International Health

NUR 410 Community Focused Nursing

Catherine T. Horat

Community health nursing need for knowledge

• interactions with new immigrants

• client exposure to potential health hazards

• identification of potential risks

• awareness of health concerns worldwide has impact on health

State of World Health

• Life expectancy worldwide average 65 years

• Decrease in death rates

• Decrease in infant mortality

Comparison

• Developing Countries– Life expectancy

• 1950 40 years• 1995 64 years

– Infant mortality• 1950 287/1000 live

births by time reached age 5 years

• 1995 90/1000

• More Developed Countries– Life Expectancy

• 1950 67 years• 1995 77 years

– Infant Mortality• Varies with countries

Comparison

• Hong Kong 2.97• Germany 4.2 •  Canada 4.82  • Greece 5.63 • Korea, South 7.18 • Canada 4.82  

  India 57.92     •  China 25.28 • Mexico 21.69• Jamaica 12.81• KoreaNorth24.84 • Haiti 74.38

 

Overview of international health

• Health for All by year 2000– first proclaimed 1977 at World Health

Assembly

– reinforced 1978 at International Conference on Primary Health Care• where Alma Alta Kazakhstan• sponsored by WHO, UNICEF

– major components• health education• environmental sanitation• training village health workers• maternal/infant immunization & family

planning• local preventive programs• accessible, affordable tx• medication availability• nutrition programs• acceptance of traditional medicine

Global Designations

• Developed country– stable economy– industrial – Technology

• Lesser developed country– unstable economy– little industry or technology

Major international health organizations

• Private/voluntary

• Philanthropic

• Professional and technological

• Private and commercial

• Governmental

• Intergovernmental

International health and economic development

• Divert financial resources to advance country’s market economy or develop technology

• Divert resources to develop underlying infrastructures

• Dependence on importation of drugs, vaccines, other health products

• Divert monies to military• Improvements in over all health status

contributes to its economic growth

Health care systems

• Who can utilize

• What kind of coverage

• Who provides

• Where is health care provided

• Who controls

Burden of Sickness and Disability

• Mortality figures do not capture effect

• Result from diseases that do not cause death– Loss of ability to work– Keep out of school– Slow economic and social development

The Global Burden of Disease (GBD)

• Losses from premature death

plus

• Loss of healthy lives due to disability

• Nearly 9/10s occur in developing countries where only 1/10 of global health expenditures occur

Disability-Adjusted Life YearDALY

• Combine losses from– Premature death

• (difference between the actual age of death and life expectancy at that age in a low mortality population)

– Healthy life that results from disability– Disproportionate burden on children

• Half of all DALYs worldwide

Key Elements of DALY

• Age at which disease or disability occurs

• How long effects linger

• Impact on quality of life

Effects on DALY By

• Single most important cause of ill health globally– Communicable diseases (44%)– Top 7/10 causes from communicable

diseases• Leading causes

– Lower respiratory diseases– Diarrheal

Causes of DALYs Compared with Causes of Death

• DALYs1. Lower Respiratory Diseases2. Perinatal conditions3. HIV/AIDS4. Unipolar depressive

disorders5. Diarrheal Diseases6. Ischemic heart diseases7. Cerebrovascular diseases8. Road Traffic accidents9. Malaria10. Tuberculosis

• Causes of Death1. Ischemic heart diseases2. Cerebrovascular diseases3. Lower Respiratory Diseases4. HIV/AIDS5. Chronic Obstructive Lung

Disease6. Perinatal conditions7. Diarrheal Diseases8. Tuberculosis9. Road Traffic accidents10. Trachea, bronchus, and lung

cancer

World Health Report 2001

Health Problems of Children Lesser Developed Countries

• Diarrheal disease– leading cause of death/illness children 5 and

under worldwide 2 million in developing countries – causes: nutritional deficits, viruses, bacteria,

environmental toxins and parasites, contaminated food

– Correct management save 90%

Health Problems of Children Lesser Developed Countries

• Nutrition – associated with poverty– leading nutrient deficiencies: protein, iron,

Vit. A, calcium– women and children mostly affected– Malnutrition accounted for 6.6 million

deaths of the 12.2 million deaths under-five years

– Growth stunted, poor cognitive development, neurological deficits

Adults in Developing Countries

• Diarrheal diseases

• Tuberculosis

• Malaria

• Venereal Diseases

• Respiratory Infections

• Maternal and Perinatal illness

Maternal and Perinatal Health

• Maternal and women’s health– deaths remain high– family planning– good nutrition– prenatal care– safe birthing practices

Health Problems of Affluence

• Result from chronic non-communicable diseases

• Related to lifestyle– Arthritis– Cancer– Cardiovascular disease– Diabetes– Hypertension

Changing World Scene

• Negative Influences– Tobacco Use– Alcohol Use– Intentional Violence Suicides, Homicides, Warfare– Dietary Imbalances– Physical Activity– Automobiles– Environment– Workplace Injuries