GEOG FINAL (12-15)

Mental Disorders

depression bipolar affective disorder schizophrenia and other psychoses dementia intellectual disabilities and developmental disorders including autism

SUNDAR

important for effective task shifting s- simplify the message uN- unpack the treatment D- deliver it where people are A-affordable and available human resources R- reallocation of specialists to supervise

alcohol WHO initiative

increase taxes, bans on advertising, reduced hours of sale, enforced dui laws, phycosocial intervention, regular reviews on pricing, minimum pricing laws, minimum age of purchasing and consumption, restrict promotion of alc for young people, provide treatment care, provide info about the harms

BCPH food safety program

inspections, eductations, partnerships,investigations

BCPH body art program

investigations, outreach, inspections

tools listed as essential for the advocate's toolkit as they apply to global health activism: o Engage in critical self-reflection

Consider own position, sources of inspiration, and potential roles in movement for global health equity Challenge is discerning the reaches of your own local morale world in the context of a larger movement or unintended consequences

tools listed as essential for the advocate's toolkit as they apply to global health activism: build a coalition

a broad base of thoughtful and engaged individuals in the community like students, churches, service oriented, political, and cultural

tools listed as essential for the advocate's toolkit as they apply to global health activism: be the change

be humble by listening before you speak out listen to those who disagree with you don't underestimate one on one conversations

tools listed as essential for the advocate's toolkit as they apply to global health activism: know the issues

be well informed about key global health issues and political climate determine issues leaders may have political leverage enduring activism is based on careful and accurate analysis of what are complex biosocial problems ability to engage with human problems are not limited to those with certificates of advanced training

tools listed as essential for the advocate's toolkit as they apply to global health activism: o find good partners

groups understand the mechanics of policy change seek to give visibility to key issues and gain political traction group that fits your interests, understand that power comes from partnerships partners need to include those most affected by the problem's your activism seeks to address

tools listed as essential for the advocate's toolkit as they apply to global health activism: organize a public demonstration

public displays like a protest, boycott, sit in , public fast, performance art where officials are held accountable for their responses press coverage and social media will amplify the impact

tools listed as essential for the advocate's toolkit as they apply to global health activism: start a dialogue with policy makers

reach out to representatives in local and national government sense their position and understand why think of ways to align with their interests with those of the movement for global health equity

tools listed as essential for the advocate's toolkit as they apply to global health activism: highlight key issues

thinking of creative ways to demonstrate the importance and promote the visibility of global health issue calling or writing to officals bird dogging can elecit public comments from political leaders drafting a petition setting up meetings with representative placing commentary in the media traditional or social media

Targeting racial/ethnic communities- tabaco

"Marketing to Hispanics and American Indians/Alaska Natives has included advertising and promotion of cigarette brands with names such as Rio, Dorado, and American Spirit.7,8 Historically, tobacco industry product promotions to American Indians and Alaska Natives featured symbols and names with special meanings to this group. For example, the American Spirit™ cigarettes were promoted as "natural" cigarettes, and their packaging featured an American Indian smoking a pipe.3 The tobacco industry has targeted African American communities in its advertisements and promotional efforts for menthol cigarettes. Strategies include:5,7 Campaigns that use urban culture and language to promote menthol cigarettes Tobacco-sponsored hip-hop bar nights with samples of specialty menthol cigarettes Targeted direct-mail promotions"

Marketing to specific groups - tabaco

"Scientific evidence shows that tobacco company advertising and promotion influences young people to start using tobacco.5 Adolescents who are exposed to cigarette advertising often find the ads appealing. Tobacco ads make smoking appear to be appealing, which can increase adolescents' desire to smoke".

Tobacco industry marketing and spending

"The money cigarette and smokeless tobacco companies spent in 2014 on U.S. marketing amounted to— Nearly $25 million each day1,2 More than $28 for every person (adults and children) in the United States per year (according to 2014 population estimate of 320,000,000)1,3 More than $227 per year for each U.S. adult smoker (based on 40 million adult smokers in 2014)1,4"

Using front groups to create illusion of support

"smoker's rights" groups Try to keep up a controversy and show that not all of the public supports smoking bans Business front groups used to say that tobacco control will hurt their business Front groups are groups that purport to serve a public cause but are actually funded by and serve the interests of another group that remains namelesss

Reinstatement of the Mexico City Policy (a.k.a. the Global Gag Rule)

'The policy requires foreign non-governmental organizations (NGOs) to certify that they will not "perform or actively promote abortion as a method of family planning," using funds from any source (including non-U.S. funds), as a condition for receiving U.S. government global family planning assistance and, as of Jan. 23, 2017, any other U.S. global health assistance. The Trump administration's application of the policy to the vast majority of U.S. bilateral global health assistance, including funding for HIV (PEPFAR), maternal and child health, malaria, nutrition, and other programs, marks a significant expansion of its scope; in FY 2017, bilateral global health assistance totaled more than $8 billion (family planning assistance accounted for approximately $600 million of that total).' Trump signed an executive order to reinstate a former policy which forbids US funding to any foreign NGO that provides abortions or which educates people about abortions.

Protein Energy Malnutrition

1) Marasmus (skeletal child) 2) Kwashiorkor; hair reddish, swollen 3) Or marasmic kwashiorkor

chronic diseases often called NCDs

1. heart disease & stroke 2. chronic respiratory disease 3. diabetes 4. cancer 5. mental health Also : blindness, arthritis, musculoskeletal, neurologic disorders and more

estimate of the number of maternal deaths per year globally

215,000

1. What does MDRTB stand for?

3. Multidrug resistant tuberculosis 4. Caused by strains of mycobacterium TB resistant to isoniazid and rifampin two of the four first line anti TB drugs 5. Affects 5 hundred thousand a year

Critiques 3 & 4 of Global Mental Health

3. Not a true collaborative partnership between north and south 4. Anthropologically and socially naïve ignores social conditions, structural violence, poverty, war, inequality, etc.

Universal access to family planning can address ALL of these issues. Must include:

Education Physical access Economic access Social access Changes in laws and social norms to give women more rights and protections

Dementia

47.5 million people Typically chronic or progressive. Deterioration in cognitive function (beyond what might be expected from normal aging)

What percent of tobacco users worldwide will die as a direct result of their tobacco use? What percent of deaths caused by tobacco use are considered preventable?

50 % 100%

What public health measures (besides those targeting tobacco) address the respiratory issues

Access to improved stoves and cleaner fuels to reduce indoor air pollution - prevent exposure to silica and asbestos in the work environment -flu vaccines for those with COPD.

Adaptation

Adjustment of natural or human systems to projected climatic changes to increase benefits and decrease harms (adapted from IPCC) Adaptation to climate change can be: Physiological Behavioral Technological

Rehabilitation in the neighborhood

Advantages: -- reduced distance/cultural barriers; less danger of cross infection. -- Foods, feeding/caring practices, rather than "medicine" are emphasized. -- The change in the child is evident to the whole community; feedback is local Constraints Who can accomplish rehabilitation in the community? (8th grade level girls can teach volunteer moms) How to find resources? How to find supervisory capacity? What are prerequisites? How can one monitor and evaluate?

