maternal age at birth, exposure to some viral infections type 2: Family history of diabetes, Diet and exercise, ethnicity, increasing age PREVENTION AND TREATMENT FOR DIABETES worldwide - no evidence that type 1 diabetes can be prevented -insulin treatment as cost-effective Type 2 prevention and treatment: -promoting a healthy diet and exercise - education on the symptoms and complications and ways to mitigate them

Life course approach

- emphasises a temporal and social perspective, looking at an individual's or a cohort's life experiences or across generations for clues to current patterns of health and disease, whilst recognising that both past and present experiences are shaped by the wider social, economic and cultural context.. It aims to identify the underlying biological, behavioural and psychosocial processes that operate across the life span" to influence health - WHO 2000

Nutritional needs throughout the life cycle

-Infancy and Young Childhood -Adolescence -Pregnancy -Adulthood and old age Infancy and young childhood - "window of opportunity" is conception to 2 years of age. - children who are stunted are generally unable to compensate growth despite nutritional improvements late in life -Nutritional gaps during this time can cause problems with stature and mental development, and frequent infection -children need sufficient protein, energy, and fasts as well as iodine, iron, vitamin A, and zinc -Grow best and stay healthiest if exclusively breastfed for first 6 months Adolescence - Adolescents need protein and energy to grow, as well as iron, iodine, folic acid, and calcium - eating habits formed in adolescence will typically be carried into adulthood - 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 Pregnant Women - Pregnant women need a sufficient amount of protein and energy and should consume 300 more calories a day - 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 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 poor nutrition is part of the feedback loop of poverty, education, and poor health. Poor nutrition negatively impacts life expectancy across the life course.

Nutrition and Health Equity

-USDA defines "food desert" as urban neighborhoods and rural towns without ready access to fresh, healthy, and affordable food - a "food swamp" refers to the condition when unhealthy eating option far outnumber healthy alternatives

biological determinants of women's health

Iron deficiency anemia related to menstruation Complications of pregnancy Increased susceptibility to some STIs Health conditions, such as ovarian cancer, specific to women for biological reasons health conditions where women have a disproportionate share of the global burden - e.g. heart disease, breast cancer

Brazil: The Agita Sao Paulo Program Uses Physical Activity to Promote Health

1970s brazil began experiencing rapid economic growth and major socioeconomic shift, and produced a lifestyle promoting obesity and overweight. 1990 69.3 % of the adult Brailian populatuion led a sedntary lifestyle Sao paulo program took two year for to be launced and the objective was to increase the level of knowledge among the Sao Paulo population about the importance of physical activity by 50% and the level of actual physical activity by 20% over a period of 10 years school children, workforce, elderly were the main targets the program concentrated on feasible, low- or no cost ways to achieve at least 30 minutes of moderate-intensity physical activity per day, most days of the week. the goal was to convince the population that this physical activity could come from routine, daily activities such as walking to and from work or chores, as opposed to less convenient exercises more likely to cause injury, such as structured fitness programs in gyms or organized sports structured as a partnership among government, industry, nongovernment organizations, and academic communities. Coordinated by the studies center of the physical fitness research laboratory of sao caetano do sul (CELAFISCS). Largely funded by Sao Paulo state secretariat of Health. the executive board included more than 300 governmental, nongovernmental and private organization representing a wide range of sectors. These organizations were responsible for planning, organizing, and carrying out the programs activities Three main types of activities to reach its target groups: mega events, actions carried out with partner institutions, and partnerships mega events to reach the majority of cities in sao paolo state and involved 100 million people partner instituions encouraged innovation and a greater exchange of ideas for new activities various evaluations of the program were conducted and found positive effect for both increasing physical activity awareness and physical activity itself. in 3 years 9.5 % to 24% Agita São Paulo has been a role model for similar local and national programs across Brazil and in other Latin American countries. The World Health Organization has praised it as a model for other low- and middle-income countries, and it has since spurred an international mega-event celebrated annually to promote worldwide physical activity

