Lecture 1.2 I Introduction to Global Health Become part of the conversation. Objectives Provide an overview of teaching resources on: Definition of Global Health and GH Successes Current GH Trends and Challenges Global Health Timeline The MDGs and the Post 2015 Agenda How to Find and Use and Communicate GH Information First Do No Harm Why Should we Care about Global Health? National Security Trade economic productivity Inequalities are unethical and unjust States have humanitarian responsibilities to other states Are we separate countries, or an interconnected world? Global health, like global climate change, may soon become a matter so important to the worlds future that it demands international attention, and no state can escape the responsibility to act. -- Gostin Have Global Health Efforts been Successful? Just say YES! Small pox eradication 1979 Vitamin A supplementation in Nepal prevents 200,000 child deaths Polio eliminated from western hemisphere 1991 Reduction of infant death due to diarrhea by 82% from 1982 to 1987 in Egypt Dramatic reduction in Guinea Worm reduced by 99% in 20 countries Fertility reduction in Bangladesh from 7 to 3 children per woman Overall improvements in IMR 126 to 56/1000, CMR 197 to 82/1000, from 1960 to Under 5 child mortality decreased by 60% from 1990 thru 2010 Between 1990 and 2010, life expectancy increased by years for men and women Burden due to HIV and Malaria is falling Successful Programs in Action Bangladesh Rural Advancement Committee (BRAC)Meningitis Vaccine for AfricaFor other success stories see RX for Survival Serieso/index.htmlo/index.html Is Global Health Engagement Optional or a Human Rights Imperative? A Preferential Option for the Poor Although PIH is a secular organization not affiliated with, motivated by, or espousing any particular religious ideology, we find the concept of a preferential option for the poor to be a powerful moral imperative. The poor includes but is not limited to those who are economically deprived. The concept of a preferential option for the poor challenges us to be advocates for the voiceless and powerless among us. Those who are in any way and for any reason deprived, marginalized, or vulnerable have a special moral claim on the community. As a matter of both justice and charity, we must put in place structures and systems to address and meet their needs, so that they might participate more fully in the common good and thereby flourish more fully as human persons. Partners in Health .for all of us, when we are vulnerable to harm? What is Global Health? Image Courtesy of: lidc.org.uk What is Global Health? Health care, but not just health care NOT just the absence of disease NOT limited to sites outside the US Linked to terms international health, global public health, public health, sustainable health Draws on many disciplines Grounded in social justice philosophy Includes HEALTH IN ALL POLICIES multi- sector efforts to improve well-being that use prevention as prime intervention strategy Linked to government, bilateral and multi- lateral cooperation, NGOs, civil society and the private sector. Global Health is Public Health for the World! Global Health Scope, Trends and Challenges Image Courtesy of: lidc.org.uk The Scope of Global Health Communicable Disease Non-Communicable Disease Nutrition and Food Systems Unintentional Injuries and Violence Disability Mental Health Environmental Health National Disasters, War and Complex Emergencies Global Population Dynamics Meeting the health needs of special populations: Difference is not disease! 11 WHO Determinants of Health Factors that Affect Health Current Global Health Trends Growing population Aging population manifesting in shifts in disease burden to NCDs Urbanization Changing patterns of consumption with economic development Global spread of tobacco Diets high in sugar, fat, salt Physical inactivity Some Current Global Health Challenges In 2011, 6.9 million (down from 11 million in 1990) children under 5 die from preventable diseases 222 million women do not have access to family planning and reproductive health services 13 million people die yearly from preventable infectious disease (half due to HIV/AIDS) 1.2 billion people do not have access to clean water Over 300 million adults are obese raising risk for chronic disease 17 neglected tropical diseases affect 1 billion people worldwide. Nearly 1 billion males and 