Repeated episodes = lack of catch up growth

Anorexia due to Infection....... Followed by lack of weight gain and then decreased growth Followed by lack of catch-up growth

an integrated way to define the problems and solutions of mental health

Anthropologist: understanding meaning of illness to her, understanding benefit of local approaches to healing Examination of structural causes of her suffering Offering medication and/or counseling as needed

Decreasing fossil fuel burning

Any efforts to decrease emissions of CO2 from power plants will decrease emissions of other air pollutants Lower levels of air pollution will benefit health globally 10% of global deaths in 2013 were due to outdoor air pollution So the co-benefit of reduced power plant emissions is decreased emissions of other air pollutants.

Which of the following would be an example of a direct impact of climate change on health?

As temperatures increase, there are likely to be more heat waves. People who work outdoors, who are older age, or who have certain health concerns can die during heat waves.

Boulder County Public Health Mission

Assess and mitigate environmental health risks Provide educational opportunities Create partnerships with communities Collaborate with other organizations

definitions of gender and of sexual orientation that should be noted

Birth: assigned a sex based on genitalia. A certain percent of people are Intersex—meaning they are born with any of several variations in sex characteristics including chromosomes, gonads, sex hormones or genitalia that make doctors unable to assign their sex as distinctly male or female. But Gender identity is not the same as sex. It's what you identify with. We think of gender as binary; people either identify as male or female. But identity is fluid. Think of it as a spectrum. CIS—if your gender identity and expression matches the sex assigned at birth Trans-if your gender identity and expression don't correlate with your assigned sex. New to our language; the emergence of pronouns that are not binary—like ze or they. Health impacts: not being treated in accordance with your identity in health care facilities.

How heat affects health

Body Temperature >38 ˚C = "heat exhaustion" Physical and cognitive impairment Body Temperature >40.6 ˚C = "heat stroke" Risks of organ damage, loss of consciousness and death increase Can also lead to: Electrolyte imbalance Kidney disease/renal failure Individual factors such as sex, age, and pre-existing illness may change these temperature thresholds Ventilation, humidity, and air conditioning exposure also alter these temperatures Suicide, homicide, and other violence also increases with increasing temperature

Screening for Breast, Cervical, Colorectal (Colon), and Lung Cancers

Breast CA: mammograms Cervical: Pap smears. Colon cancer: Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. Screening tests can find precancerous polyps, so they can be removed before they turn into cancer. Screening tests also can find colorectal cancer early, when treatment works best. Colonoscopies are most common. Also tests for blood in stool. Lung cancer: yearly lung cancer screening with low-dose computed tomography (LDCT) for people who have a history of heavy smoking, and smoke now or have quit within the past 15 years, and are between 55 and 80 years old.

BCPH Reduce Obesity by Supporting Active Living

Built Environment- Focuses on increasing physical activity and active transportation among young children and their families in Boulder County People who live in neighborhoods with sidewalks are 65% more likely to walk than those without sidewalks Public Transit users take 30% more steps per day than people who rely on cars for transport Physical activity improves mental health and well-being and lowers lifelong health risks Built environment work supports a culture of physical activity by: Improving access to public transportation Increases access to places to be physically active Promotes walking and biking for transportation and recreation Collaborate with other divisions in Boulder County to improve the built environment in Boulder County and increase alternative transport and walkability

Global Cancer Facts

Cancer is the second leading cause of death globally. Tobacco use is responsible for approximately 22% of cancer deaths.2. Cancer causing infections, such as hepatitis and human papilloma virus (HPV), are responsible for up to 25% of cancer cases in low- and middle-income countries3. Late-stage presentation and inaccessible diagnosis and treatment are common in low-income countries. Cancer is the second leading cause of death globally, and was responsible for 8.8 million deaths in 2015. Globally, nearly 1 in 6 deaths is due to cancer. Approximately 70% of deaths from cancer occur in low- and middle-income country Late-stage presentation and inaccessible diagnosis and treatment are common. In 2015, only 35% of low-income countries reported having pathology services generally available in the public sector. More than 90% of high-income countries reported treatment services are available compared to less than 30% of low-income countries.

Wildfire smoke air pollution

Clear evidence of respiratory health effects Particularly for exacerbation of asthma, COPD Growing evidence of increased risk of all-cause mortality Mostly null findings for cardiovascular outcomes A few studies have found associations with adverse birth outcomes Mental health effects - solastalgia (distress caused by environmental change or loss of land) Occupational health effects on wildland firefighters

climate change on Vector-borne diseases

Climatic changes in temperature and precipitation can affect: Geographic range of vectors both in latitude and altitude Changes in duration of the season Can alter feeding frequency of vectors A lot of variability by disease, vector, agent Human behavior changes can also account for some changes in rates of disease Socio-economic changes Control measures

Step 4 - Share PD Findings with Community & Design activity

Community validation of findings and creation of a PD informed activity in order to enable other community members toACCESS and ADOPTnew demonstrably successful behaviors (BCC Strategy)

new approach to malnutrition

Community workers, growth monitoring, counseling; home visits Home based rehab or Village Volunteers rehab child in neighboring home; Nutrition aids stress Learning by doing Caretaker active, uses/makes local foods; uses colostrum, breastfeeding in « mothers club »setting) Go to the people: Community health worker home visits & assembly posts for immun, deworming, nutrition surveillance, supplementation; Coverage: 90% with door-to-door regist. + follow-up; home records Village level Nutrition Rehab with Demonstration ed; mom participates; sees « change in the child »

Bipolar Affective Disorder

Consists of both manic and depressive episodes What manic looks like: elevated or irritable mood, over-activity, pressured speech, inflated self-esteem, decreased need for sleep What's the difference between Bipolar 1 and Bipolar 2? The depression is the same. The mania in bipolar 1 is more severe than in 2. In 2 the mania is sometimes referred to as hypomania.

How does tobacco impact the body besides causing lung cancer?

