HMB203 Midterm Review
Principles and Goals of Global Health
Health: a state of complete physical, mental and social wellbeing and not merely the
absence of disease or infirmity.
Public Health: the art of preventing disease, prolonging life, and promoting physical
health and mental health and efficiency through organized community.
Global Health: area for study, research, and practice that places a priority on improving
health and achieving equity in health for all people worldwide.
Determinants of Health
Income and social status - higher income and social status are linked to better health. The
greater the gap between the richest and poorest people, the greater the differences in
Education low education levels are linked with poor health, more stress and lower self-
Physical environment safe water and clean air, healthy workplaces, safe houses,
communities and roads all contribute to good health. Employment and working
conditions people in employment are healthier, particularly those who have more
control over their working conditions
Social support networks greater support from families, friends and communities is
linked to better health. Culture - customs and traditions, and the beliefs of the family and
community all affect health.
Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood
of developing certain illnesses. Personal behaviour and coping skills balanced eating,
keeping active, smoking, drinking, and how we deal with lifes stresses and challenges all
Health services - access and use of services that prevent and treat disease influences
Gender - Men and women suffer from different types of diseases at different ages. 2
Millennium Development Goals
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria, and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
Case study 1: Eradication of Small-Pox ()
In 1966, there were approximately 10 million to 15 million cases of smallpox in more
than 50 countries, and 1.5 million to 2 million people died from the disease each year.
WHO formed Smallpox Eradication Unit, technical and financial support from USA,
concentrated surveillance and vaccinate around new cases
In 1980, WHO declared smallpox the first disease in history to have been eradicated
Total cost $298 million; USA saves contribution every 26 days.
Impact of eradication:
Legacy to public health of the smallpox eradication campaign is the demonstration of
how the combination of good science, outstanding organization, focused monitoring, and
international commitment can make a substantial difference to global health, saving
generations from disability and premature death.
The Eradication Debate:
Preconditions of disease eradication:
1. No animal reservoir for the virus is known or suspected.
2. Sensitive and specific tools are available for diagnosis and surveillance.
3. Transmission from one individual to another can be interrupted.
4. Nonlethal infection or vaccination confers lifelong immunity.
5. The burden of disease is important to international public health.
6. Political commitment to eradication efforts exists.
During the 1900s, global efforts were made to eradicate seven diseases: hookworm,
yellow fever, malaria, yaws, smallpox, guinea worm, and polio
Benefit of Eradication Hard of Eradication
No illness or death from that disease will Short-term: focus efforts on one ailment,
occur. move the force of health system to deal with
Save on money and resources.
Improve health infrastructures, better Long-term: impossible to obtain all the
coordination. promised benefits because vaccination must
continue even if the program is successful in
A lot money spent on eradication
Health Determinants, Measurements, and Trends
Life expectancy at birth: the average number of years a new born baby could expect to
live if current mortality trends were to continue for the rest of the newborns life.
o Top 4: Japan, Singapore, Australia, Canada
Infant Mortality Rate: the number of deaths of infants under age 1 per 1000 live births in
a given year.
o Top 3: Sub-Saharan Africa, South Asia, Middle East and North Africa.
Neonatal Mortality rate: the number of deaths of infants under 28 days of age in a given
year per 1000 live births in that year.
o Top 3: Africa, Eastern Mediterranean, Southeast Asia.
Under-Five Mortality Rate (Child Mortality Rate): the probability that a newborn baby
will die before reaching age five, expressed as a number per 1000 live births.
o Top 3: Sub-Saharan Africa, South Asia, Middle East and North Africa
Maternal Mortality Ratio: the number of women who die as a result of pregnancy and
childbirth complications per 100,000 live births in a given year.
o Top 3: Sub-Saharan Africa, South Asia, Middle East and North Africa
The number of affected persons present in the The number of new cases of a disease that
population divided by the number of people in occur during a specified period of time divided
the population by the number of persons at risk of developing
the disease during that period of time
Useful for assessing the burden of disease High incidence represents diseases with high
within a population occurrence; low incidence represents diseases
Valuable for planning with low occurrence
Not useful for determining what caused the Can be used to help determine the causes of
Can be used to determine the likelihood of
developing the disease
Global Burden of Disease: Leading Causes of Death
Low- and Middle-Income Countries High-Income Countries
1. Ischemic heart disease 1. Ischemic heart disease
2. Cerebrovascular disease 2. Cerebrovascular disease
3. Lower respiratory infections 3. Trachea, bronchus, & lung cancers
4. HIV/AIDS 4. Lower respiratory infections
5. Perinatal conditions 5. Chronic Obstructive pulmonary disease
6. Chronic Obstructive pulmonary disease 6. Colon and rectal cancers
7. Diarrheal disease 7. Alzheimers and other dementias
8. Tuberculosis 8. Diabetes Mellitus
9. Malaria 9. Breast cancer
10.Road traffic accidents 10. Stomach cancer 4
Measuring the Burden of Disease
Health-Adjusted Life Expectancy (HALE): The number of years in full health that a
newborn can expect to live based on current rates of ill health, disability and mortality.
Disability-Adjusted Life Year (DALY): The number of future healthy (disability-free)
life years lost as a result of premature death, illness, or disability.
Criticisms of DALY
Difficult to predict the severity of a disability or illness
Subjective criteria used
Health professionals make estimates, rather than others
Social, cultural and economic context not considered
Health of elderly and young not considered as important (age weighted differently)
If there is more than one disability may be more severe than death
Case study 2: Kerala State in India
Kerala State: Southwestern India (~31million)
Offered free primary and secondary education, extensive network of primary healthcare
Significant decline in Infant mortality rate, under-five mortality, maternal death. Increase
in life expectancy, GDP.
Health Education, Poverty and the Economy, and Immunization
Health vs. Education
The Higher the Level of Education of the Mother, the Greater Chance her Child will be
Maternal Education and infant mortality:
In 1962, Chile was the country (compare with USA and Cuba) with the highest infant
mortality rate and a high fertility rate.
In 2005, Chile and USA had almost the same mortality rate; however, within Chile,
women with higher education will have a lower mortality rate.
Health vs. Equity
Equity across countries
Enormous variance in basic indicators of health across regions and countries
Largely, but not completely varies by income
o Geographic availability
o Responsible for need of people
Equity within counties
Some countries have substantial variation in health indicators across population groups