BME 301

Lecture One

Overview of Lecture 1

Course Overview: Course organization Course goals Four questions we will answer Technology assessment – The big

picture Activities we will do

World health: an introduction

Course Organization

People Syllabus Website:

http://www.bme.utexas.edu/faculty/richards-kortum/BME301

BME 301 Roadmap

Design of New health Technologie

s

Health Technolog

y Assessme

nt

Ethics

Management

The Science of Understanding a Disease.

Preclinical Testing

Abandoned due to poor technical performance,

efficacy, efficiency, and safety, ethical, legal, or social

issues.

Clinical Trials

Adoption and Diffusion

Roadmap for BME 301

Four Questions

What are the major health problems worldwide?

Who pays to solve problems in health care?

How can technology solve health care problems?

How are health care technologies managed?

BME 301 Concept map

Start here

What are the problems in health today? Advance to next unit

Screening and Prevention Diagnosis Treatment and Therapy

Definition of Health

Role of WorldHealth

OrganizationHealth Data

Types and Uses

Sensitivity and

SpecificityPPV

Epidemiology Burden of DiseaseQALY, DALY,HRQL

Mortality Ages 15-44

AIDS/HIVAccidents

Interpersonal Violence

Mortality Ages 45-60

Respiratory Cancers

TB

Heart Disease

Cerebrovascular disease

Developing and Developed World

Contrasts

Who pays to solve problems in health care?

How have health care costs changed over time? Advance

to next unit What contributes to increasing health care costs?

InternationalInternational

Start here

United StatesVendor/Purchaser System – choice dependent on ability to pay

Financing of the system

Health Technology Development

Provider of services

Hospitals Nonprofit Private (for profit) Public

Ambulatory Care Private Practice Public Health Services Voluntary Agencies

University Student

Private insuranceHMOPPO

Public (tax based)Medicare/Medicaid

Military Out of pocket expenses

CanadaUniversal Insurance13 provincial systemsHospitals – nonprofit (all government funded)Government sets ceilings on gross revenue for physician private practices.

IndiaPublic – free treatment health centers Private care – for profit usually urban areasWestern and traditional medicineInternational aid – especially in rural areas

Angola27 year civil war“Near absence” of government Displacement and malnutritionInternational aid only source of health care.

Start here

How can we use science and technology to solve problems in health care?

Advance to next unit

How do we test and refine innovations? Case studies

Technology Assessment: The Big Picture

Biological plausibility

Clinical Trials

Where do innovations come from?

Patient Outcomes

Societal Outcomes

Early Detection of Cancer Prevention of Infectious Diseases

Technical Feasibility

Science Drives Engineering

Scientific Method

Engineering design

Treatment of Heart Disease

Microorganisms

Immunity

Vaccines

HIV Cost effectiveness

Pre-cancer cancer transformationDetection of Morphologic Changes

Gene Chips – molecular changes

CervixBreast Prostate

The circulatory system

Arteriosclerosis

CABGPTCA

Heart Failure

LVADTransplant

OutcomesCost effectiveness

OutcomesCost effectiveness

How are health care technologies managed?

Examples:

MRI

Laparoscopic cholecystectomy

Vitamin C treatment for scurvy

ResearchFunding

RegulatoryApproval

Reimbursement Diffusion

Three Case Studies Prevention of infectious disease

HIV/AIDS Early detection of cancer

Cervical Cancer Ovarian Cancer Prostate Cancer

Treatment of heart disease Atherosclerosis and heart attack Heart failure

Activities

Homework (HW) Web Assignments (WA) Class Activities (CA) Projects Due dates

Technology Assessment

What is it? Why do we need it? Example

Bone marrow transplants for breast cancer

Start here

What are the problems in health today? Advance to next unit

Screening and Prevention Diagnosis Treatment and Therapy

Definition of Health

Role of WorldHealth

OrganizationHealth Data

Types and Uses

Sensitivity and

SpecificityPPV

Epidemiology Burden of DiseaseQALY, DALY,HRQL

Mortality Ages 15-44

AIDS/HIVAccidents

Interpersonal Violence

Mortality Ages 45-60

Respiratory Cancers

TB

Heart Disease

Cerebrovascular disease

Developing and Developed World

Contrasts

What is health?

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.”