Contributes to other cancers such as liver and colorectal cancers Can impact chronic diseases like diabetes and tuberculosis Can impact every part of the body

Cost and Consequences of Women's Health Issues

Costs and Consequences: Violence, STIs, and fistula tend to isolate women socially When a woman dies in childbirth, her family is typically left without a primary caregiver Substantial economic costs from women's health issues With better family planning, fewer unintended pregnancies occur fewer complications from pregnancy

Occupational inequities

Deaths of agricultural laborers in the US Not given shade, rest, water Pregnant women and those with pre-existing conditions are more vulnerable Workers in unventilated or crowded working conditions Chronic kidney disease of unknown origin Some places are getting too hot for people to work during daytime hours in the hottest times of the year More places will become that way

DSM-IV definition of major depressive disorder: Requires >= 5/9

Depressed mood or irritable most of the day, nearly every day Decreased interest or pleasure in most activities, most of each day Significant weight change (5%) or change in appetite Change in sleep: Insomnia or hypersomnia Change in activity: Fatigue or loss of energy Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt Concentration: diminished ability to think or concentrate Suicidality

Schizophrenia and other psychoses

Distortions in thinking, perception, emotions, language, sense of self and behavior. Common: hallucinations delusions (hearing, seeing or feeling things that are not there) and delusions( fixed false beliefs or suspicions that are firmly held even when there is evidence to the contrary)

What Went Wrong In Flint

E. coli was found in the city's water, forcing Flint to issue multiple advisories to residents to boil the water before use poisoning from a well-understood neurotoxin: lead. • Against federal guidelines, they chose not to require the Flint water plant to use optimized corrosion control • They took few samples and took them from the wrong places, using a protocol known to miss important sources of lead, failures here had nothing to do with the fact that Flint's residents are largely poor and majority black, but that didn't assuage many who feel this wouldn't have happened in a wealthier, whiter city. • were also asked to flush the systems the night before. This "pre-flush" is known to lower detection in samples. • causes miscarriages and low birth weight for babies, and it shifts the entire IQ of a population down a few points. It's also believed to cause decreases in impulse control and increases the incidence of attention deficit hyperactivity disorder, learning disabilities and potentially violent behavior.

Aeroallergens and Allergic Diseases- climate change

Earlier onset of pollen season Increased CO2 and temperature increase pollen production Increase length of pollen season Increased pollen counts Increase in allergenic content of pollen is unclear Increased growth and toxicity of poison ivy

Secondary prevention of chronic illness

Early diagnosis and treatment of: Blood pressure Overweight/obese Blood sugar levels

Examples of public health adaptation

Early warning systems for extreme weather events that target the most vulnerable Moving hospitals to areas that will not be affected by sea level rise Establishing cooling centers for extreme heat events and coordinating public health messaging during those heat events Mapping where the most vulnerable are so that emergency services can be provided quickly during extreme events Distributing bed nets to areas projected to become malaria-endemic regions

CDC works to prevent chronic disease and associated risk factors in 4 domains

Epidemiology and surveillance refers to systems that are used to track chronic diseases and their risk factors. Environmental approaches refers to changes in policies and physical surroundings to make the healthy choice the easy choice. Health care system interventions refers to improvements in care that allow doctors to diagnose chronic diseases earlier and to manage them better. Community programs linked to clinical services refers to those that help patients prevent and manage their chronic diseases, with guidance from their doctor.

Maternal Morbidity and Mortality

Estimates suggest that there are about 342,000 maternal deaths per year globally (in 2000), but 216,000 in 2015 50% of all maternal deaths occur in six countries- Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo Maternal mortality is higher in rural than in urban areas

Myth Vapes don't contain nicotine.

Fact A 2015 study found that 99 percent of e-cigarettes sold in U.S. convenience stores, supermarkets, and similar outlets contained nicotine, the same highly addictive substance that is found in regular cigarettes.5 It's worth noting that 100 percent of JUULs - teens' top choice for vaping devices - contain nicotine. And each JUUL pod contains the same amount of nicotine as a whole pack of cigarettes.

Myth It's just harmless water vapor.

Fact It's not harmless, and it's not just water vapor. It may contain toxins, potentially cancerous agents and dangerous chemicals like diacetyl, which is known to cause a potentially fatal lung disease called popcorn lung. It most often contains a combination of propylene glycol, vegetable glycerin, flavorings and nicotine

Myth Vaping is a healthy alternative to cigarettes.

Fact Vape e-juice may contain nicotine, chemicals that cause cancer, and can lead to health problems including wheezing, coughing, sinus infections, nosebleeds, shortness of breath and asthma.1

Myth Vaping has nothing to do with smoking regular cigarettes.

Fact Young people who took up vaping were more than four times more likely to smoke traditional cigarettes a year later, according to one study

Step 3 - What to look for?

Feeding Practices Frequency of feeding,  Supervision of feeding (active feeding) Variety of food in the child's diet Amount of food and consistency Appropriate feeding of child during & after illness - Caring & Hygiene Practices Experienced secondary caretaker  Positive interaction with child -psycho-social care Gender equity in child care Good body, food & environmental hygiene Health Care Practices (home management & health-seeking) Appropriate home management of childhood illnesses Identification of danger signsTimely seeking qualified help when child is sickComplete immunization

Other health issues that burden women

Female Genital Cutting—previous case study Sexually Transmitted Infections Violence against women - covered by Dr. Rebecca Singer

Health effects of extreme weather events

Flooding and storms Climate change is projected to increase the risk of extreme precipitation events and tropical storms Drownings, injuries, hypothermia Infectious diseases related to water (cholera, diarrheal diseases, vector-borne diseases) Mental health impacts Mold - respiratory health

Health concerns for LGBT individuals

Gender identity and sexual orientation are not asked on most surveys of health we don't know enough of differential health within the LGBT population LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights Higher rates of substance abuse, psychiatric disorders, and suicide among LGBT individuals has been linked to discrimination

Climate Change and Equity

Geographical inequities Socioeconomic inequities/differential vulnerabilities Intergenerational inequities Occupational inequities Even within a society, the results of climate change will affect people differentially depending on the way the society is structured. Factors that influence vulnerability and resilience include gender, class, ethnicity, age, race, and disability.

BCPH Climate Change & Sustainability Policies

Goal - To increase community resilience to the changing climate and decrease greenhouse gas emission sources. • Boulder County maintains a Greenhouse Gas Inventory and developed the Sustainable Energy Plan to address the key sectors contributing to greenhouse gas emissions. • Boulder County Public Health and the Commissioners' Office of Sustainability collaborate to originate and support policy addressing greenhouse gas emission sources, including vehicles, oil and gas operations, and commercial and residential buildings. • Boulder County's Climate Change Preparedness Plan addresses community resilience and adaptation to unavoidable changes. • Colorado is also part of the Climate Alliance, which is committed to upholding the goals of the 2015 Paris Agreement.

BCPH Promote Business Sustainability

Goal - To increase widespread adoption of environmentally sustainable business practices. PACE helps businesses make upgrades and self-identify with sustainable practices Covers energy efficiency, waste minimization, water conservation, sustainable transportation PACE has advised the majority of Boulder County businesses on at least one project Annual impact of PACE efforts- are just over $2 million in utility cost savings to businesses every year Successes 2011-2018: Business Partners: 3,430 Annual Energy Savings: $2.3M Annual Carbon Savings: 20.5M tons

BCPH We Reduce Outdoor Air Pollution

Goal - To reduce outdoor air pollution through inspection, stakeholder processes, and policies. Voluntary Oil and Gas Inspection Program- in place since 2014, includes visits with an infrared camera for gas leak detection. Data was compiled in a white paper to successfully show the need for increased leak detection and repair visits at oil and gas facilities during a rulemaking before the Air Quality Control Commission (AQCC) in 2017. BOCC have funded several air monitoring studies to try and understand the impact that emissions from oil and gas have on the Boulder area. BCPH continues to engage during rulemakings and stakeholder processes. Strong proponent of the clean cars initiative and have pushed for the inclusion of the zero emission vehicle standards. Boulder County conducts inspections of businesses to determine compliance with State and Federal Air Pollution Regulations. Maintains the monitoring network for regulated pollutants. Emerging Issues: Ground level ozone and living near major roadways as a risk factor for asthma exacerbation and respiratory irritation. Noise and light pollution.

