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Intro to Global Health: First Course

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Jennifer Bellows

on 5 December 2016

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Transcript of Intro to Global Health: First Course

Global Health Defined
Jennifer W. Bellows MD, MPH

What is Health?
Case Study: 2014 Ebola Outbreak West Africa
•Transmitted to people from wild animals; human-human transmission is possible via close contact with bodily fluids

•Corpses can transmit virus

•Incubation period: 2-21 days

•Fever, liver dysfunction, bleeding disorders

•40% Case Fatality Rate

What is
"Global Health"?
"A state of complete physical, mental, and social well-being and
not merely the absence of disease or infirmity
" -World Health Organization, 1946
A little about me...
Take Home Points
1. Global health is any health issue that concerns many countries or is affected by transnational determinants and solutions.
3. Determinants of global health are complex, multifactorial, and extend well beyond traditional definitions of medicine, thus solutions to global health problems must be as well.
2. Efforts to improve global health do not always correlate with burden of disease patterns.
Defining Global Health
The Intersection of
Public Health
and
International Health
Public Health
International Health
"The combination of sciences, skills, and beliefs that is directed to the maintenance and improvement of the health of all people thought collective and social actions"
Last, J. A dictionary of epidemiology. New York: Oxford, 2001.
Mid-19th century construct in Europe and United States
combining social reform movements and understanding disease, "Global" from the beginning
•Decision making based on data and surveillance
•Focus on populations, not individuals
•Goal of social justice and equity
•Emphasis on prevention rather
than cure
...the term used to describe health work abroad, with a geographic focus on developing countries and often with a content of infectious and tropical diseases, water and sanitation, malnutrition, and maternal and child health"
•Still used by many academic and private organizations
•Focus on bilateral and often uni-directional efforts
•Both prevention and clinical care
•"Seeks to help"
•Not necessarily multi-disciplinary
Koplan JP et al. . Towards a common definition of global health.
Lancet
373(9679), June 2009.
Global health is...
"...an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants, and solutions;
involves many disciplines
within and beyond the health sciences and promotes inter-disciplinary collaboration; and is
a synthesis of population-based prevention with individual-level clinical care.”
Consortium of Universities for Global Health Executive Board. Towards a Common Definition of Global Health.
Lancet
2009; 373: 1993–95.
...replacing "international health" to reflect the collaborative nature of the field as well as the inclusion of many different disciplines.
Since we are discussing terminology...

Human Development Index (HDI):
composite statistic of life expectancy, education, and income indices
used to rank countries into four tiers of human development.
Disability-Adjusted Life Years (DALYs):
Used to quantify burden of disease, indicates one lost year of
"healthy" life


"Third World":
Coined in Cold War era to define countries that were neither capitalist (First World) or
Communist (Second World) Pejorative; implies that these countries are "third-rate". No longer used
within the discipline of global health.

"Developing country" or "less-developed country":
More common, refers to socio-economic status
of the country but without standardized criteria. Implies inferiority as it is used opposite the term
"developed country", assumes desire to follow Western economic development model

"North" versus "South":
Differentiates between richer (North) and poorer (South) areas of the world.
Inaccurate (New Zealand, Australia)

"Low Income" (LIC) "Middle-Income" (MIC) and "High-Income" (HIC) countries:
Most commonly used
Health and development measurements
Differentiating richer and poorer countries
How to we measure the world's health?
Direct Indicators
Indirect Indicators
Mortality
Morbidity
Life Expectancy
Disease Prevalence
Disease Incidence
Poverty
Literacy rates
Social development
GDP


Years of Life Lost due to premature mortality (YLL)
PLUS
Years Lost due to Disability (YLD)
EQUALS
Disability-Adjusted Life Years (DALYs)


Measuring the burden of a specific disease or risk factor:
But don't take my word for it....
Global Burden of Disease Study 2010
•"Largest systematic effort to describe the global distribution and causes
of a wide array of major diseases, injuries, and health risk factors."

•Institute of Health Metrics and Evaluation, WHO, Schools of Public Health

•Uses DALYs to calculate the burden of disease

•http://vizhub.healthdata.org/gbd-compare/

Global Burden of Disease Results
What has the highest DALY in the world?
Diet
High Blood Pressure
Smoking
Ischemic Heart Disease
•Double burden of disease in LICs and MICs
•Life expectancy rising, but so is disability
•Biggest successes: maternal and child deaths, malnutrition, infection

http://vizhub.healthdata.org/gbd-compare/
http://vizhub.healthdata.org/irank/arrow.php
What has the highest DALY in the world?
Redefining "Communicable" Disease
Yes....
But also....?
Determinants of Health
What accounts for regional differences?
Individual:
genetics, ethnicity, gender

Social:
globalization, gender inequality, income, literacy, political marginalization, cultural norms, access to health services

Physical:
air quality, sanitation, food security, transportation, urbanization, violence, climate change
•March 2016: 11,310 deaths

•Guinea, Liberia, Sierra Leone, Nigeria

•Patient zero: 2 year old died Dec 6th2014 in
Guéckédou, Liberia

•Much harder to contain than previous ebola outbreaks
http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html
*
Guéckédou
Sierra Leone
Liberia
Guinea
http://www.nytimes.com/2014/07/28/world/africa/ebola-epidemic-west-africa-guinea.html
"There is no root, no leaf, no animal that can cure you. Don't be fooled." - Guéckédou prefect Mohammed Cinq Keita
Treatment and Prevention Challenges
Response
"Just letting the disease burn out and considering that the price of controlling it — we don’t live in that era anymore." Dr. Martin S. Cetron, CDC quarantine expert
•"Cordon Sanitaire": Isolation of triangular area including 70% of cases
Traditional healing practices
Cola nuts as prevention
•Inclusion of social anthropologists
Someone tell my dad that this was a TOTALLY worthwhile undergrad major
Allow families to view bodies
Providers attending funerals
•Increasing capacity and response times to new cases
•Training villagers to recognize cases, report deaths, and bury bodies safely
Incentives given (money, mobile phones)

Effect of the outbreak
Future public health responses
Vaccine


Muslim tradition of same-gender family members washing the body
Caused by witchcraft or sorcery

Brought on by saying "ebola"
Is this any different than the "Big C"?

Brought by Western health care providers
and/or a guise for body-part trafficking (Uganda)
What factors may have contributed to the rapid escalation of the ebola outbreak?

What are some potential barriers to containing the ebola outbreak?

What can be done to mitigate these barriers?

3. Determinants of global health are complex, multifactorial, and extend well beyond traditional definitions of medicine, thus solutions to global health problems must be as well.
2. Efforts to improve global health do not always correlate with burden of disease patterns.
1. Global health is any health issue that concerns many countries or is affected by transnational determinants and solutions.
Take Home Points
Questions?
Thank you!
Full transcript