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/