BCPH Reduce Obesity by PromotingHealthy Eating

Goal: Reduce obesity and improve rates of chronic disease, improve walkability of communities, improve access to healthy foods for low income communities Increasing fruit and vegetable consumption and healthy food access among young children and their families in Boulder County including "Harvest Bucks" coupons to allow purchases of produce at Farmers' Markets. Emerging Issue-Reducing sugary drink consumption among young children and their families in Boulder County through policy improvements, taxes on sugary drinks, and voluntary changes to drinks offered on children's menus in restaurants

Results of malnutrition rehabilitation

Haiti 60% of children rehabilitated sustainably (better than hospital results); Remaining 40%: ½ had hidden infections, like childhood TB, chronic asthma ½ of mothers suffered extreme poverty (their children were helped only after mom entered micro-lending programs) vietnam In one province in Vietnam, using PDI and the hearth model, Severe malnutrition disappeared on a county-wide basis; Result was sustained two years later when national institute of Nutrition compared nutrition results in Than Hoa with nearby province, where it remained the same.

Effective PH initiatives targeting these 3 risk factors

Harmful use of alcohol Physical inactivity Unhealthy diet

Shared risk factors of NCDs

High blood pressure Tobacco use and exposure to secondhand smoke Obesity (high body mass index) Physical inactivity Excessive alcohol use Poor diets (low in fruits and vegetables; high in sodium and saturated fats)

Tobacco Industry Interference in Tobacco Control

Hijacking the political and legislative process Exaggerating the economic importance of tobacco Manipulating public opinion Using front groups to create illusion of support Discrediting proven science Intimidating governments with litigation

Manipulating public opinion

Hire public relations firms "corporate social responsibility" campaigns Fund ineffective youth smoking prevention programs Social programs for tobacco growers and their children Fund unrelated social causes such as campaigns against domestic violence

old approach to malnutrition

Hospital/clinic rehab programs; records kept there; Rx with meds, formulae not replicable at home. Cross infections high. A child with TB next to a malnourished kid. Teaching with words (no actions) 1970s nutritional rehab centers Caretaker passive; depends on magic foods she can't find. Self selected: child must come to you; no home visits; Coverage: only 30% of those who need it; Clinic based: rehab/records available to doc; ; no record at home Food: handouts for those 30% who come Preaching, not using adult participatory learning (change in knowledge not practice)

Long-acting reversible contraception (LARC)

IUDs (Intra-uterine devices) Inserted into uterus 2 types: copper (12 yrs) hormonal (3-5 yrs) Implants Inserted under skin in upper arm Releases progestin Lasts 3 years BUT they are expensive and require several trips to the doctor BIG hurdles for low-income women Only ~ 10% of American women use LARCs, compared to 20% in other developed nations Expensive compared with daily birth control pills Good if a person knows that she doesn't want to get pregnant for many years The problem is that they are expensive and usually require several trips to the doctor, insurmountable hurdles for many low-income women. One solution to the access issue is to insert LARCs immediately after childbirth.

Positive Deviance Hearth Nutrition Model

Identifying Solutions to Community Problems Within the Community Today positive results despite their situation

Step 1 - Defining Norms

Identifying current feeding, caring and practices in the community target groups: primary caretakers and decision makers How often are kids fed? Breastfeeding practices? What do moms do when kids get diarrhea? What do they drink? How about sugary intake? Handwashing before meal preparation? How attentive are adults to kids' needs? If the norm is to breastfeed for a month, then you know one place to start. Who breastfeeds longer and why?

Justification for rehabilition

If one acts upon knowledge that there are poor mothers whose children are well nourished, one can hope to use skill transfer, not only to rehabilitate, but to prevent malnutrition. Cost per child with neighborhood level Nutrition education/rehabilitation is less than half of cost per hospitalization for malnutrition

Critique #2 of Global Mental Health

Ignores indigenous knowledge and practice Care in developing countries is provided within family, a spiritual community, or traditional healers. People are less isolated that way (isolation is one contributor to stigma). One study: functional outcomes (like employment) of schizophrenia were better in developing countries (thought due to less stigma and separation) This critique is really about what is seen as appropriate treatment. It's not really a critique about people being inappropriately diagnosed

County Fair Chocolate Scare

In Colorado, the maximum serving size for retail, marijuana-infused foods is 10mg of active THC, and single serving sizes must be clearly marked. A retail product cannot contain more than 100mg THC total. must have pre-made indents that allow each serving to be easily and clearly broken, and each piece can contain no more than 10mg THC. All four persons attended the Pot Pavilion at the Denver County Fair on August 3rd. They all reported consuming samples at the LoveAll booth in the Pot Pavilion, including chocolate bars, which they were assured did not contain marijuana. They experienced symptoms such as nausea, vomiting, dizziness, confusion, dry mouth, increased blood pressure, and hallucinations. The onset of symptoms ranged from 1-4 hours after visiting the Pot Pavilion. One case was hospitalized with severe symptoms. A blood toxicology screen confirmed marijuana ingestion had occurred

How would these chronic diseases impact the DALY?

In general would have a significant number of life years lost due to early deaths from these diseases (the "LY" part of the DALY) In general would have a significant number of years of disability due to the long lasting nature of the diseases (the "DA" part of the DALY)

mental health Treatment GaP

In low- and middle-income countries, 76-85% of people with mental disorders receive "no treatment" for their disorder. In high-income countries, 35-50% receive "no treatment"

Hijacking the political and legislative process

Inciting controversy between trade groups and ministries of health Use 'front groups' to lobby for them Got industry access to the WHO FCTC negotiations Have gotten themselves involved in writing tobacco legislation in some countries

What mitigation options could have health co-benefits?

