Global Health 101 Deepti Thomas Paulose MD MPH

Global Health 101 Deepti Thomas- Paulose MD, MPH July 14 th 2011

WHO Definition of Health “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. ”

Outline o Define Public Health and International Public health o Define major principles o Understand major issues in global public health o History of Global Health o Current Challenges o Future Challenges

Public health o The science and practice of protecting and improving the health of a community through: n n n Preventative medicine Health education Control of communicable diseases Application of sanitary measures Monitoring of environmental health hazards

John Snow- The father of modern public health Cholera outbreak in London during 1848 -1848 n Different water sources were the basis for illness n “The Ghost Map” n

Multitude of sciences o Epidemiology and Biostatistics o Biological sciences concerned with humans, microorganisms and vectors o Social and behavioral scienceseconomics, psychology, anthropology and sociology

Social Justice o Central pillar of public health o Equity in health to all groups in any society o Impeded by differences in gender, social class, ethnicity, and race

International Public Health § Application of principles of public health to health challenges that affect low and middle-income countries and to the complex array of global and local forces that influence them including: § Urbanization § Migration § Information technology § Expanding global markets

Improving health requires understanding characteristics: o Social o Cultural o Behavioral o Economic o Environmental

What are the issues you should understand in International Public Health?

1)Main causes of Morbidity and Mortality in the world today and in the future in view of : o The demographic transition- many countries are transitioning from high to low fertility rates

2)The cultural diversity of population groups within countries and regions Values, belief systems and responses to illness and death

3)The causes and consequences of human population growth and the beneficial effects for women and children of reproductive health programs.

4) The complex relationship between nutritional status and disease patterns, including the importance of micronutrient deficiencies.

5)The main infectious agents and vectors responsible for communicable diseases

6) The increasing rates of non-communicable or chronic diseases.

7) The increasing burden of mortality and morbidity attributable to non- intentional and intentional injuries.

8) The various approaches to the design, financing, organization, and management of preventative and curative services in countries with diverse economies and resources

9) The appropriate responses to complex humanitarian emergencies, especially those involving large displacements of populations within a country and between neighboring countries

10) The importance of health for the economic development of a nation and the productivity of its population, and the reciprocal impact of development, as reflected by such factors as educational levels and economic growth, on health status

11) The roles of national, regional, international and intergovernmental development agencies, as well as nongovernmental and private volunteer agencies in delivery of preventive and care services

A Summarized History of International Public Health

400 BC o. Hippocrates presents causal relation between environment and disease

1 st Century AD o. Romans introduce public sanitation and organized water supply system

14 th century o. Black Death leads to quarantine and cordon sanitaire

Middle Ages o Colonial expansion spreads infectious diseases around the world o Many cities in Europe build hospitals and other institutions to provide medical care and social assistance

1750 -1850 (Age of Enlightenment) o. Industrial revolution results in extensive health and social improvements in cities in Europe and the US n Outbreaks of cholera and other epidemic diseases that resulted in high rates of child mortality

1850 -1910 o Great expansion in the knowledge about the causes and transmission of communicable diseases n n n Louis Pasteur’s proof of germ theory Robert Koch’s discovery of tubercle bacillus Walter Reed’s demonstration of the role of the mosquito in transmitting yellow fever

1850 -1910 o Discoveries in the sciences of physiology, metabolism, endocrinology, and nutrition o Dramatic decreases in child and adult mortality through improvements in social and economic conditions, discovery of vaccines and implementation of programs in health education

1910 -1945 o Reductions in child mortality o Establishment of schools of public health and international foundations and intergovernmental agencies interested in public health o League of Nations

1945 -1990 o End of WWII beginning of current era of international public health o Creation of World bank, IMF and other UN agencies; WHO eradicates smallpox; HIV/AIDS pandemic begins; Alma Ata Conference gives emphasis to primary health care; UNICEF leads efforts for universal childhood immunization; greater attention to chronic diseases

Alma-Ata Conference in 1978 o Switch in paradigm from control of specific diseases to strengthening the capacities of low and middle income countries to extend their health services to populations with poor access to prevention and care

1990 -present o Priority given to health sector reform, equity, health and development, impact of and responses to globalization, costeffectiveness, public-private partnerships in health, and use of information and communications technologies

Ottawa Charter of 1986 o Health as a resource for development not merely as an outcome o Importance of structural factors that affect health on a societal level o Shift from “risk behavior to “risk environment” o Prerequisites for health n Peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity

The success of global health o Life expectancy is around 80 in many countries o o o around the world Life expectancy in developing countries has climbed to about 65 from 41 in the early 1950 s Elimination of smallpox (certified in 1979) Almost elimination of polio and measles Decline in global child mortality from 192 (1950 s) to 79 per 1000 live births by 2004 Immunization coverage approximately 75 -80% worldwide.

