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Future Challenges in Global health + exam
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Lecture notes of 40 pages for the course Future Challenges in Global Health at VU
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Future challenges in Global Health September 2013Objectives
• Acquire insight in current and future challenges in global health
• Understand how new developments in the health and life sciences interact with global health
problems
• Acquire insight in de different policies which have been developed at national and
international level to address global health challenges
• Obtain knowledge on how policy-making processes take place and what different visions on
policy exist
• Acquire skills on policy analysis, including problem analysis and analysis of possible
interventions;
• Gain experience in working in a team on a project addressing a real-world global health
challenge;
• Be able to apply several data collection and analytic skills, such as formulate research design,
conduct literature study, critically analyse various policy documents and scientific
publications, and justify and present findings both orally and in writing
Lecture 1 – Introduction to Future Challenges in Global Health
Global Health
• Tropical medicine → International Medicine → International (Public) Health → Global Health
Medicine individual, diagnosis & treatment
Public Health population & prevention
Poverty is the main determinant of a worse global health.
• Global health implies global interdependence for health
• A broad field that seeks to enable all disciplines to work effectively globally: to understand
and solve problems that cause greatest GH morbidity and mortality; and to reduce GH
disparities
Collective action we take worldwide for improving health and health equity, aiming to bring the
best available cost-effective and feasible interventions to all populations and selected high-risk
groups.
5 Global health Agenda’s
1. Communicable diseases agenda: HIV/AIDS, TB, malaria, STD, diarrhea, zoonoses. ‘Threat of
Pandemic’.
- Antibiotics resistance: Health council is very concerned about antibiotics and targets
livestock for action: “Verterinarians should stop prescribing certain antibiotics to
livestock. The medicines for which large-scale resistance threatens to develop should be
reserved for people.”
- Animal to human transmission: 335 newly emerging infectious diseases 1945 to 2004. Of
newly emerging pathogen, 75% are zoonotic.
2. Maternal & Child Health and Reproductive Health disparities agenda
3. Accidents, injury, violence, war agenda
4. Non-communicable disease agenda: aging, nutrition-obesity, diabetes, tobacco smoking,
cardiovascular diseases, cancer, mental illness…
5. ‘ECO-health’ Agenda
- Climate change: Changing Patterns of infectious diseases and extreme events (heat,
flood, drought)
- Food safety and security
- Water and sanitation
, - Shelter and human settlements
- Population, migration, mega cities & slums outgrowing the built environment
6. NEW: Health system challenges: clinics & hospitals, leadership & governance (stewardship),
financing, transportation to hospital, health workforce and medical products, vaccines &
technologies.
- Staff shortage: almost 4.3 million doctors, midwives, nurses and support workers
worlwide
- Underfunding of HSs in low- and middle income countries
- Rising costs of health care in high-income countries
Millennium development goals: 2000 2015 (no NCD’s, and ECO-
health).
Progress is diverse: Sub Sahara Africa remains.
A balanced Global Health Agenda
How can we promote investment in research and public health, while promoting a balanced,
sustainable global health agenda?
Gaps
- Social Justice: discrimination (indigenous people, ethnic minorities, poor people, HIV+
people, people with disabilities, migrants), gender bias.
- Responsibility: unclear accountability, lack of synergy.
- Implementation: inadequate resources, disproportionate allocation to cure and high tech in
urban settings, focus on pilot projects, negative effects of interventions.
- Knowledge: research not focused on areas of need (some diseases, prevention, ageing), how
to scale up, evidence-based policy-making.
Why some global health issues attract attention & resources (e.g., HIV/AIDS), while others (e.g.,
pneumonia, diarrhea, seasonal, influenza, malnutrition) do not?
- Framing: a “problem” claim (based on severity and neglect) a “solution” (tractability) claim
- Building “institutions” to carry the torch: e.g., UNAIDS, Global Fund, GAVI
- Improving social determinants of health requires
collaboration with other domains: e.g. economic
affairs, social affairs (gender), housing, education,
environment. In the end it is a political decision
policy making
Policy: “A purposive course of action followed by an actor or
set of actors in dealing with a problem or matter of concern.
Problem = desired situation – current situation.” Health Policy Triangle
Phases of policy making process
,Challenges
• What challenges are formulated depend on organization responsible for making the policy
WHO Bill & Melinda Gates Foundation
Investing in health to reduce poverty Improving childhood vaccines
Building individual and global health security Creating new vaccines
Promoting universal coverage, gender Controlling insects that transmit agents of
equality, and health-related human rights disease
Tackling the determinants of health Improving nutrition to promote health
Strengthening health systems and equitable Improving drug treatment of infectious
access diseases
Harnessing knowledge, science and Curing latent and chronic infections
technology
Strengthen governance, leadership and Measuring disease and health status
accountability accurately and economically in developing
countries
As you can see, the Bill & Melinda Gates Foundation pick out the Harnessing knowledge,
science and technology challenge, and specialized this to infectious diseases.
New opportunities
• Interest from academia
• New technologies
• New resources from governments and foundations
• Public-private partnerships
• Professional organizations go global
• New strategies
New Technologies
• Biotechnology
New vaccines- rotavirus, HPV
New diagnostics
- Rapid tests: malaria, syphillis
- New tests: genomics
• Information technology
- Distance learning
- Surveillance
- Telemedicine
• Generic pharmaceuticals- HIV, malaria, TB
We can make a much bigger difference if we work together, strategically and systematically, and
avoid conflict.
Problem: Difference between desired situation and current situation
Interventions: Solutions to a problem
Policy: Plan of an actor to use interventions to solve a problem
, Lecture 2 – Policy 1
Policy Triangle
The eightfold path of Collins
1. Define the context **
What is going on here?
Is the prevalence of mental illness really that high and climbing?
Or are we learning to recognize and diagnose mental disorders that were always
there?
Or are we simply expanding the criteria for mental illness so that nearly everyone has
one?
And what about the drugs that are now the mainstay of treatment? Do they work? If
they do, shouldn’t we expect this prevalence of mental illness to be declining, not
rising?
2. Define the problem ***
What is a policy problem?
a. There should be a discrepancy between the current situation and the ideal or desired
condition.
b. The reason for this difference should be unclear.
c. There should be more than one possible solution to the problem.
Define the problem
Phrase the problem “too many … too less …”
Personal problems are not relevant … think in marketing failures/system failures …
Quantify: estimate 250.000, but between 100.000 and 400.000.
Diagnose deeper causes behind the problem.
Look for opportunities, improvements.
Pitfalls in problem definition
Don’t hide the solution in the “problem”. (Begging the question/circularity)
Not: Too little shelter for homeless families
Instead: Too many families are homeless
Check the logic of deeper causes. EU legislation causes unfair treatment of farmers.
Crime might be caused by cocaine, but cocaine does not necessarily causes to crime.
(necessary and sufficient causes)
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