Increasing active transport: Walking, biking and taking public transit decreases emissions from gasoline-powered vehicles This decreases emissions of greenhouse gases AND There are health benefits by increasing physical activity Increasing Urban Forests: Planting trees sequesters CO2 Epidemiological research has shown that trees benefit health by Decreasing temperatures in urban areas Increasing physical activity Increasing time spent outdoors, with neighbors - "social capital" Decreasing air pollution and noise pollution Mental health benefits Decreasing meat consumption: Agriculture is a large source of methane (CH4) emissions Ruminant animals such as cattle, buffalo, sheep, goats, and camels Decreasing red meat consumption can decrease risks of CVD and may decrease caloric intake

Colorado Family Planning Initiative

Initiated by Colorado Department of Health and Environment with private funding from an anonymous donor Goal: To increase long-acting effective contraception at Title X-funded family planning clinics CO program provided: Funding for IUDs and implants Training of staff (including counseling strategies, managing side effects, coding, billing, etc.). Some funds for increased staffing, expanded hours Also funding for tubal ligation and vasectomies

Climate Change Mitigation

Interventions to reduce the sources and enhance the sinks of climate-active pollutants (aka greenhouse gases) Health co-benefits benefits to health that occur from an action that is taken for another reason

BIOLOGICAL determinants of women's health

Iron deficiency anemia related to menstruation Complications of pregnancy Increased susceptibility to some infections compared with men Conditions specific to women, such as ovarian cancer Example of infections: STIs due to more mucosal area exposed than men in sex, Mastitis - infections of the mammary glands urinary tract infections because the urethra is short and empties close to the vaginal opening, so easy for bacteria from vagina to travel to the urethra and then to bladder, causing acute cystitis. Note that men can get breast cancer and there are some cancers specific to men that women don't get.

Behavioral risk factors for undernutrition

Lack of exclusive breastfeeding first 6 months (increases infection risk) Inappropriate supplementation (no special prep or meal for the child—no mashing the beans to make them more digestible; no frequent snacks for kids Adverse weaning practices: ex: sudden weaning No refeeding after infection Infection: Child undernutrition is often related to infection. Why? Intrauterine growth restriction( about 1/3 to 2/3 of preg women are anemic; iron/folate supplement is not routine Mothers in some countries lose weight in 3rd trimester) Diarrhea Zinc, Vit A, Iron, Iodine deficiencies

Lalitha- mental illness

Likely malnourished Possibly anemic Husband drinks Lives in poverty Marital discord Raising 2 sons without enough money Her diagnosis reflects the medicalization of social suffering Her diagnosis is anthropologically and socially naïve

Results of malnutrition

Linear growth retardation Anemia Increased susceptibility to diarrhea,pneumonia, & malaria Immune system depression (x 6 months!) Even if treated, long term effects on cognitive and motor function

Women's health concerns related to pregnancy and childbirth

Maternal mortality Obstetric fistula Condition in which a hole opens up between the bladder and vagina or rectum and vagina during childbirth 50,000 to 100,000 women each year will suffer a fistula Women with fistulas are often stigmatized or abandoned Risk factors are those associated with an obstructed delivery unsafe abortions

The money for CFPI:

Medicaid avoided approximately $79 million in birth-related costs from 2010 to 2012 by funding LARCs, making the initiative's return on investment $5.85 for every dollar spent. (CDPHE) Private funding ran out in June 2015 Colorado state house of representatives passed a funding measure but it was voted down in a senate committee in 2015 Private foundations provided $2.1 million in bridge funding CO has now passed a measure to fund it again (fall 2016) - 2.5 million increase

Resources possible- rehabilition

Model mothers Volunteer mothers who will give their time/kitchen 8th grade level nutrition aids who can teach/supervise rehabilitation Training/supervision/monitoring and evaluation at village level with feedback?

Most e-cigarettes contain nicotine, which has known health effects.

Nicotine is highly addictive. Nicotine is toxic to developing fetuses. Nicotine can harm adolescent brain development, which continues into the early to mid-20s. Nicotine is a health danger for pregnant women and their developing babies. This includes cancer-causing chemicals and tiny particles that reach deep into lungs. However, e-cigarette aerosol generally contains fewer harmful chemicals than smoke from burned tobacco products.

BCPH water quality

OWTS Program, Outreach and Partnerships, Goal - To protect the water in the environment from sources of pollution The quality of the water that enters the Boulder County drainage system and waterways directly impacts the health of aquatic life and residents. Stormwater pollution occurs when rain or snow melt picks up trash, oil, dirt, and other pollutants as it travels over the land. These pollutants are then carried to the storm drainage system, which flows directly into our local creeks and streams, untreated. BCPH detects and eliminates pollution from entering Boulder County storm drains as part of the County Illicit Discharge Ordinance, our local clean water act. Residents and visitors can help by reporting water pollution.

Discrediting proven science

Paid scientists (not always scientists who knew anything about health) to publicly claim that there was doubt about the growing overwhelming evidence linking smoking (and second-hand smoke) to numerous health outcomes Created the idea in the minds of the public that there was a disagreement among scientists when indeed there was not Tobacco executives continue to deny the health evidence linking smoking and second-hand smoke to death, cancer, cardiovascular disease

Step 2 - Identifying PD Children

Weigh all children in target area Select well-nourished children Identify well-nourished children from poor families (as defined by community wealth ranking

chronic respiratory disease (COPD, chronic bronchitis risk factors

Primarily smoking, exposure to secondhand smoke or pollution

Which type of prevention are the programs that address risk factors (high blood pressure, lack of exercise, poor diet, obesity, alcohol use)?

Primary prevention because they aim to change the risk factors before disease develops

The first Public Health Treaty: WHO Framework Convention on Tobacco Control (FCTC

Purpose: to strengthen coordination to decrease tobacco use Approach: some are concrete obligations; others goals/recommendations Includes agreements to: -restrict advertising, sponsoring and promotion -implement labeling requirements -establish clean indoor air controls -strengthen legislation to combat tobacco smuggling Treaty also calls for: Tax and price policies Testing and regulating tobacco product contents Require manufacturers and importers to disclose contents Governments disclose to public the toxic ingredients

Typical objectives of rehabilitation of malnutrition

Rehabilitate, village by village, all 6-36 month olds who are malnourished (over x number of months or years) Enable parents to maintain good nutrition over long periods of time Prevent malnutrition in younger siblings and the "future generation".

SOCIAL determinants of women's health

Related to gender norms and roles: Female abortion or infanticide Malnutrition or undernutrition Often fed less nutritious food than male children In some cultures, men eat first or get more nutritious food Male dominance can lead to physical and sexual abuse Gendered division of labor Cooking with poor ventilation contributes to respiratory disease Low social status limits access to health care

What can excessive alcohol use cause?

Short term: injuries, violence, miscarriage, risky sex, alcohol poisoning What about long term? High blood pressure, heart disease, stroke, liver disease, and digestive problems.6,16 Cancer of the breast, mouth, throat, esophagus, liver, and colon.6,17 Learning and memory problems, including dementia and poor school performance.6,18 Mental health problems, including depression and anxiety.6,19 Social problems, including lost productivity, family problems, and unemployment.6,20,21 Alcohol dependence, or alcoholism.5

Cardiovascular disease and stroke risk factors

Smoking, obesity, diets high in saturated fats, lack of physical activity, high blood pressure

Factors influencing undernutrition

Sociocultural (example: children weaned from breast early, then eat only once or twice/day in Haiti) Poverty- increases psycho social risk & biologic risk (lack of food security) (this may take years to change) Both above affect CNS development and function

What do these chronic diseases have in common?