Current Challenges in International Public Health

o Nearly 11 milllion children below age 5 die each year from preventable causes such as n n n Pneumonia Diarrhea Malaria Malnutrition Measles HIV/AIDS 98 % of these deaths occur in developing countries

More than 120 million women want to space or limit childbearing, but do not have access to modern contraceptives

Nearly 600, 000 women die annually from complications of pregnancy and childbirth, and another 30 million suffer pregnancy related health problems that can be permanently disabling

o Each year 13 million persons die from infectious diseases, most of which are preventable or curable; half of these deaths are in adults and are due to TB, malaria, or HIV/AIDS

Worldwide 1. 2 billion people do not have access to clean water

o. More than 300 million adults are obese, putting them at significantly increased risk for cardiovascular diseases, diabetes, HTN, cancer, stroke and musculoskeletal disorders

There is a broad consensus that poverty is the most important underlying cause of preventable death, disease and disability More people live in poverty today than 20 years ago

Literacy, access to housing, safe water, sanitation, food supplies and urbanization are determinants of health status that interact with poverty

Globalization § Economic globalization, driven by increasing world trade, greater openness of national economies to world markets and the vast expansion of information technology, has contributed to uneven economic growth, increased economic inequality, and concerns about subordination of human and labor rights

Millennium Declaration by the UN in September 2000 o Address inequities that have been created or worsened by globalization o Form new international linkages to achieve and protect peace, disarmament, poverty eradication, gender equality, the environment, human rights, and good governance o The goals dealing specifically development and poverty eradication have become known as the Millenium Development Goals (MDGs), three of which explicity refer to health

Millennium Development Goals by 2015 n n n MDG 4 - Reduce under 5 mortality by twothirds MDG 5 - Reduce maternal mortality by three-quarters MDG 6 - Reverse the spread of HIV/AIDS, malaria, TB and other major diseases

Future Public Health Challenges n Emergence and reemergence of infectious disease- MDTB, SARS, influenza, West Nile Virus, etc n Dual burden in low and middle income countries of communicable and noncommunicable diseases n Global forces that have imported Western lifestyles such as tobacco smoking and increased consumption of processed foods have hastened the increase of chronic diseases in these countries

Future Public health Challenges o Mental illnesses and depressive disorders remain a largely ignored and major source of death and disability worldwide o Complex and multifaceted issues n n n Human Migration and displacements Bioterrorism Disaster preparedness, nuclear threats

Future Public health Challenges Motor vehicle safety n Road traffic accidents are the second leading cause of death worldwide among persons aged 5 to 29 years Occupational Workplace safety n In 2002, 2 million work-related deaths per year Coronary artery disease and stroke n In 2005, 80% of all CVD deaths worldwide took place in developing low and middleincome countries

Future Public health Challenges o Landmines o Population growth and shifts o World hunger and poverty o Environmental Issues n n n Global warming Indoor air pollution Water pollution

Important crossroad in international public health n n Confront global forces while at the same time promote local, evidencebased, cost-effective, public health programs that deal with diseasespecific problems and more general issues such as poverty More public health research is needed to gain a better understanding of the determinants of illness and of innovative approaches to prevention and delivery of care

Summary n Public health strives to maximize the well- being of an entire population n Chronic diseases are becoming more prevalent with aging populations n Global health is improving in general but there are parts of the world that lag behind n Other factors play a role in health like poverty, nutrition, education, water and sanitation n Health is central to global development objectives

Back to you! § International public health practitioners can make a big difference by being well trained in their disciplines and highly sensitive to the beliefs, culture, and value systems of the populations with whom they collaborate or serve