Some Perceptions of Health

Pain, fever, symptoms of illness Interference with normal activities Deviation from a pre-determined

norm Ability to respond to stress and

physical insult

Individual Health vs. Population Health

Pooled figures such as: Infant mortality rates Numbers of deaths and causes Immunization rates

Example of Health Data

Questions about health data

Why do we need it? What data do we need? Where do we get it? How do we use it?

Why do we need health data?

From 1870-1900: Biomedical science advanced more than it had

in previous 3 millennia Darwin’s concept of evolution Chemistry Microscopy Field based research around the world

Means, transmission, causative agent of almost every important infectious disease

In this period, governmental health agencies were first established.

World Health Organization

Established by charter of the UN after World War II

Headquartered in Geneva Mission:

“Attainment by all peoples of the highest possible level of health”

Website: http://www.who.int/en/

Functions of the WHO Services to governments:

Epidemiologic intelligence International standardization of vaccines Reports of expert committees Data on world health problems

Member countries must provide certain info in regular reports Disease outbreaks Health of population Steps to improve health

Uses for health measures Identify emerging problems (early

warning) Rubella during pregnancy Thalidomide during pregnancy AIDS Kaposi’s sarcoma, PCP

Help determine public policy Estimate impact of health problems

# people affected, ages, locations Set priorities for funding Educate legislators

Monitor progress toward goals

Types of health data Data on the population

# of people Age, sex, ethnic origin, urbanization

Vital statistics Live births Deaths (including infant deaths) by sex, age, cause

Health statistics Morbidity by type, severity and outcome Data on reportable diseases Tumor registries

Statistics about health services # and type of facilities # and qualifications of health personnel Services and utilization rates Costs and payment mechanisms

Quantitative measures of health

Incidence Number of new cases of a disease in a

population over a period of time Annual incidence rate

year same that ofyear -midat populationin that #

year onein population defined ain condition defined a of cases new of #denceRateAnnualInci

Quantitative measures of health

Prevalence Number of existing cases of a disease in a

given population at a specific time Point prevalence

in timepoint sameat populationin that #

in timepoint aat population defined ain condition defined a of cases of #Print evalencePo

Quantitative measures of health

Mortality rate Mortality = Death Crude death rate, Infant, Neonatal, Post-

neonatal, Maternal Age adjustment is important because different

populations have very different age distributions

Mortality Rate

Infant mortality rate

year same theofyear -midat populationin that #

year ain population defined ain deaths of #ateMortalityR

year samein populationin that births live of #

year ain population defined ain age ofyr 1under deaths of #alityRateInfantMort

Quantitative measures of health

Morbidity rate Morbidity = a diseased state

Why is it important? Estimate magnitude of health problem Detect epidemics

Mandatory notification Cholera Plague Yellow fever

Evaluate preventive measures

year same theofyear -midat populationin that #

year ain population defined ain condition specific of cases of #ateMorbidityR

Burden of disease Quality adjusted life year (QALY)

Measure of quality adjusted life years gained by an intervention

Disability adjusted life year (DALY) Years of disability free life lost Combines several elements

Levels of mortality by age Levels of morbidity by age Value of a year of life at specific ages

Examples: Stroke: 6 DALYs Car accidents: 9 DALYs Self inflicted injuries: 17 DALYs Violence: 9 DALYs Lower respiratory infections: 1 DALY HIV: 28 DALYs

The study of global health Epidemiology

The study of the prevalence and spread of disease in a community

Measures of health Vary throughout the world

Burden of disease Varies throughout the world

How can technology impact health and disease? Varies throughout the world

We will examine in detail in BME 301

Leading causes of mortality in Member States 1998

Group 1 = communicable diseases, maternal/perinatal conditions, nutritional deficienciesGroup 2 = Non-communicable diseases (cardiovascular, cancer, mental disorders)Group 3 = Injuries

Mortality from cervical cancer in 1990 (per 100 000 age standardized world population) From:   Jones: BMJ, Volume 319(7208).August 21, 1999.505-508

Income

Sources of World Health Data

The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Murray CJL, Lopez AD, eds. Harvard School of Public Health on behalf of the World Health Organization and the World Bank, 1996.

World Health Organization Annual Reports International Agency for Research in Cancer

Summary of Lecture One

Course organization What is health? Role of WHO Health data and uses

Assignments Due Next Time

WA1