Some have shared risk factors Often are long-lasting and take a long time to fully develop Often these diseases co-exist

Exaggerating the economic importance of tobacco

Stating that any control efforts on tobacco will mean huge job losses and economic pain for countries No evidence to date that there were significant job losses from tobacco control In some countries that believed the industry and did not legislate against tobacco still had job losses because the industry changed its production methods

CDC on TB

The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. If not treated properly, TB disease can be fatal. • TB bacteria become active if the immune system can't stop them from growing. When TB bacteria are active (multiplying in your body), this is called TB disease. People with TB disease are sick. They may also be able to spread the bacteria to people they spend time with every day. Drug-resistant TB can occur when the drugs used to treat TB are misused or mismanaged.

Human Rights Issues & Mental Health

The dignity of many people with mental health conditions is not respected Frequently they are locked up in institutions Many are subjected to physical, sexual and emotional abuse and neglect in hospitals and prisons, but also in their communities. They are very often deprived of the right to make decisions for themselves. denied access to general and mental health care. deprived of access to education and employment opportunities. prevented from participating fully in society.

Targeting Asian American communities tabaco

Tobacco companies' marketing to Asian Americans has included:7,8Sponsorship of Chinese and Vietnamese New Year festivals and other activities related to Asian/Pacific American Heritage Month Heavy billboard and in-store advertisements in predominantly urban Asian American communities Financial and in-kind contributions to community organizations Support of Asian American business associations"

Critique #1 of Global Mental Health initiatives

The medicalization of social suffering Alien concepts like PTSD or depression are introduced in new places People who previously had "problems in living" are now "mentally ill" Treatments are counseling and medications produced in the West

undernutrition, malnutrition

Underlies as many as 35- 60% of all deaths of kids under 5 in LDC's Takes heavy toll Accounts for 11% of global disease burden indicated by: # of under-3's falling behind growth # with anemia

BCPH Protect Health through Data, Vision, and Planning

Use existing data sources to identify needs Gather new data to fill gaps in knowledge Create a Vision and then conduct strategic planning every 5 years Use population-based and equitable approach to address health and health disparities

Colorado Family Planning Initiative (CFPI), 2009-2015

Use of long term contraception (primarily IUDs and implants) increased from 5% to 19% among 15-24 year olds 29% lower fertility rates than expected among low income 15-19 year olds Teen birth rate under this program declined faster than any other state 24% reduction in high-risk births among unmarried, <25, <high school education (2009-11) 34% reduction in abortion rates among 15-19 year olds 23% reduction in infant enrollment in WIC (2010 to 2013) the number of teens with repeat births decreased by 53% Prevents 27,000 unintended pregnancies annually

Intimidating governments with litigation

Use their lawyers and their money to threaten expensive litigation against any government that sets policies to curb tobacco use

The PD Inquiry

We must discover what they are doing differently from their neighbors To empower community to discover and "own"their own solution, based on their own resources 1. Define community norms that effect the nutritional status of children 2. Identify well nourished children from poor families in the community("Positive Deviant Children") 3. Conduct Positive Deviant Inquiry (PDI) to discover what uncommon successful behaviors caregivers practice that are accessible to all 4. Share results with community and design an initiative or activity based on PD findings

Targeting women -tabaco

Women have been targeted by the tobacco industry, and tobacco companies have produced brands specifically for women. Marketing toward women is dominated by themes of social desirability and independence, which are conveyed by advertisements featuring slim, attractive, and athletic models."

risk factors for Type II diabetes?

You are more likely to develop type 2 diabetes if you are overweight or obese are age 45 or older have a family history of diabetes are African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander have high blood pressure have a low level of HDL ("good") cholesterol, or a high level of triglycerides have a history of gestational diabetes or gave birth to a baby weighing 9 pounds or more are not physically active have a history of heart disease or stroke have depression have polycystic ovary syndrome , also called PCOS have acanthosis nigricans—dark, thick, and velvety skin around your neck or armpits

Title X

a network of 4,200 family planning centers, serving 4.5 million clients/yr Provides services through state, county, and local health departments; community health centers; Planned Parenthood centers; and hospital-based, school-based, faith-based, and other private nonprofits Enacted by Nixon in the 1970s - the ONLY federal grant program dedicated solely to providing comprehensive family planning and related preventive health services Prioritizes needs of low-income families and uninsured people

2. List 3 harmful experiences of childhood that increase one's risk for chronic mental disorders

a. Developmental attrition (stemming from malnutrition) lack of education, child labor, and child prostitution are early life experiences that elevate the risk of chronic mental illness

how gender is a social construct and how viewing it as such affects the way we view health care for women.

a. Gender is the social construction of biological difference-systems of symbols, practices, and discourses through which society gives meaning of man and women b. Viewing gender as a social construct allows us to interrogate what was previously seen as natural and thus indisputable c. Reproduction is more than simply the biological production of infants- also social mores, community traditions, and cultural beliefs d. Shift from needs to rights is radical because it depoliticized domains of family women and bodies

reasons for resistance to contraception in the 1950s

a. Misinformation about the side effects and efficacy, lack of access to modern methods, economic issues such as value of childrens labor as opposed to the cost of educating them, fears that it would empower women to engage in infidelity or allow them to take on wider economic and political roles outside the household and outside control of men in the family

1. Describe the problem with utilizing the Diagnostic and Statistical Manual of Mental Disorders in populations other than Europe and North America.

a. Uncertain validity within a populations other than US and europes or developed countries b. Potentially limited clinical utility across diverse cultural and social contexts given the phenomenological variation in psychiatric presentation and the culture specific rhetoric used to signal distress c. Fail to account for the risk of co morbidities associated with mental illness d. Mental illness increases the risk of non communicable and communicable diseases e. Physical diseases were found to increase risk of developing mental disorders f. The experience of insecurity and hoplessness and rapid social change, the risks of violence and physical ill health explain greater vulnerability of the poor to common mental disorders g. Hunger and malnutrition, inadequate living and working conditiona, urban crowding, rural isolation also contribute to higher risk of mental illness for poor h. Many of the same social and economic circumstances that predispose global poor to infectious and chronic physical diseases also predispose them to mental illness

"mainstreaming of gender" shift the focus of reproductive health from just contraception to other health concerns? What were some of these health concerns that were increasingly being addressed at global conferences in 1994 and 1995

a. Using term gender rather than women made the case that gender was a system of social relations that had to be transformed in order to mitigate womens vulnerability powerlessness and ill health b. Reducing death in relation to childbearing and dying from unsafe abortions c. Emphasis in family planning shifted from issues of access and population limitation to a strategy to alleviate poverty and facilitate development ti concern about quality of care d. Environment housing and micro credit were also global agendas e. 1994 un conference on population and development concerned with population growth family planning reproduction and contraception f. In 1995 un fourth world conference on women held in Beijing on gender equality g. The gender summits promoted women as equal participants and beneficiaries of sustainable development peace and security governance and human rights h. The Beijing declaration drew upon 1945 un charter to aaer human dignity and rights for women by asking for explicit recognition and reaffirmation of the right of all women to control aspects of their health like fertility and basic empowerment