The Challenge of Iodine Deficiency Disease in China

400 million people in China were estimated to be at risk of iodine deficiency disorders, constituting 40 percent of the global total. Scientific evidence linking iodine deficiency to mental impairment was seen by the Chinese government as a threat to its one-child per-family policy, since families were concerned about the potential health of the only child they were allowed to have. . In 1993, China launched the National Iodine Deficiency Disorders Elimination Program, with technical and financial assistance from the donor-funded Iodine Deficiency Disorders Control Project. The public needed to be made aware of the risk of iodine deficiency, especially in regions where goiter was so common that it was regarded as normal. A nationwide public education campaign was launched, using posters on buses, newspaper editorials, and television documentaries to inform consumers and persuade them to switch to iodized salt. made sure education efforts reached even the most remote villages. The supply of iodized salt was increased by building 112 new salt iodination factories and enhancing capacity at 55 existing ones. Bulk packaging systems were installed to complement 147 new retail packaging centers, with packaging designed to help consumers easily recognize iodized salt. The sale of noniodized salt was banned, and technological assistance was provided to salt producers to adopt iodination. Salt quality was monitored, both at production, where the amount of iodine added needs to be just right, and in distribution and sales, because iodine in salt dissipates easily, reducing the shelf life of iodized salt. China's nationally controlled network of production and distribution made licensing and enforcement of legislation easier iodine deficiency was reduced dramatically, and goiter rates for children ages 8 to 10 fell from 20.4 percent in 1995 to 8.8 percent in 1999. The Chinese government invested approximately $152 million in the program, recovering some of this cost by raising the price of iodized salt. The World Bank, one of several donors, deemed the project extremely cost-effective China's success in reducing iodine deficiency offers valuable lessons for future efforts to reduce other micronutrient deficiencies such as iron and vitamin A through fortification. The government made a firm and long-standing commitment to tackle the problem and brought about administrative, legal, technical, and sociocultural changes that were needed to do so special targeting of resources on areas where the consumption of iodized salt is particularly low, usually in poor and remote mountainous regions where residents see iodized salt as too costly, especially when salt can be obtained cheaply from local salt hills, dried lakes, or the sea.

HIV/AIDS transmission

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: HIV/AIDS Transmission: - unprotected sex (typically penetrative sex) - mother - child (birth or breastfeeding) - Blood contact (e.g. transfusion, needle sharing, accidental needle stick) - Infected organ/tissue transplant

Determinants and Burdens of Undernutrition

Immediate causes: - Inadequate dietary intake: weakens the body and opens it up to infection Illness: makes it harder for people to eat, absorb the nutrients they take in, and raises the need for some nutrients relationship creates a cycle of illness and infection Burdens: - The rate of underweight children younger than 5 years of age in low- and middle income countries fell from about 28% in 1990 to about 14% in 2016 - However, about 100 million children globally are still classified as moderately or severely underweight, 155 million are stunted, and more than 50 million are wasted

CASE STUDY: Preventing HIV/AIDS and STIs in Thailand

In thailand approximately 575,000 infected, the second highest in the Asia/Pacific region Thai authorities initially recognized the severity of the situation in 1988, when the first wave of HIV infections spread among drug users Survey among "sentinel" groups found that HIV was spreading rapidly through sex Between 1989 and 1990, the proportion of direct sex workers in Thailand infected with HIV tripled, from 3.5% to 9.3% and later reached 21.6% NO CONDOM, NO SEX PROGRAM Pioneer program in Ratchaburi Province started in 1989, eventually extended to the whole country in 1992: - all sex establishments had to implement the 100% condom use program - condoms were provided at no cost to establishment or sex workers - health officials held information sessions about HIV and proper condom use - Political and police commitment to the program - Three-pronged approach: 1) institution 2) individual sex workers and men seeking treatment for STIs 3) media warnings PROGRAM OUTCOMES - condom use went from 14% in 1989 to 90% by June 1992 - New HIV cases dropped by 80% - Other STI cases dropped from 200,000 to 27,597 increased reported condom use - Report from World Bank: program likely prevented some 200,000 new HIV infections EX: The program to control HIV/AIDS in Thailand is basically no condom, no sex. Why did this campaign work? the sex industry is relatively stuctured in Thailand, Thailand had a good network of STI services for treatment and survelliance, All sectors cooperated: legislators, governors, health worker, police Leadership from the top with adequate funding Remaining problems - Client increase in "indirect sex work" - Casual non-protected sex among young people - lack of intervention among frug-users - Women trafficked in from Burma, Cambodia

Neglected Tropical Diseases (NTDs) (definition, burden, treatments and preventions) (oct 17)

