global health 12 hour elective planning an international health elective
TRANSCRIPT
Global Health Global Health 12 hour elective12 hour elective
Planning an international Planning an international health electivehealth elective
Goals of 12 hour electiveGoals of 12 hour elective
Consider benefits and challengesConsider benefits and challenges Steps in planningSteps in planning Choice of siteChoice of site Goal settingGoal setting Minimize risksMinimize risks Check listCheck list
The Global VillageThe Global Village
If we could shrink the earth’s If we could shrink the earth’s population to a village of population to a village of exactly 100 people, with all exactly 100 people, with all the existing human ratios the existing human ratios remaining the same, the remaining the same, the village would look like village would look like this…….this…….
Then in this Global villageThen in this Global village….….
There would be 57 Asians, 21 There would be 57 Asians, 21 Europeans, 14 from North and South Europeans, 14 from North and South America, and 8 AfricansAmerica, and 8 Africans
51 would be female:49 male51 would be female:49 male 70 would be non-white and 30 white70 would be non-white and 30 white 50% of the entire world’s wealth 50% of the entire world’s wealth
would be in the hands of only 6 would be in the hands of only 6 people and those 6 would be from people and those 6 would be from the US the US
In this Global villageIn this Global village …. ….
80 would live in sub-standard housing80 would live in sub-standard housing 70 would be unable to read70 would be unable to read 50 would suffer from malnutrition50 would suffer from malnutrition 1 would be hear death: 1 would be 1 would be hear death: 1 would be
near birthnear birth only one would have a college only one would have a college
educationeducation no one would own a computerno one would own a computer
March 8March 8Anne Fanning, Lory Laing, Daniel RothAnne Fanning, Lory Laing, Daniel Roth
Hour 1-global burden of disease and Hour 1-global burden of disease and health systems-AFhealth systems-AF
Hour 2- opportunities and experiences Hour 2- opportunities and experiences at UA-LLat UA-LL
Hour 3-ethical considerations-some Hour 3-ethical considerations-some case senarios, based on personal case senarios, based on personal experience-DRexperience-DR
Assignment for March 15, Goal settingAssignment for March 15, Goal setting
scheduleschedule
March 15March 15Stan Houston, Lynora Saxinger, Walter KippStan Houston, Lynora Saxinger, Walter Kipp • Goal settingGoal setting• Assignment for March 22 fill in the cross culture Assignment for March 22 fill in the cross culture
information on your chosen countryinformation on your chosen country March 22March 22
• Examining different health care settings and Examining different health care settings and Cross cultural issuesCross cultural issues
• Assignment Fill in the check list and set time Assignment Fill in the check list and set time lineslines
March 29-all facilitatorsMarch 29-all facilitators• Check list Check list
introduction to global health issuesintroduction to global health issues
GoalsGoals
Health determinantsHealth determinants
Burden of diseaseBurden of disease
Health systemsHealth systems
Essential programsEssential programs
1. Poverty and disparity1. Poverty and disparity
1.3 billion live in Extreme poverty 1.3 billion live in Extreme poverty (<$1USD/d) unable to afford (<$1USD/d) unable to afford adequate food water and shelter adequate food water and shelter (and other 1 billion in relative (and other 1 billion in relative poverty, <$2/day). poverty, <$2/day).