3. Regarding suicide in China, know what specific social upheaval resulted in increased risk of suicide for rural women

a. Womena suicide rate is 25 percent higher than males b. Suicide is the first or second leading cause of death among fifteen to thirty four year olds in china but also highly effect the elderly in china c. 14 cases of suicide per 100000 but more accurate may be 28 per 100000 d. Not like global norm where mens suicide is 3.5 higher for men than women e. Rapid social and economic transformations of modern china f. More than 150 million internal migrants mostly men moved from rural to urban areas weakening the support system for married women who had to take care of children and elderly parents g. New market oriented reforms like mental disorders, substance abuse increased as did aids and sexually transmitted dieases and violence h. Privitation of health care changed health care delivery from solidarity based insurance schemes to individual based i. Sudden policy shift shocked the system, rural hospitals and clinics were emptied of patients who couldn't pay the required fees j. When people over came the stigma there was no prompt affordable or quality care k. Women also had low social satus in chinese society

Climate change

an exacerbation of the greenhouse effect. We need some greenhouse gases in our atmosphere or otherwise the earth would be too cold for life. But we are increasing levels of CO2 and other greenhouse gases with our increased use of fossil fuels and land-use change and with more greenhouse gases, we would expect that more heat would be trapped through this greenhouse effect.

cervical cancer and liver cancer

can be caused by infectious agents (HPV and hepatitis). Because of this, they blur the line between infectious and chronic diseases. HPV and hepatitis B vaccines

Impact of climate change on human health

changes in vector ecology: malaria, dengue, lyme increasing allergens: respitory allergens asthma water quality impact: cholera, harmful algae blooms water and food supply- malnutrition diarreah environmental degradation- forced migration civil conflict, mental health extreme heat- heat related illness and death severe weather- injuries fatalities mental health air pollution- asthma cardiovascular disease

Maternal death

death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes" "To facilitate the identification of maternal deaths in circumstances in which cause of death attribution is inadequate, a new category has been introduced: Pregnancy-related death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death."

BCPH Vector Control Program

disease investigations, outreach, prevention

best interventions for malnutrition

exclusive breastfeeding x 6 months supplementation (iron, Vit A + zinc, could reduce stunted growth at 36 months by 36% (stunting is associated with risk for death and lack of cognitive and social development; best interventions are in under-threes)

air quality will be impacted by climate change

formation of ozone is a temperature dependent reaction of nitrogen oxides and volatile organic compounds. There is clear evidence that with increasing temperature, there is increasing ozone levels Therefore, even if emissions of nitrogen oxide and volatile organic compounds remains constant, with increasing temperature, there would be higher levels of ozone.

According to the WHO, around one third of deaths from cancer are due to

high body mass index low fruit and vegetable intake lack of physical activity tobacco use alcohol use

Vaping in Colorado

highest in country among teens 26 percent of high schoolers in Colorado used electronic vapor products, or e-cigarettes in the last 30 days. The national average for high school use was 13.2 percent. niccotine= 1 pack of cigs

MPOWER

is a list of types of policies that governments can implement to try to curb tobacco use. Monitoring tobacco use - you need data on tobacco use to know if it is increasing or decreasing. Protecting people from tobacco smoke could include things like public smoking bans, smoking bans in bars/restaurants Offer help to quit tobacco use - provide counseling and cessation drugs Warn about dangers of tobacco - effective public health messaging, warning labels on cigarettes Enforce bans on tobacco advertising, promotion and sponsorship - Raise taxes on tobacco

Climate Justice

justice links human rights and development to achieve a human-centered approach, safeguarding the rights of the most vulnerable people and sharing the burdens and benefits of climate change and its impacts equitably and fairly the environmental justice movement in using scientific knowledge to advance an understanding of the inequities in who has traditionally been responsible for climate-active emissions and who is going to be affected most.

Obstetric fistula

leads to urinary incontinence, kidney problems, skin infections, -- this is what leads to the social isolation and stigma Obstetric fistula can be prevented by delaying childbirth to older ages, having appropriate prenatal and attendance of delivery by a trained medical professional Up to 90% of vaginal fistulae can be fixed with a simple surgical procedure, but yet 2 million women (mostly in Asia and Sub-Saharan Africa) live with untreated fistula

cigarette smoking is high in certain populations

low education, males, young adult, south/ midwest, LGBT, poverty, disabled, race

top 10 global cancers

lung breast colorectum prostate stomach liver cervix oesophogus bladder non-hodgkin lymphoma

BCPH healthy homes

mold, meth, lead, radon

cardiovascular disease and risk in CO

over the past decade the prevalence of HTN increased from 21-26%. High cholesterol and cardiovascular disease didn't change significantly. more common in males, diff sexual identification, older, lower socioeconomic status, education black coloradoans had highest high blood pressure while hispanic CO had highest cholesteral lower areas of economics have higher cardiovascual disease heart disease, stroke and high blood pressure Over the period 2003 to 2013, death rates from heart disease and stroke decreased while deaths attributable to HTN remained unchanged. Black Coloradans had significantly higher death rates from heart disease and stroke compared to other racial and ethnic groups. Other differences between groups were not statistically significant. eating too much sodium increases development to high blood pressure

physical inactivity WHO initative

public awareness campaigns on physical activity, routine physical activity counselling, urban deisgn to increase physical actvity, PE for school, safe places for working out, workplace programs, promotion of work out groups and programs

unhealthy diet WHO initative

reducing salt in foods, public institution foods, behavior change, and labelling reduce trans fat sugar tax promote breastfeeding in first 6 months subsidies to increase fruit and veggies limiting portion size implementing nutrition and education counselling mass media campaign on healthy diets

Unsafe abortion

safe abortion is one performed by a trained healthcare provider, with proper equipment, technique, and sanitary standards WHO estimates 22 million unsafe abortions per year worldwide, 19 million in low- and middle-income countries 47 000 women die from complications of unsafe abortion each year Deaths due to unsafe abortion remain close to 13% of all maternal deaths. Estimated that 40% of global pregnancies are unintended (50% in US), and about 50% of those (varies by location) end in abortion millions of women each year seek abortions and many of those are done in unsafe settings with severe health consequences for that woman that can last a lifetime. A lot of unsafe abortions are due to lack of access to birth control, but also lack of access to safe abortion with a skilled professional. When abortion is illegal, some women are still going to try to abort unwanted pregnancies....pregnancies caused by rape or just unwanted for other reasons

curve of cigarette consumption in the US over the 20th and into the 21st century

steadily increased from 1900 - 1960. In WWII, they gave out cigarettes free to all members of the military - this essentially got them hooked. Even my parents talk about how when they were in college in the early 60s, that cigarette companies gave out cigarettes for free. In 1954, a landmark study came out that showed definitively that smoking caused lung cancer. There had been many, many, many studies leading up to that point but all had some flaws, this study clearly showed a link and the evidence continued to mount, yet, smoking rates climbed In 1964, the Surgeon General's Report stated: "declared it the official position of the U.S. Public Health Service that the evidence pointed to a causal relationship between smoking and lung cancer Decline from: Public health messages on TV and then ban of cigarette ads on TV, Non-smoker's rights movement, 1986 = Surgeon General's Report on second hand smoke, Increasing taxes on cigarettes Bans on smoking in public places Public health messaging Improved methods to help people quit

task shifting

the democratization of health knowledge and therefore power and Alma Ata. training ordinary people from the community to deliver a range of treatment interventions for mental health

