Global Health

Global Health

What is global health?

i. Health problems, issues, and concerns that
transcend national boundaries, which may be
influenced by circumstances or experiences in
other countries, and which are best addressed by
cooperative actions and solutions (Institute Of
Medicine, USA- 1997)
Global Health Issues
A. Refers to any health issue that concerns many countries
or is affected by transnational determinants such as:
i. Social and economic status
ii. Demographic dynamics
iii. Climate change
iv. Urbanisation
v. Malnutrition – under or over nutrition
Global Health Issues

A.Or solutions such as:

i. Polio eradication
ii. Containment of avian influenza
iii.Approaches to tobacco control
iv.Targeted/high–risk strategy in disease in
handling global health issues.
Communicable Diseases and Risk Factors

i. Infectious Diseases are communicable

diseases caused by pathogens that can
spread from person to person or between
people and animals are called infectious
diseases.
Communicable Diseases and Risk Factors

i. Pathogens include viruses, bacteria, fungi,

parasites, and the like.

ii. Infectious Diseases are also known as

Contagious, communicable, or Transmissible
diseases.
 The Epidemiologic Triangle
Host Factors
Host Personal traits
behaviors
genetic predisposition
immunologic factors
Influence the chance for disease or its severity
Agents
Biological
Physical
Chemical
Agent Environment
Necessary for disease to occur
Environment
External conditions
Physical or biologic
or social
Contribute to the disease process
The epidemiologic triad of disease

i. Agent: is the cause of disease- viral,

bacterial, fungal etc- With regards to NCDs:
agent could be a chemical (from dietary
food, tobacco smoke, solvents), radiation,
nutritional deficiency etc.
The epidemiologic triad of disease

ii. Agent: should be able to multiply, emerge

from the host, reach and infect a new host.

iii. Agents lives and multiply in the reservoir

from where it is transmitted to other habitat.
The epidemiologic triad of disease
Three terms are used to describe an infectious disease according to the
various outcomes that may occur after exposure to its causative agent.

i. Infectivity refers to the proportion of exposed persons who become

infected.

ii. Pathogenicity refers to the proportion of infected persons who develop

clinical disease.

iii. Virulence refers to the proportion of persons with clinical disease who
become severely ill or die.
The epidemiologic triad of disease

I. Physical agents : Common cold, humidity, pressure

II. Chemical: endogenous (e.g. urea, bilirubin etc) or

exogenous (e.g. allergens, metals and dusts)to the
host.

III.Social agents: poverty, alcohol, smoking, drug abuse

etc.
The epidemiologic triad of disease

i. Host (Reservoir) : is an organism usually

human or animal that harbors' the disease.

ii. Reservoir or source of infection: It is the

ecological niche (person, animal , arthropod,
soil etc) in which an infectious agent lives
and multiplies and on which it depends
The epidemiologic triad of disease

i. primarily for survival and where it reproduces

itself in such a manner that it can be
transmitted to a susceptible host.
The epidemiologic triad of disease

Host/Environment: surrounding where

disease thrives: Physical, Biological and
Psychosocial.

1.Host creates lodging or subsistence for the

agent
The epidemiologic triad of disease

1. Host factors include:

i. Demographic: age, sex, race
ii. Biological such as genetic make up, blood groups,
iii. Socioeconomic factors; education, occupation, housing
iv. Lifestyle factors: personality traits, living habit, exercise etc
v. Others: level of immunity, overall fitness, state of health
NCDs: Definition

1. Comprise all impairments or deviations from

normal, which have one or more of the following
characteristics:

a) Are permanent

b) Leave residual disability

NCDs: Definition

1. NCDs

a) Are caused by non-reversible pathological alterations

b) Require special training of the patient for

rehabilitation

c) May be expected to require a long period of

supervision, observation or care
Non-Communicable Diseases and Risk
Factors

A.NCDs: we talk about risk factors, not the

agent: It is an attribute or exposure that is
significantly associate with development of
a disease.
Non-Communicable Diseases and Risk
Factors
A. So these are elements of western lifestyles:
1. Dietary changes
2. Lack of physical activity
3. Reliance on automobile transport
4. Smoking
5. Stress
6. Urbanisation
Risk Factor

i. “An aspect of personal behavior or lifestyle,

an environmental exposure, or a hereditary
characteristic that is associated with an
increase in the occurrence of a particular
disease, injury, or other health condition.”
Modifiable Risk Factor
i. A risk factor that can be reduced or controlled by
intervention, thereby reducing the probability of disease.

The WHO has prioritized the following four:

ii. Physical inactivity

iii. Tobacco use

iv. Alcohol use

v. Unhealthy diets
Non-Modifiable Risk Factor

A risk factor that cannot be reduced or controlled by

intervention, for example:

i. Age

ii. Gender

iii. Race

iv. Family history (genetics)

