Global Health : Attention to the health outcomes of the most socially and economically vulnerable populations

Global Impact Orientation 2011Jay Mclean-Riggs MPH Jay Zanzibar 08

Let us be thankful for the fools. But for them the rest of us could not succeed. (Mark Twain [Samuel Langhorne Clemens] (1835-1910), U.S. author. Following the Equator, ch. 28, "Pudd'nhead Wilson's New Calendar," (1897).)

Social Determinants of HeathSocial Determinants of Heath

Social determinants of health are the economic and social conditions under which people live which determine their health.

Social Determinants of HealthSocial Determinants of Health• Genetic• Socio-economic

– Access to adequate clean water, quality and quantity of food, sanitation, adequate housing– Access to education

• Psychosocial– Gender equality– Emotional support and nurture, safety– Cultural acceptance

• Environmental - presence and absence of factors• National and regional infrastructure in

electrification, communications, IT, sewage disposal, employment, transportation

• Health services access, quality, affordability of treatments, preventions and screening

• Health Promotion

Virtually all major diseases are primarily determined by a network of interacting exposures that increase or decrease the risk for the disease.

Example : Measles

Measles is a viral disease that has killed 190 000 children in 2011 so far.

NoNo children in any part of the Americas, North, Central or South have died of measles in 2011.

• If a child gets measles they have not been vaccinated (a failure of public health, nationally and globally)

• If a child who is well nourished, has no other diseases and has access to clean water, sanitation and care child gets measles it is a mild inconvenience

• If an extremely poor child, malnourished without access to care, food, shelter, good hygiene and sufficient clean water gets measles there is a 40% chance they will die. Their immune systems cannot cope with measles.

Global Health Strives to improve the health of vulnerable

populations and those who need help most

Poverty impacts Health more powerfully than anything else. Alleviation of dire poverty is the cornerstone of Global Health.

Social justice is the cornerstone of poverty alleviation. Awareness and empathy is the key to social justice activism.

International: International: between or among nations

Global Global implies not only among nations but within nations (intra-national) and includes indigenous peoples, internally displaced peoples, transnational immigrants and refugees

Life Expectancy, Mortality and Morbidity• Life Expectancy: the average time a

person lives subjected to the mortality risks in the environment they live in.

• Mortality: the number of people who die of a particular cause/population

• Morbidity: the suffering, loss of productive work days and capacity, disability from a particular cause

… is the average

lifespan a newborn can expect

… is short when

child deaths are common

20 000 $2000 $200 $

Income per person (comparable dollars per year)

100

80

60

40

20

0

50 years50 years BurundiBurundi

81 years81 years

Sweden

Sweden

20 000 $2000 $200 $

Income per person (comparable dollars per year)

100

80

60

40

20

0

50 years50 years BurundiBurundi

20 000 $2000 $200 $

Income per person (comparable dollars per year)

100

80

60

40

20

0

50 years50 years BurundiBurundi

20 000 $2000 $200 $

Income per person (comparable dollars per year)

100

80

60

40

20

0

50 years50 years BurundiBurundi

Look at the expected life of five newbornBurundians…

Look at the expected life of five newbornBurundians…

100

80

60

40

20

0

SarahAnnJeanLizPierre

…if conditions remain as in Burundi in 2007during their whole lifetime?

How long will they live…

100

80

60

40

20

0

SarahAnnJeanLizPierre

8472

57

36

1

100

80

60

40

20

0

SarahAnnJeanLizPierre

8472

57

36

1

childchild

adultadult

oldold

So yes, 2 of 5get old in Burundi

So yes, 2 of 5get old in Burundi

100

80

60

40

20

0

SarahAnnJeanLizPierre

8472

57

36

1

This is the Life Expectancy

This is the Life Expectancy

50 years50 years

Calculate the mean…1+36+57+72+84

5= 50

20 000 $2000 $200 $

Income per person (comparable dollars per year)

100

80

60

40

20

0

8472

57

36

1

BurundiBurundi50 years50 years

81 years81 years

Sweden

Sweden

31 years31 years

20 000 $2000 $200 $

Income per person (comparable dollars per year)

100

80

60

40

20

0

81 years81 years

Sweden

Sweden

20 000 $2000 $200 $

Income per person (comparable dollars per year)

100

80

60

40

20

0

81 years81 years

Look at the expected life of five newbornSwedes…

Look at the expected life of five newbornSwedes…

Sweden

Sweden

100

80

60

40

20

0

SaraAntonJanLisaPer

How long will they live…

…if conditions remain as in Sweden in 2007during their whole lifetime?