250 million females smoke 76.3 million struggle with alcohol use disorders, 185 million use other drugs Global Health Timeline Global Health: A Timeline Ancient Civilizations -- herbal knowledge, rituals, bone-setting, obstetric practices, sanitation measures 542--Plague of Justinian extends from Asia to Ireland Black Death kills 25 million in Europe alone First Quarantine in Venice Middle Ages: smallpox, diphtheria, measles, influenza, tuberculosis, rabies, scabies, leprosy 1100s--First Hospitals in Europe 1400s--Colonial Era Begins and diseases spread Influenza, measles, typhus, smallpox, Cholera, syphilis, dysentery, malaria, sleeping sickness Codex Badianus Compendium of medicinal herbs from Latin America (Aztecs), and interest in other ancient traditions 1600sJesuits learn indigenous n=malaria cure in South America Cinchona Bark Quinine Enlightenment brings urban sanitation and water systems to European cities. Paris, then others. Edward Jenner safe vaccine for Small Pox Charles IV commissions the Balmis-Salvany Smallpox Expedition. It is the first public health vaccination campaign in South America THEN:NOW: First International Sanitary Conference (international cooperation regarding quarantine to prevent cholera and other problems) 1905 Yellow Fever and Malaria control: Panama (William Crawford Gorgas) medical discoveries, vaccines, health education global health infrastructure begins to develop (schools, foundations, agencies) 1960s and 1970s immunization, disease specific programs 1978 Alma Ata Declaration Health for All, 134 countries sign SMALL POX ERADICATION Ken Horne, the first AIDS case in the United States is reported to the Center for Disease Control UN Millennium Declaration 2004 PEPFAR and others launch global HIV/AIDS treatment initiative 2012 UN High Level Mtg on Non-Communicable Diseases January 2014 Polio eradication in India. Continued challenges in Nigeria, Pakistan and Afghanistan. Last case may be seen in The MDGs and the Post 2015 Agenda Image Courtesy of: lidc.org.uk Alma Ata, 1978, 134 countries Millennium Development Goals 2000 By the year 2015, all 191 UN member nations have pledged to meet these goals Millennium Development Goals 2000 By the year 2015, all 191 UN member nations have pledged to meet these goals Eradicate extreme poverty and hunger Eradicate extreme poverty and hunger Achieve universal primary education Achieve universal primary education Promote gender equality and empower women Promote gender equality and empower women Reduce child mortality Reduce child mortality Improve maternal health Improve maternal health Combat malaria, AIDS and other diseases Combat malaria, AIDS and other diseases Ensure environmental sustainability Ensure environmental sustainability Develop a global partnership for development Develop a global partnership for development Images Courtesy of:pnowb.org (top), cities-localgovernments.org (bottom) Were the MDGs Good for Health? Raised profile of GH and mobilized assistance Considerable progress in low and middle income countries MDGs contributed to fragmentation of interventions Further progress will require the reduction of inequality, discrimination and human rights violations. A Post-2015 Agenda Focused on Health and Well-being Other Post 2015 Themes: All Relate to Health Population Education Food and Nutrition Security Environmental Sustainability Water Energy Disasters, Conflict and Fragility Economic Growth and Employment Inequalities Governance Information Sources Useful Links BBC News Country Profiles The World Health Organization (WHO) Country Reports, see World Bank Country Profileshttp://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/0,,page PK:180619~theSitePK:136917,00.htmlhttp://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/0,,page PK:180619~theSitePK:136917,00.html CIA World Factbook at https://www.cia.gov/library/publications/the- world-factbook/https://www.cia.gov/library/publications/the- world-factbook/ 2010 GBD Country Summaries Food and Agriculture Organization (FAO), Set up TWITTER or other News Aggregator and follow as a class The Global Burden of Disease Studies Image Courtesy of: lidc.org.uk GBD 2010 Global Burden of Disease, Injuries and Risk Factors Published in Lancet, December 2012 Builds on World Band and WHO studies for 1990, and partners: WHO, Inst of Health Metrics, 5 universities 235 causes of death (from 107), 67 (from 10) risk