After midterm quiz questions- global health

role of faith based organizations

"30% - 70% of health-care services are provided by faith-based entities worldwide"

what is culture

"A set of rules or standards shared by members of a society, which when acted upon by the members, produce behavior that falls within a range of variation the members consider proper and acceptable" (Skolnik, 2015, pg. 146).

social determinants of womens health

- Related to gender norms and roles - Female abortion or infanticide - Often fed less nutritious food than male children - Male dominance leads to physical and sexual abuse - Cooking with poor ventilation contributes to respiratory disease - Low social status limits access to health care

roles of private sectors

Formal and informal health care providers Operate health clinics, hospitals, health services, labs May operate on own financing or sell/contract services to the government

multilateral development banks: world bank

Headquarters: Washington, DC (employs 10,000 people; 187 member countries

What do you think is the most important change that needs to take place in order for Chad to decrease mortality mortality? Why do you think this is the most important change?

I think one of the most important changes is providing access to better health services. A lot of the deaths could be prevented with better drugs or equipment that could be provided. Along with access to better health services would also include information and education. If the people who are currently delivering babies could get education and training on how to correctly do what they are currently doing, that could also reduce many deaths. I also think information regarding family planning and possibly access to birth control would reduce a lot of pregnancies, which would reduce the deaths. But the most important change is better health services, which would reduce preventable deaths.

biological determinants of womens 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

Why can it be said that "being born female is dangerous to your health?"

It can be said that being born female is dangerous to your health because females go through a lot more hospitalizations and medical procedures than men do. Pregnancy can be very dangerous depending on where you live and your socioeconomic status. Females in low income countries are put in danger when they are pregnant because they don't have access to healthcare that they need.

A significant health systems challenge during the Ebola outbreak was the poor response and weak leadership of the World Health Organization. Describe one specific strategy that was discussed in your assigned readings (listed below) for how the World Health Organization response could be improved for future outbreaks.

It was discussed in the text that Community Engagement and Social Mobilization Around Infectious Diseases could combat the issue of the poor response and week leadership of WHO. The reading discusses that it is important to start a conversation between community leaders and elders. The reading discusses that African societies are hierarchial in structure, meaning that finding an intervention must get the approval of the community leaders. It is important that during the Ebola outbreak or for future outbreaks that we understand the Countries beliefs and that we communicate with them appropriately. If the WHO would have understood that it was important to communicate with the leaders and elders, it is possible that they wouldn't have had such a poor response and weak leadership. Overall, for future outbreaks it is important for WHO to understand the culture of the place of the outbreak and to have correct communication with the place of the outbreak.

Another significant health systems challenge during the Ebola outbreak was a shortage of health workers. Describe one specific strategy that was discussed in your assigned readings (listed below) for how countries could address this challenge in future outbreaks.

It was discussed in the text that the development of public-private parternships (regional and international) for infectious disease control could combat the issue of a shortage of health workers. The ebloa epidemic is an issue that cannot be addressed by just one country. The text discusses that governments in the affected countries do not have all of the resources for the whole problem. It is important when epidemics like Ebola happen, that the international community helps the affected country out. For future outbreaks, it is important that regional and international governments work together to combat a lack of resources, like the shortage of health workers.

middle income countries and health systems

Many have a system organized around a national insurance scheme. Working toward universal coverage

dietary diversity

Neandertals were successful hunters of a variety of large game animals as were AMH - Mostly same (big game hunting) - AMH more focus on communal effort collecting small game (higher nutrient load, more reliable calories)

roles of NGOs sectors

Not-for-profit Independent of the government Address issues in support of the public good May operate on own financing or work under contract to the government, private, or philanthropic sector

The assigned article (listed below) describes six opportunities to create synergies and integrate non-communicable diseases with other health programs. List two of the six opportunities.

One of the six opportunities is integrated monitoring and evaluation systems. The article discusses that integrated information systems can bring together individual-level data which is important to build individual risk profiles. Another one of the six opportunities is financing for universal coverage. The article discusses that in places like Kyrgyzstan, Mexico, and Thailand they have an expansion of social protection schemes and pooling of inneficient out-of-pocket expenditures that help these countries to provide social insurance schemes that support non-communicable diseases.

costs of noncommunicable diseases

Out-of-pocket costs Loss of income -> Take loans Deplete savings Sell assets Lower productivity Higher health expenditures Premature deaths undermine economic benefits World Economic Forum "has ranked NCDs as a greater threat to global economic development than fiscal crises, infectious diseases, natural disasters, and crime."

roles of public sectors

Responsible for stewardship of the system Different levels: national, state, or municipal levels Raising and allocation of funds Establishing approaches to health insurance Managing key public health functions

importance of womens health

Subjected to discrimination and prescribed roles Face unique health problems Disparities between the health of men and women Result in social and economic consequences Investments in women's health would avert many deaths and DALYs Improving the education and health of women and their place in society is on of the most cost-effective approaches to social and economic development

low income countries and health systems

Tend to have fragmented health systems that include both public and private providers

You were assigned, "To Hell with Good Intentions," by Ivan Illich for your reading on Tuesday. This was an address given to a conference of students embarking on a summer volunteer experience in Mexico. In 2 - 3 paragraphs, please reflect on the reading and consider the following: - The reading is from 1968. Do you think it is still relevant today? Why or why not? - What, if any, aspects of Ivan Illich's address do you agree with? Why? - What, if any, aspects of Ivan Illich's address do you disagree with? Why?