NTDs: a diverse group of communicable diseases that prevail in the tropical and subtropical conditions in 149 countries Burden of NTDs - 22 NTDs on the WHO list -WorldWide: diseases of poverty that affect the "bottom billion": more than 1 billion infected (about 1 in 6) about 500 million children -More likely to affect women and children - People who engage in farming in endemic regions - People who rely on rivers for drinking water in endemic regions Consequences of NTDs - impede child growth and development -harm pregnant women - social sigma -impact on productivity and future wage-earning -impact school attendance -increased susceptibility to other diseases -other possible complications: blindness, liver cancer, remarkable swelling, and skin problems Treating for NTDs - Rapid-impact package of drug for the seven most common NTDs - Develop hookworm and schistomiasis vaccine - develop new drugs to combat the NTDs more effectively and combat resistance -Work with communities to combat underlying risks such as hygiene, unsafe water supply, unsanitary disposable of human waste, and worm and parasite breeding sites - enhance political commitment to the prevention an control of these diseases - strengthen health systems in endemic areas - strengthen public-private partnerships to help address health systems in the meantime

NCDs

Noncommunicable diseases (NCDs): Cannot be spread by an infectious agent, they last a long time, and they are often disabling and lead to death is not treated appropriately Highly variable burdens, risks, preventions, and treatments within this category BURDEN OF NCDS GREATER THAN BURDEN OF COMMUNICABLE DISEASES IN LOW-,MIDDLE-,AND HIGH-,INCOME COUNTRIES

Key terms for Child Health

Perinatal: first week of life Neonatal: referring to the first month of life infant: referring to the first year of life Under-5: referring to children 0-4 years old

Control (disease control):

Reducing the incidence and prevalence of a disease to an acceptable level

Which of the following groups are least likely to face inequities in healthcare access and treatment?

Religious majorities

Keolu Fox's TED TALK VIDEO Keypoints

Where did the leprosy bacteria come from ? The human genome project 2.7 billion project promised an era of predictive and preventative medicine based on our unique genetic makeup We would need to sequence a diverse cohort of people to obtain the full spectrum of human genetic variation on the planet 96% of genome studies associating common genetic variation with specific diseases have focused exclusively on individuals of european ancestry fat less than %1 in indengiouns people, so who is the human genome project actually for? 95% of clinical trials have also exclusively featured individuals of european ancestry This bias and systematic lack of engagement of indigenous people in both clinical trials and genome studies is partially the result of history distrust ex: 1989 researchers from ASU obtained blood samples from arizona havasupai tribe promosing to alleviate the burden of type 2 diabetes that was plaguing their community only to turn around and use those exact samples without consent for schizophrenia, inbreeding and challenge Havasupai origin story sued for $700,000 and banned asu still believe that indigenous people can benefit from genetic research considering the history of distrust hawaiins have the highest rate of type 2 diabetes obesity and cvd and cancer how to make sure that the populations of people that need genome sequencing the most are not the last to benefit make genetic reaserch more native to indigenize genome sequencing technology genomes are sequenced in laboratories life size of a refridgerator this nanopore-based sequencer is smaller size than traditional. it allows genome sequencing in a way where it is collaborative and emersive activating and empowering indigenous communities 100 years later we now have access to sequence leprosy bacteria in real time using mobile genomes sequencers remote access to the internet and cloud computation and only if thats how hawaiians people want Indigenomics- genetic research to improve minority health through methods that respect indigenous knowledge indigenous people need to be partners in and not subjects for genetic research

How is the Disability Adjusted Life Year (DALY) calculated? Note that: YLL = years lost due to premature death; YLD = years lived with disability; and LEB = life expectancy at birth

YLL plus YLD

Gender equaility

a state in which rights, responsibilities and opportunities for people are unaffected by gender

gender equity

a type of social equity indicated by the distribution of mutable resources, socially valued goods and services, opportunities, capital, compensation and reward, or well-being in a way that is fair and just

who is typically the individuals or the population that is used for psychological or psychiatric research?

american, european, college male students tend to be the more research mental illness

reemerging infectious diseases

an existing disease that has increased in incidence, spread to new place, or has taken on new forms