95% of the worlds resources are 95% of the worlds resources are controlled by 5%controlled by 5%
2. Education2. Education, particularly of , particularly of the mother impacts child the mother impacts child
health health (% reduction in Child mortality )(% reduction in Child mortality )
0%10%20%30%40%50%60%70%80%
years of schooling
motherfather
3. 3. Social disruptionSocial disruption
MigrationMigration-over 1 million cross borders -over 1 million cross borders daily daily
War or civil strifeWar or civil strife (emergency defined as (emergency defined as >1 death/10,000/d) introduces issues of >1 death/10,000/d) introduces issues of food security, psychological trauma as well food security, psychological trauma as well as need for essential health servicesas need for essential health services
UrbanizationUrbanization• 45% live in cities45% live in cities• 41 cities have >5 million41 cities have >5 million• increase industry, increase pollutionincrease industry, increase pollution
4. 4. Climate impactClimate impact AgricultureAgriculture Global warming: Optimal temperature for Global warming: Optimal temperature for
mosquitos is 25-27degree C, a few mosquitos is 25-27degree C, a few degrees in average temp can transform a degrees in average temp can transform a no fly zone into malaria breeding groundno fly zone into malaria breeding ground
Water access: 3 billion have limited access Water access: 3 billion have limited access to clean waterto clean water
Pollution: COPollution: CO22 emissions range from emissions range from 0.8metric tons /capita in ssAfrica to 12.3 in 0.8metric tons /capita in ssAfrica to 12.3 in high income countries (WB 2000)high income countries (WB 2000)
Sun exposureSun exposure
Global Burden of disease Global Burden of disease causing deathcausing death
53.9 m deaths each year53.9 m deaths each year 31% CV31% CV 25% infectious( in low income 45%, <4 25% infectious( in low income 45%, <4
years 63%)years 63%) 13% cancer13% cancer 11% injury11% injury 9% resp and GI9% resp and GI 5% maternal5% maternal 6% other6% other
Causes of Death in 1990Causes of Death in 1990 Gwatkin Lancet1999;354: 586Gwatkin Lancet1999;354: 586
0%
10%
20%
30%
40%
50%
60%
communicable diseases
non-communicablediseasesinjuries
DALY lostDALY lost
0%10%20%30%40%50%60%70%80%
communicable diseases
non-communicablediseasesinjuries
Causes of 11.6 million deaths Causes of 11.6 million deaths among children <5, 1995among children <5, 1995
other53%
pneumonia21%
malaria4%
diarrhoea16%
measles6%
Malnutrition54%
Global Health Global Health
Health of the poor, those Health of the poor, those living on less than $2 a dayliving on less than $2 a day
Global Mortality due to infectious Global Mortality due to infectious
diseasesdiseases WHO 1997WHO 1997
DiseaseDisease #deaths (mil)#deaths (mil) % all deaths% all deaths
Acute Resp InfAcute Resp Inf 3.7453.745 7.27.2
TBTB 2.912.91 5.65.6
Diarheal disDiarheal dis 2.4552.455 4.74.7
HIV/AIDSHIV/AIDS 2.32.3 4.44.4
MalariaMalaria 1.5-2.71.5-2.7 2.9-5.22.9-5.2
MeaslesMeasles .96.96 1.81.8
HepBHepB .605.605 1.21.2
PertussisPertussis .41.41 0.80.8
Neonatal tetanusNeonatal tetanus .275.275 0.50.5
Dengue FeverDengue Fever .14.14 .3.3
Cost of Effective interventions Cost of Effective interventions (assuming (assuming
use is consistent and correct, Heymann,director CD cluster, WHO)use is consistent and correct, Heymann,director CD cluster, WHO)
5. 5. Access to Health careAccess to Health care
A.A. Public health servicesPublic health services
B.B. Clinical careClinical care
Principles of health delivery:Principles of health delivery: POLITICAL WILLPOLITICAL WILL Set priorities, Agree on essentialsSet priorities, Agree on essentials Central planning for country- wide deliveryCentral planning for country- wide delivery Essential management unit the District to assure ease of Essential management unit the District to assure ease of
accessaccess Enlist inter-sector support from education, social services, Enlist inter-sector support from education, social services,
industryindustry Create partnerships between public, military, private, Create partnerships between public, military, private,