Although the reading is from 1968 I do agree that it is still relevant today. I believe it is still relevant for two reasons. The first reason is all of the political issues we are experiencing right now with our current president and Mexico. The next reason I think it is still relevant is because still today we send a lot of people to different countries to help in many ways. Ivan Illich is making his argument that people can go visit Mexico, but not to help, which is why I think his argument is still relevant. I agree with a couple of things that Illich discusses. Illich discusses that the Peace Corps spends $10,000 on each member to help them adapt to their new environment. I do agree that we could be using that money in a different way, maybe for training before they get to their destination or also for helping the people in the other countries adapt to people coming to help. I agree that a lot of volunteers are probably under educated, a lot of volunteers are from churches that have had no training and cannot even communicate with the people they are meeting because they can't speak their language. I agree with Illich that people could be actually harmful without even knowing. They think they are helping but they are not realizing the damage they are doing. I also agree with the flaws in our system that Illich discusses. He says, "the dictators were formerly at the service of the plantation owners, but now they protect the new industrial complexes". I have been learning a lot about the construction of race in the U.S. and I do agree with this statement. Our system has flaws and this is one of the many flaws that we do have with our system. I do although, disagree with one main point. I disagree that nothing good can come from United States citizens going to other countries to help. I believe that when we have trained professionals going to other countries, they do more good than harm. For example, with all of the epidemics that occur worldwide, the United States offers help to other countries, help that they need in order to get over the epidemic. For example with the Ebola epidemic, the United States was the worlds largest single country donor to respond to the West Africa Outbreak. I don't agree with his last statement that we can come to vacation, but don't come to help. I understand his point, that we can do harm without realizing, but I do believe that when we send trained professionals to help other countries, they do help. I do understand that volunteers who havent had training could be seen as condescending or harmful, but trained professionals can do a lot of good in other countries.

other medical systems health care providers

Chinese herbalists, acupuncturists, Ayurvedicpractitioners

what are the different categories of health system challenges and reform

Demographic and Epidemiologic Change Stewardship Human Resources Issues Quality of Care Financing of Health Systems Financial Protection and the Provision of Universal Coverage Access and Equity

nutrition status definition

Directly linked to the growth of young children, their mental and physical development and their health as adults.

List the three steps described in the stepwise approach for scaling up health systems to tackle non-communicable diseases (refer to the assigned reading listed below).

The article says that the first step should focus on inclusion of management of non-communicable diseases and multimorbidity when national health plans, strategies, and government budgets are developed. It also discusses how committed leadership would be needed. The second step should identify ways to reduce fragmentation in service delivery through judicious integration across health system functions where synergies are possible. The third step should aim to strenghten primary and community care services through gradual integration of HIV, tuberculosis, and other health programmes.

what is a health system

The sum of organizations, institutions, and resources whose primary purpose is to improve health.

What surprised you the most about the Documentary, Dead Mums Don't Cry? Why do you think this surprised you?

What surprised me the most about the documentary was just how common death is for pregnant mothers in Africa. It was surprising that oftentimes they do not have a trained nurse or an aid, but they have someone that has not been properly trained to deliver their baby. I think this surprised me because of the fact that most times they are preventable deaths. Here, in the United States, it would be considered crazy if someone that wasn't trained delivered a baby. The struggles of pregnant women in Africa is heartbreaking.

health workforce

appropriate number of trained staff in the right fields, in the places they are needed

sex

biological

determinants of nutritional status causes underlying causes and basic causes

causes: food availability and utilization, disease prevention, quality of maternal and child care underlying causes: inadequate access to food, poor health services and environment, and inadequate care for children and women basic causes: inadequate education, resources and control, and political/economic factors/structures

key micronutrients: consequence when you don't eat enough, what food has it iron

consequence when not enough: anemia, poor mental development, reduce immune function, cognitive and motor skills what foods has it: fish, meat, poultry, fruit, grains, veg, nuts, dried beans

key micronutrients: consequence when you don't eat enough, what food has it iodine

consequence when not enough: fetal loss, stillbirth, congenital anomalies, hearing, intellectual disabilities what foods has it: seafood, plants grown in iodine rich soil, supplementation

key micronutrients: consequence when you don't eat enough, what food has it zinc

consequence when not enough: growth retardation, immune system, skin disorders, cognitive dysfunction, susceptibility to infection what foods has it: red and white meat, shell-fish

key micronutrients: consequence when you don't eat enough, what food has it vitamin A

consequence when not enough: night blindness, proper immune response growth what foods has it: leafy green veg, yellow and orange fruit, some animal products

service delivery

deliver safe and effective health interventions in an efficient manner

health information system

delivers the info needed for monitoring health status and health system performance

obesity definition

excessive body fat content

T or F The belief that health is a right is fundamental to every countries' health system?