factors, 21 regions, 20 age groups, sex, morbidity and mortality, DALYs Universal access to findings at: The way it was. Ranked Causesof Diseases and Risk Factors: Interactive Visual Tools to Access GBD Dataleading-causes-and-risks-between-1990-and leading-causes-and-risks-between-1990-and-2010 Patterns and Distributionby Broad Causes: Interactive Visual Tools to Access GBD Datapatterns-broad-cause-grouppatterns-broad-cause-group Heat Map Comparisons: Interactive Visual Tools to Access GBD Datacauses-and-risks-region-heat-mapcauses-and-risks-region-heat-map Using GPH Information Effectively The River of Mythshttps://www.youtube.com/watch?v=OwII-dwh- bk Population Growth and Climate Changehttps://www.youtube.com/watch?v=SxbprYyjyyU Will Saving Poor Children Lead to Overpopulation? https://www.youtube.com/watch?v=BkSO9pOVpRMhttps://www.youtube.com/watch?v=OwII-dwh- bkhttps://www.youtube.com/watch?v=SxbprYyjyyU https://www.youtube.com/watch?v=BkSO9pOVpRM mage Courtesy of: lidc.org.uk Disparities within Countries Image Courtesy of: lidc.org.uk 42 Note: Based on 1990 post-censal estimates of the United States resident population. Source: National Center for Health Statistics. Health, United States, 2006: With Chartbook on Trends in the Health of Americans Life expectancy in years of life remaining, 2003 Chart 3-4. Life expectancy at birth is five years lower for blacks compared with whites. 43 Chart 3-5. Infant mortality rates are more than two times higher for blacks than for whites, despite a slight decline for all groups in the past eight years. Deaths per 1,000 live births by maternal race/ethnicity, 1995 and 2003 AI/AN = American Indian/Alaska Native. Note: Infant is defined as a child under one year of age. Source: T. J. Matthews and M. F. MacDorman, Infant Mortality Statistics from the 2003 Period Linked Birth/Infant Death Data Set, National Vital Statistics Reports, May 3, (16):129. 44 AI/AN = American Indian/Alaska Native. Note: Data are age adjusted. Source: National Center for Health Statistics. Health, United States, 2006: With Chartbook on Trends in the Health of Americans New cases per 100,000 female population, 2003Deaths per 100,000 female population, 20002003 Incidence Mortality Chart Minority women have lower rates of breast cancer, but black women are more likely to die from the disease. 45 Chart Black men are 50 percent more likely to have prostate cancer than whites but are more than twice as likely to die from it. AI/AN = American Indian/Alaska Native. Note: Data are age adjusted. Source: National Center for Health Statistics. Health, United States, 2006: With Chartbook on Trends in the Health of Americans New cases per 100,000 male population, 2003 Deaths per 100,000 male population, 20002003 IncidenceMortality 46 Chart Blacks are three times more likely to die from asthma than whites. Number of asthma deaths per 100,000 people, 2003 AI/AN = American Indian/Alaska Native. Note: Data are age adjusted to the 2000 United States standard population. Source: L. Akinbami, Asthma Prevalence, Health Care Use and Mortality: United States, 200305. National Center for Health Statistics. First Do No Harm.Do Students do Too Much Too Soon?Let/142777/ Let/142777/ Image Courtesy of: lidc.org.uk Selected References Birn, Ane-Emanuelle, and Yogan Pillay, and Timothly Holtz. Chater 2, the historical Origins of Modern International Health, in Textbook of international Health: Global Health In a Dynamic World, Oxford University Press, Beaglehole R and Bonita R, What is global health? Global Health Action, 2010,3, Fried LP, Bentley ME, Brekens P, Burke DC, Frenk JJ, et.al. Global health is public health. Lancet 2009; 375, Gostin, L. Why Should Rich Countries Care about the Worlds least healthy People? JAMA, July 4, 2007Vol 298, No. 1 Koplan J, Bond C, Merson M et. Al. Towards a common definition of global health. Lancet 2009; 373: Fineberg H, and Hunter, D. A Global View of Heath, NEJM, January, 2013 Levine R, Case Studies in Global Health: Millions Saved. Jones and Bartlett Lindstrand et al. Global Health, Narayana Press, Denmark, United Nations Millenium Declaration, Read primary text posted at learn at UW and explore Millennium Development Goals indicators and progress at Alma Ata Declaration, GBD 2010, The Lancet, December Rx for Survival.Health in the Post 2015 Agenda. Report of the Global Thematic Consultation on Health. April Pages 7-15 and