Maternal Mortality Ratio

the number of maternal deaths per 100 000 live births 2015 maternal mortality ratio for women ages 15-49 by country, ranges from a high in the Central African Republic of 143 deaths per 100,000 to a low in other countries Why doesn't CAR appear in the list on the previous slide? Low population, so low total #s. Although as a proportion of the total population, maternal deaths are highest.

BCPH Protect Health respond to environmental emergencies

to ensure protection of the environment and public health. EERT responds to all hazmat incidents in Boulder County. Ensure spills are cleaned up properly. Meet regularly with partners who work with hazardous materials and respond to emergencies. (CU and other large organizations working with chemicals, fire departments, sheriff's office, Emergency Preparedness officials) Staff on call carry a pager 24/7 and respond in partnership with local fire hazmat teams.

violence as a contagious disease

treating violence as a disease because it behaves and reacts as a disease way to reverse epidemics 1. interupt transmission by detecting and finding cases 2. preventing further spread by finding who has been exposed and not yet acted 3. shifting the norms by adding community activites and increasing group immunity

Voluntary or Regulated? The Trans Fat Campaign in New York City

• Artificially produced trans fatty acids—or partially hydrogenated oils long shelf life, provided stability during deep frying, and enhanced the taste of baked goods and sweets • trans fats caused an increase in "bad" cholesterol and decreased "good" cholesterol, creating an increased risk of heart disease. • The department launched a highly visible public education campaign with the hope that pressure from customers, along with the desire to do the right thing, would persuade restaurants to stop using trans fat artificial trans fat forms • those in low-income areas were at special risk when it came to diet and cholesterol levels. Studies showed that with more fast food restaurants in lower-income and minority neighborhoods, as well as fewer supermarkets selling healthy foods, residents of low-income neighborhoods were more likely to consume high levels of trans fat, putting them at greater risk of developing heart disease • In August 2005, the New York City Department of Health and Mental Hygiene officially unveiled its trans fat public education campaign. The program developed and distributed posters, brochures and a health bulletin on trans fat and sent this information to the 30,000 licensed food outlets in the city, 15,000 suppliers and supermarkets, and hundreds of thousands of consumers through the City's 311 information system and other routes

3. Why is the DOTS program in Peru cited as an example of the limits of cost-effectiveness analysis in the RGH chapter?

• Deemed extremely cost effective in world banks 1993 development report • High cure rates achieved while finding that pockets of drug resistant disease were developing in other countries due to suboptimal implementation of the dots program • More than 90 percent tested positive for strains of MDRTB • Though policies blamed patients for treatment failure, decades of clinical trials suggested that elusive use of dots had little to no efficacy against drug resistant strains • Instead of endorsing MDRTB strategy like CDC PERU national tuberculosis program advised treatment with DOTS for people who failed the first course • The green light committee used a strategy of coordinated procurement and financing to achieve reductions in the cost of second line TB drugs of up to 98 percent in 1997-1999 • A typical five drug MDRTB treatment regimen costs about 3000 per patient per year and availability is sporadic • Widespread use of any intervention has unintended and sometimes harmful consequences if implementation lacks feedback loops and rigorous monitoring and evaluation • DOTS was advocated by global public health because is was considered highly cost effective

1. What is DOTS? Why did the WHO recommend use of DOTS for TB? Why didn't they recommend something else for MDRTB?

• Dots= directly observed treatment, short course for tb treatment • Patients were to be observed taking their medications as recommended by the CDC guidelines • Adherence to the treatment regimens • Those who were not cured by first round medications DOTS called for retreatment with first line therapy even if patients were found to have drug resistant disease • In 1990s- MDRTB requires expensive and coplex therapeutic regimes that policymakers at the WHO and elsewhere judged unfit for resource poor settings

swasthya- politics of women's health in rural south india

• Initial mission was to empower women with information and other tools to make and act upon health care decisions • Goal is to provide not merely treatment but sldo health education illness prevention id the goal • Local terrain was important to womens access to care because they region was heavily forested and many villages were tucked into hillsides also many homes were separated ny fields to distance and lack of transportation were barriers to health care access • Women would rather see a lady doctor because they are shy and would miss opportunities with male doctors • Make trips to estate management and invited mny women to hear talks/presentations on hygiene aches and pains and explained each ones and how to help them- allowing women to take charge of their lives and take health into their own hands • Most CHW were upper and middle caste and did not want to hire a lower caste girl because they believed others wouldn't respect her or let her into their homes and they were also afraid of what people would think of them being associated with lower caste and it would look like they were tyring to fight a political battle • Sustha or fatigue was a common problem in women here as the result of hard physical labor along with stresses related to poverty, martial discord, trouble with neighbors and landlords, bosses and raising children

2. Socios en Salud is the name of Partners in Health (the organization that Paul Farmer and colleagues run in various countries throughout the world) in Peru. Explain why Socios en Salud implemented "DOTS-Plus" and explain what "DOTS-Plus" entailed.

• Staff were surprised to find patients presenting with MDRTB in slum north of central lima • DOTS plus added use of a second line medication monitoring with sputum culture drug susceptibility testing and directly observed individualize therapy to the existing DOTS regimen • Every patient as visited once per day by a community health care worker who observed ingestion of medicines provided nutritional and financial support and attended to other physical and psychosocial needs • By moving treatment into the community socios en salud was able to cut costs and reduce the risk of MDRTB spreading socially (in hospitals and clinics) without undermining the quality of therapy

Measuring and responding to violence against women in Kiribati

• The WHO Commission on Social Determinants of Health underlined in 2008 that gender inequality impacts health through "discriminatory feeding patterns, violence against women, lack of decision-making power, and unfair divisions of work, leisure, and possibilities of improving one's life • consequence of gender inequality is the high level of gender-based violence, including sexual, emotional and physical, perpetrated by intimate partners and non-partners. gender-based violence in Kiribati: 68% of women aged 15-49 who had ever been in a relationship had experienced some form of violence (emotional, physical and/or sexual), from an intimate partner; 90% had experienced controlling behaviour from a male partner; and 10% had faced violence from a non-partner • Four main causes of violence against women given by men in focus groups were: i) jealousy; ii) alcohol; iii), acceptance of violence as a form of discipline and iv) gender inequality.