false

Which of the following is NOT one of the building blocks of the WHO Health System Framework? health workforce leadership and governance financing health research

health research

low birthweight definition

is birthweight less than 2,500 grams

malnutrition definition

is many types of poor nutrition including underweight, overweight and micronutrient deficiencies

folic acid sources and selected functions

leafy green vegetables, fruits, dried beans, peas, and nuts, enriched breads, cereals, and other grain products helps body make new cells and is essential for preventing children being born with neural tube defects

wasting

low weight for height

leadership and governance

management, oversight, and regulation of health systems in open, participatory, and accountable ways, that seek to maximize health for the money spent

calcium sources and selected functions

milk and dairy products, some green leafy vegetables, almonds, brazil nuts, beans building strong bones and teeth, clotting blood, sending and recieiving nerve signals, reduces problems of hypertension in preggos

protein sources and selected function

milk, eggs, chicken, beans proper growth of children and immune functions

causes of maternal deaths

other, hemorrhage, blood clots, abortion complications, sepsis, hypertensive disorders

health financing system

raises enough money to fund an agreed-upon health program and protect individuals from financial harm due to the cost of health services

what are the building blocks of the WHO health system framework?

service delivery health workforce health information system medical products, vaccines, and technologies financing leadership/governance

equitable access to medical products, vaccines, and technology

that are safe, of appropriate quality, have been procured at the best available prices, and can be used in cost-effective ways

stunting

the failure of children to grow to a normal height for their age due to severe and chronic malnutrition

According to the WHO, what is a health system?

the sum of organizations, institutions, and resources whose primary purpose is to improve health

indigenous health care provider examples

traditional birth attendants, shamans, curers, spiritualists, witches, sorcerers, priests, diviners, herbalists, bonesetters

nutrition definition

¤Eating healthy and having balanced diet. Having all the important nutrients to be healthy.

nutrition needs at different stages of life course

¤Meeting all the nutrition needs for everyone is important in particularly for young children and pregnant women. ¤Pregnant women needs sufficient amount of protein from the food and vitamins. They should consume 300 calories more per day then when she is not pregnant. ¤The birthweight of the baby is associated with their lifespan

barriers to adequate nutrition

¤Poverty - meaning food insecurity ¤Food disruption (drought, war) ¤Illness (chronic diarrhea, infections) ¤Environmental conditions

vitamin A deficiency definition

¤can cause adverse health affects such as blindness, dry skin, reproductive health and frequent infections.

undernutrition definition

¤is commonly used indexes for both children and adults. - Children's are measured height-for-age, weight-for-age and weight-for-height. - For adults BMI is used to measure undernutrition.

anemia defintion

¤is low level of hemoglobin in the blood, a reduced quality or quantity of red blood cells.

other actors

•Advocacy Organizations (ie: International AIDS Alliance) •Think Tanks (ie: Center for Global Development) •Universities •Consulting Firms (ie: For profit -AbtAssociates; Not-for-profit - FHI 360) •Specialized Technical Organizations (ie: CDC) •Private industry (Public-Private Partnerships)

U.S. National Institutes of Health

•Biomedical and behavioral research •Supports research at major academic and research institutions •Global Health - Fogarty International Center

importance of non communicable diseases

•Burden of NCDs is greater than the burden of communicable diseases in low- and middle-income countries •54% of the total number of DALYs (Disability-Adjusted Life Year)in 2010 are attributed to NCDs •The burden of NCDs will increase in LMIC as they grow economically, urbanize, and age •Prevention is essential and cost-effective relative to the treatment of NCDs.