100

80

60

40

20

0

93

SaraAntonJanLisaPer

6377 84 88

1 adult1 adult

4 old4 old

100

80

60

40

20

0

93

SaraAntonJanLisaPer

6377 84 88

63+77+84+88+935

=81

81 years81 years

Calculate the mean…

100

80

60

40

20

0

Sweden

Sweden

81 years81 years

20 000 $2000 $200 $

Income per person (comparable dollars per year)

Let’s compare

20 000 $2000 $200 $

Income per person (comparable dollars per year)

100

80

60

40

20

0

81 years81 years

Sweden

Sweden

50 years50 years BurundiBurundi

100

80

60

40

20

0

8181

5050

100

80

60

40

20

0But “dying young” in Sweden

is very differentfrom “dying young” in Burundi

But “dying young” in Swedenis very different

from “dying young” in Burundi

So, no,

all Burundians do not live 31

years shorter than Swedes

So, no,

all Burundians do not live 31

years shorter than Swedes

“To live long” in Swedenis almost the same as

“to live long” in Burundi

“To live long” in Swedenis almost the same as

“to live long” in Burundi

… is an average

… is low when child-deaths are common

-Most Burundians get older than 50-Some die in childhood

-It is low in Burundi not because all die a bit earlier

-But because some die much younger

Life Expectancy and Wealth

• At a certain GDP per capita (estimated at about $23,000) a rise in GDP and income per capita does not generate significantly better life expectancy

• The richest countries do have health and well-being related to GNI but to equity of resource distribution

InfectiousDiseases (malaria, HIV, TB and others)

Gender Inequality: burdens on women

Weak water Infrastructure & transportation

POVERTY

Nutrition

INEQUALITY

Genetic Inheritance

Environment:Physical & Psychosocial

Chronic Diseases(Diabetes, Heart (IHD), Strokes (CVD), BloodPressure (HTN),Obesity

Inequities between nations and within nations:Inequities between nations and within nations:• Levels of Poverty• Gender Inequality• Access to education• Water and sanitation

infrastructure • Patterns of Diseases:

AIDS, Malaria, TB, Parasitic Worms, Diarrhea, Pneumonias

What are the Millennium Development Goals?

The Millennium Development Goals (MDGs) are the most broadly supported, comprehensive and specific development goals the world has ever agreed upon.

Eight time-bound goals provide concrete, numerical benchmarks for tackling extreme poverty in its many dimensions.

Goals and targets on income poverty, hunger, maternal and child mortality, disease, inadequate shelter, gender inequality, environmental degradation and the Global Partnership for Development.

The eight MDGs break down into 21 quantifiable targets that are measured by 60 indicators.

Pangani Beach, Tanzania Jay08

Global Impact Global Impact Supports the MDGsSupports the MDGs

In Tanzania: In Tanzania:

Sustainable Agriculture, Orphan Care, Special Education For better immunity, poverty alleviation, and environmental sustainability and conservationAnd global partnership

Supporting MDGs Supporting MDGs 1, 3, 4, 5, 7, and 81, 3, 4, 5, 7, and 8

In Vietnam:In Vietnam:

Building Infrastructure, providing access to clean water, preventative dental services, access to care, and Global Partnership

Supporting MDGs Supporting MDGs 2, 4, 7 and 82, 4, 7 and 8

In Peru: In Peru:

Preventing respiratory diseases, reducing fuel consumption by installing stoves, Increasing access to clean water with water filters, access to care and preventative health services, and Global Partnership

Supporting MDGs Supporting MDGs 1, 3, 4, 5, 7, and 81, 3, 4, 5, 7, and 8

In India:

Environmentally sound infrastructure projects, reducing fecal-oral disease with sanitation and medical and dental outreach work

Supporting MDGs 1,3,4,5,7,and 8

Health is vigor, vitality, strength, fitness, well being, stamina, soundness of body and mind, and the capacity to live a full and productive life. Global Health is for everyone.

Education is the most powerful weapon which you can use to change the world. Nelson Mandela Global Impact 2011Global Impact 2011