NGO, Missions, industryNGO, Missions, industry Build community with participation, consultation, feedbackBuild community with participation, consultation, feedback Training and supervisionTraining and supervision evaluationevaluation
Cost effective interventionsCost effective interventions
Clinical servicesClinical services Management of sick childManagement of sick child Prenatal and delivery carePrenatal and delivery care Family planningFamily planning Short course Short course
chemotherapy for TBchemotherapy for TB Treatment of STDTreatment of STD Limited care (assess, Limited care (assess,
advise, alleviate pain, treat advise, alleviate pain, treat infection, minor trauma, infection, minor trauma, and complicated as and complicated as resources permit)resources permit)
Public Health packagePublic Health package EPI Plus((DPTpolio BCG, EPI Plus((DPTpolio BCG,
Measles) =+hepB, yellow Measles) =+hepB, yellow fever, Japanese fever, Japanese encephalitis+ micronutrient encephalitis+ micronutrient supplement iron, iodine, vit supplement iron, iodine, vit AA
School health programSchool health program Tobacco and Alcohol controlTobacco and Alcohol control AIDS preventionAIDS prevention Other public health Other public health
(information, education (information, education communication about the communication about the above, when to seek care above, when to seek care and vector control, and vector control, +SURVEILLANCE+SURVEILLANCE
Cost $12/capita in low income and 21.5 in middle income depending on salaries
In Africa...In Africa... Life expectancy is 48.9 Life expectancy is 48.9
years and falling in years and falling in countries with high countries with high rates of HIV, compared rates of HIV, compared with the world life with the world life expectancy of 66.7expectancy of 66.7
in Zambia life in Zambia life expectancy has fallen expectancy has fallen from 61 years in 1990 from 61 years in 1990 to 38 in 1999!to 38 in 1999! 0
10
20
30
40
50
60
70
life expectancy
AfricaWorld
In Africa...In Africa...
public public expenditure expenditure on health as on health as % of GDP% of GDP
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
health %GDP
AfricaWorld
Doctors per 100,000Doctors per 100,000The world The world
has 122 has 122 doctors per doctors per 100,000 and 100,000 and Africa has 16Africa has 16
0
20
40
60
80
100
120
140
MDs /100,000
AfricaWorld
Foreign Aid to AfricaForeign Aid to Africa
Foreign aid to Foreign aid to Africa has Africa has decreased in all decreased in all but three but three countries of countries of AfricaAfrica
12.5
13
13.5
14
14.5
15
15.5
16
USD billions
Africa1991Africa1997
District health center with hospital and clinic and district officerManagement Unit
Population about 100,000
Village health center
Village Health Center
Village Health Center
Village Health Center
Village Health Center
Lets talk about elements of a useful Lets talk about elements of a useful electiveelective
Supervision by someone who knows Supervision by someone who knows your needsyour needs
What are they? What are they? • To see health problems of the area and To see health problems of the area and
how they are managedhow they are managed• To do so in safetyTo do so in safety• To learn the best practice and priorities To learn the best practice and priorities
Measures of health systemMeasures of health systemCNDCND MalawiMalawi
GNP/capitaGNP/capita 19,17019,170 210210
Life expectancyLife expectancy 7979 3939
Infant mortality/1000Infant mortality/1000 66 134134
Maternal mortality/10Maternal mortality/1066 live live 620620
LiteracyLiteracy 97%97% 56%56%
Daily caloric supplyDaily caloric supply 30563056 20002000
Doctors /100,000Doctors /100,000 221221
Where –LL lists, -IHMEC newsWhere –LL lists, -IHMEC news When When How longHow long Urban/ruralUrban/rural• Health center/hospitalHealth center/hospital
ReferencesReferences
Bobadilla JL et al Design content and Bobadilla JL et al Design content and financing of an essential national financing of an essential national package of health services . Bull package of health services . Bull WHO 1994;72:653-662WHO 1994;72:653-662
World Guide New InternationalistWorld Guide New Internationalist IHMEC guideIHMEC guide www.talcuk.org http://www.ih.ualberta.ca/http://www.ih.ualberta.ca/