Modifiable risk factors of NCD

Lifestyle

a)– Cigarette smoking

b)– Excessive alcohol

c) – Dietary patterns

d)– Physical inactivity

Modifiable risk factors of NCD

Environmental
i. – Occupational hazards
ii.– Radiation
iii.– Other pollutants
Modifiable risk factors of NCD
a) Failure or inability to get preventive health services such as:

i. Screening

ii. Early treatment

b) Stress factors

c)Recently identified etiological factors

–Viral carcinogenesis

d) HPV, Epstein barr virus, HIV,

Non-modifiable risk factors

A. Family history

B. Advancing age
Key Concepts in Relation to Global Health

1. The determinants of health

2. The measurement of health status

3. The importance of culture to health

4. The global burden of disease

5. The key risk factors for various health problems

6. The organisation and function of health systems

Determinants of Health
Source: Dahlgren G. and
Whitehead M. 1991
Determinants of Health
1.1 Biological deters

i. Genetic make up

ii. Age

iii.Gender

1.2 Behavioural deters

iv.Lifestyle choices

v. Community influences
Determinants of Health
1.1Income/economic status

i. Education

ii. Occupation/work conditions

iii. Geographical location

iv. Culture, religious

1.4 Environmental deters

Other deters

v. Access to health services

vi. Health professionals

vii. Health systems and technology

Determinants of Health
PLUS MORE GENERAL FACTORS SUCH AS:

i. POLITICAL STABILITY

ii. CIVIL RIGHTS

iii. ENVIRONMENTAL DEGRADATION

iv. POPULATION GROWTH/PRESSURE

v. URBANISATION

vi. DEVELOPMENT OF COUNTRY OF RESIDENCE

Multi-sectoral Dimension of the Determinants of
Health
A. Malnutrition – more susceptible to disease and less
likely to recover

B. Cooking with wood and charcoal – lung diseases

C. Poor sanitation – more intestinal infections

D.Poor life circumstances – commercial sex work and

STIs, HIV/AIDS.
Multi-sectoral Dimension of the Determinants of
Health
A. Advertising tobacco and alcohol – addiction and
related diseases.

B. Antimicrobial resistance and residues - Building

resistance against bacterial diseases.

C. Rapid growth in vehicular traffic often with

untrained drivers on unsafe roads- road traffic
accidents
The Measurement of Health Status
A. Cause of death
i. Obtained from death certification but limited because of incomplete
coverage. Supplement with surveys and verbal autopsies

ii. Cause of death as defined in the Communicable Diseases.

B. Life expectancy at birth

i. The average number of years a new-borns baby could expect to live if
current trends in mortality were to continue for the rest of the new-
born's life.

ii. Strongly affected by infant and child mortality.

The Measurement of Health Status
A. Maternal mortality rate
i. The number of women who die as a result of childbirth and
pregnancy related complications per 100,000 live births in a
given year

*The maternal mortality rate can be converted to a maternal

mortality ratio (MMR ⎯ expressed as deaths per 100,000 live births)
by dividing the maternal mortality rate by the general fertility rate
(GFR) that prevailed during the same time period and multiplying the
result by 100,000.
The Measurement of Health Status….

A. Infant mortality rate

i. The number of deaths in infants under 1 year per
1,000 live births for a given year

B. Neonatal mortality rate

i. The number of deaths among infants under 28 days
in a given year per 1,000 live births in that year
The Measurement of Health Status….

A. Child mortality rate

i. The probability that a new-born will die before reaching
the age of five years, expressed as a number per 1,000
live births

B. Disability-Adjusted Life Years (DALYs)

i. Express years of life lost to premature death and years
lived with disability adjusted for the severity of the
The Measurement of Health Status….

A. Health care delivery indicators

i. Doctor/nurse – patient ratio

ii. Patient – bed ratio

iii.Population per health centre

The Measurement of Health Status….

A. Utilization rates/ actual coverage

i. The proportion of people in need of a service who

actually receive it in a given period, usually a year.

ii. Affected by availability and accessibility of health

services; and attitude of individuals towards ones health
and the health care system.

iii. e.g. fully immunization

3. Culture and Health
A. Culture:
i. The predominating attitudes and behaviour that characterise the functioning of a group or
organisation

B. Traditional health systems

C. Beliefs about health

i. e.g. epilepsy – a disorder of neuronal depolarisation vs a form of possession/bad omen
sent by the ancestors
ii. Psychoses – ancestral problems requiring the assistance of traditional healer/spiritualist

D. Influence of culture of health

i. Diversity, marginalisation and vulnerability due to race, gender and ethnicity
4. The global burden of disease
A. Predicted changes in burden of disease from
communicable to non-communicable between 2004
and 2030.
i. Reductions in malaria, diarrhoeal diseases, TB and
HIV/AIDS
ii. Increase in cardiovascular deaths, road traffic
accidents and diabetes mellitus.
4. The global burden of disease

A.Ageing populations especially in high and middle

income countries

B.Socioeconomic growth with increased car

ownership.

C.Based on a ‘business as usual’ assumption

Globalization and Health

1. Globalization is the process of increasing

political and social interdependence and global
integration that takes place as capital, traded
goods, persons, concepts, images, ideas and
Values diffuse across the stated boundaries.
(Hurrel &woods 1995).
Globalization and Health

1.Globalization must ensure that people,

particularly the poor, enjoy better health
that is the most important factor in
improving the economic wellbeing of the
population in general and in reducing
poverty in particular.
Threats to Global Health

1. The effects of Globalization on health are

diverse; these can be positive, negative or
mixed.

2. Some of the effects of Globalization are listed

hereunder.
Threats to Global Health
Effects of Globalization on health includes:

i. Externalities of some diseases due to increased

communication decreased human mobility.

ii. Accelerated economic growth and technological advances

have enhanced health and life expectancy in many population

iii. Increasing effects of international and bilateral agencies

(structural adjustment programs and Global initiatives).
Threats to Global Health
Effects of Globalization on health includes:

i. Jeopardizing population health Via erosion of social and

environmental conditions and exacerbating inequalities.

ii. Other health risks of Globalization includes -

Fragmentation and weakening of labor markets due to
greater power of mobile capital - Tobacco induced
diseases.
Threats to Global Health
1. Food markets & obesity as well as chemicals in
food.

2. Rapid spread of infectious diseases.

3. Depression in aged and fragmented population.

4. Adverse effects on the environment.