Case:

an individual with a particular disease

Parasite:

an organism that lives in or on another organism and takes its nourishment from that organism

key points from bonnie kaiser guest lecture

haiti was her main research site state of the field - mental disorders represent a significant health and economic burden globally that burden is greatest in Low- and Middle- Income Countries low income countries comprise 15% of the population but only 0.4% of mental health research publications (The least research) shortage of specialists: 1 million Task Shifting: taking the tasks that is done normally in a high income setting is covered by people who are more readily available in low income settings (teachers primary care providers) Integrating mental health care into primary care prime was 5 country project testing Haiti: Combined task-shifting and specialist care provision Barriers in Global Mental Health: 1) Gaps in Knowledge : Discrepancy between HIC resources (american and europe) and LMIC needs (more attention) Anxiety. BPD, Drug Abuse, Schizophrenia, Depression, Alcohol, Psychosis, Somatoform Disorders, PTSD, Psychosis etc anthropolgy can contribute to ongoing debates universality of mental disorders how to identify and communicate about mental illness avoiding medicalizing/pathologizing how to measure mental illness what interventions work etc anthropology and mental health - fundamental question "how to distinguish the normal from abnormal" as well as perception, experience, expression, treatment, and relationship between social world and the body/self Idioms of distress: "socially and culturally resonant means of experiencing and expressing distress in local worlds" there is common perception that vodu concepts preclude biomedical mental health care seeking 2. lack of validated instruments the majority of studies in LMICs have not used validated instruments therefore, it is difficult to interpret the meaning of prevalence studies e.g. what does 97% prevalence of PTSD mean? questions for GMH research and practice who is need of care how effective are mental health interventions what shapes vulnerability and resilience to mental disorder what are the goals of measurement in mental health research - cross-cultural comparison - enthographic validity 3. Lack of Culturally Appropriate Interventions 4. Lack of experts in context of task-sharing e.g. no supervision after trainings; lack of human and institutional resources to receive referrals 5. Increasing funding & political will

life course approach (oct 26)

instead of thinking of health in terms of one specific illness, takes in consideration of one person's life (childhood, adolescence, young adult) it matters to look at these different stages of life

South Korea's Promotion of and Adherence to a Traditional Diet

the need of intervention, the intervention, and the outcomes of interventions: South Korea grew in economy due to lifestyle changes, most importantly the transition of a more western diet; fast food restaurants in particular were popular among younger generation in 1988 tradition food low fat/high vegetable Due to a dietary evaluation in 1998, it was found that south korea had lower than expected levels of fat intake (by 16.7 %) and obesity prevalence found to be largely due to programs led by the government and private organizations to encourage the traditional South Korean diet. government held public educational event and the Korea Dietetic Association (KDA), a private organization, provided nutrition education through seminars and obesity camps, aided nutrition services at local health centers, and offered nutrition information for citizen on its website. KDA also monitored food and nutrition advertising through mass media and nutritional campaigns/ 1998 evaluation of the combination of these efforts revealed that the retention to keep the korean traditional diet and subsquent positive health outcomes. South Korea was among the highest in Asia for vegteable consumption. 20% among total food consumption (280 grams daily) Fruits (197.5 grams of fruits were consumed daily per capita, more than a tenfold increase from the 18.9 grams consumed in 1970. ) Fat increase from 16.9 1969 grams to 41.5 grams 1998/still lower than other asian countries, traditional cooking style involved small amounts of oil, and the meat consumed was cooked in korean style with vegetables obestiy rates were low 1.7 % men 3.0 % women 5.3% total in today demonstrarted that the potential for effective public-private collaboration in the pursuit of a healthy diet. By using a combination of dissemination and provision of sills, the country was able to adapt its message to society and successfully retain its traditional diet slowing the spread of obesity

Case fatality rate:

the proportion of persons with a particular condition (cases) who die from that condition

Control Measures

vaccination vector control improved water, sanitation, hygiene improved care seeking, disease recognition case management (treatment) and improved caregiving case surveillance, reporting, and containment behavioral change

Gender Equality, Gender Equity, Gender Empowerment

● Gender Equality: A state in which rights, responsibilities and opportunities for people are unaffected by gender ● Gender Equity: A type of social equity indicated by the distribution of mutable resources, socially valued goods and services, opportunities, capital, compensation and reward, or well-being in a way that is fair and just ● Gender Empowerment: "An iterative process with key components including an enabling environment that encourages popular participation in decision-making that affects the achievement of goals like poverty eradication, social integration and decent work for all as well as sustainable development" UNSD 2012