USAID (U.S. Agency for International Development)

•Bureau for Global Health •Focus areas: Maternal and child health, HIV/AIDS, communicable diseases, family planning and reproductive health, nutrition, and health systems •Works with other governments, universities, businesses, international agencies, and NGOs

bilateral agencies

•Development assistance agencies of high-income countries that work directly with low- and middle-income countries to enhance health

Research funders

•Foundations and National Governments •U.S. National Institutes of Health

large foundations involved in global health:

•Gates, Clinton, Rockefeller, WellcomeTrust, Ford, Hewlitt, MacArthur, Packard

Gates foundation

•Headquarters: Seattle, Washington •Global development work (social determinants of health and directly in health; agriculture, financial services, WASH, family planning, MCH, vaccine delivery) •Global health work (focus areas: discovery and translational sciences, enteric and diarrheal diseases, HIV, Malaria, Neglected infectious diseases, pneumonia, and tuberculosis

purpose/function of multilateral development banks

•Lend or grant money to low- and middle income countries and economies in transition •Financial intermediary: channel financial resources from high-income countries to development activities in low- and middle-income countries •Owned by member countries

what are other examples of how culture and health intersect

•Perceptions of illness •Perceptions of disease •Prevention of illness •Diagnosis/treatment of illness •Health Providers

Nongovernmental organizations

•Thousands of NGOs worldwide that aim to improve health in low- and middle-income countries •Funding: private sources or through grants from governments or global health partnerships •BRAC •Largest NGO •Founded in Bangladesh; currently in 11 countries Other examples: Doctors without Borders and Partners in Health

access and equity challenge

◦A lack of coverage of basic services in areas where poor, rural, and minority people live ◦Service coverage with a lower level of inputs (ie: trained personnel) in areas where poor, rural, and minority people live ◦Service coverage that varies with income, education levels, and location ◦Availability of access to more expensive services is limited to higher-income individuals or those not marginalized

stewardship reform

◦Anti-corruption programs ◦Make procurement systems more transparent ◦Increase audits of health systems and enforce penalties ◦Community oversight and feedback ◦Carry out customer satisfaction surveys

gender

◦Cultural ◦Societal norms about the roles of women and their social position relative to men

National Health Service

◦Government is the sole payer for healthcare and owns most of the healthcare facilities

united nations AIDS (UNAIDS)

◦Headquarters: Geneva, Switzerland ◦Monitors and evaluates the HIV epidemic and the world's response, engages in advocacy, generates and shares knowledge, and mobilizes resources

world health organization

◦Headquarters: Geneva, Switzerland (employs 7000 people) ◦Engages in advocacy and the generation and sharing of knowledge

united nations childrens fund (UNICEF)

◦Headquarters: New York City ◦Engages in advocacy, the generation and sharing of knowledge, and financing of investments in health

demographic and epidemiological change challenge

◦Increasing burden of noncommunicablediseases ◦Chronic diseases ◦Higher costs ◦Triple threat: noncommunicable disease, communicable disease and injuries

financing of health systems challenge

◦Insufficient public sector funds for health ◦Ineffective and/or inefficient spending ◦Small portion of GDP dedicated to health

human resources issues challenge

◦Lack of staff ◦Maldistributionof staff ◦Inadequate training ◦Quality of personnel ◦Poor working environment

financial protection and universal coverage challenge

◦No social insurance scheme or strategies in place to protect individuals and families from catastrophic health costs

national health insurance

◦Offer health insurance to all people for an agreed package of services

quality of care challenge

◦Poorly trained health workers ◦Maldistribution of health workers ◦Poor Management and supervision ◦Lack of financial resources ◦Unempowered patients

Pluralistic

◦Public sector, private, for-profit sector, and private, non-profit sector play important role

quality of care reform

◦Quality of care assessments ◦Improved oversight, supervision, and continuing training ◦Use of clear guidelines, protocols, and algorithms ◦Link payments to performance for contract work ◦Total quality management approach

financial protection and universal coverage reform

◦Raise additional revenue for health ◦Improve the efficiency of health sector expenditures ◦Reduce dependency on out-of-pocket expenditures (ie: greater financial protection for the poor; fund a free or subsidized basic package of health services) ◦Enhance equity

demographic and epidemiological change reform

◦Reduce disease burden related to tobacco use ◦Take actions to reduce traffic accidents ◦Strengthen and adapt health systems to manage prevention, treatment, and care of noncommunicabledisease

financing of health system reform

◦Shifting resources (greater portion of GDP to health) ◦Development assistance ◦Focus on low-cost, high-impact interventions ◦Increase data on health expenditures ◦Improved efficiency of expenditures

human resources reform

◦Support for education and training of health workers ◦Better policies and programs for retaining health workers ◦Task-shift certain responsibilities ◦Improve financial incentives

access and equity reform

◦Use data to identify gaps in health status and health coverage ◦Target health resources to places and people in greatest need

stewardship challenge

◦Weak governance ◦Unable to enforce rules and regulations ◦Poor management of human resources ◦High corruption

key characteristics of non communicable diseases

1.Cannot be spread from person to person by an infectious agent 2.Tend to last a long time 3.Can be very disabling and, if not treated appropriately, can lead to death

what are the goals of health systems

1.Good Health 2.Responsiveness to the expectations of the population 3.Fairness of financial contribution

high income countries and health systems

: Most have a national health insurance system.

western biomedical healthcare providers

: pharmacists, nurse-midwives, nurses, nurse-practitioner, physician, dentist