Lecture 1 – Introduction
Chapter 1
What is global health?
health problems and issues that transcend national boundaries and may be best addressed
by cooperative actions
focused on improving the health of the entire population
issues that extend beyond national borders
specific attention to social justice
much attention to low- and middle-income countries where morbidity and mortality are
high and health system functions are fragile
focused on delivering health services that are: accessible, affordable, appropriate,
acceptable and with good quality
considers the social, political, and economic forces that increases the risk of poor health
outcomes (structural violence)
acknowledges the cultural differences that lead to varying health outcomes
an interdisciplinary approach to understanding health outcomes
considers the role of international NGOs, private philanthropists, and community-based
organizations
History of Public/Global Health
, 1750 – 1850:
Industrial Revolution - bad working conditions and environmental pollution
urbanization - unhygienic living conditions in cities
epidemics - cholera, smallpox, TB, and other infectious diseases that resulted in high
infant mortality
improvement of water supply, sanitation & sewerage
start of formal public health policy
1850 – 1900:
first international meeting on public health problems in 1851 - start international
cooperation
substantial increase in knowledge about infectious diseases, including cause and
transmission
insight into possible intervention strategies
start targeted intervention programs
1900 – 1945:
substantial decrease in (child) mortality
antibiotics and medications
start of academic training in health sciences
first international organization: Health Organization of the League of Nations in
Geneva,1920
creation of charity organizations, such as Rockefeller Foundation
1945 – 1980:
establishment of UN, with WHO and UNICEF as public mandate
intervention strategies targeting:
family planning
infectious diseases – EPI (Expanded Program on Immunization)
initiated in 1974 & Smallpox eradicated (1966-1980)
PHC (Primary Health Care) strategy - Alma Ata Conference 1978
research programs on emerging diseases
1980 – 1990:
UN organizations The World Bank and IMF become important
economic crisis leads to health reforms
increasing role of NGOs in providing health services
focus on non-communicable diseases
UNICEF's campaign for child survival (GOBI FFF):
included interventions for: Growth monitoring, Oral rehydration,
Breastfeeding, Immunization
then added: sexual health (female) education, Family spacing, Food
supplements
HIV/AIDS and establishment UNAIDS
1990 – now:
focus on cost effectiveness
PPP (public-private partnership)
, attention to CBPR (Community-Based Participatory Research)
more attention to other health issues: chronic diseases, gun violence, injuries,
neglected tropical diseases and more
Sustainable development goals
Sustainable Development Goals were developed and supported by governments and the
international community
the goals apply equally to all countries
the goal is to reduce health inequalities through processes, policies, and programmes
Critical global health
determinants of health
global burden of disease
measurement of health status
importance of culture
demographic and epidemiologic transitions
organization and function of health systems
health equity and social justice
Lecture 2 – Global Burden of Disease
Chapter 3
, burden of disease – a concept that describes death and loss of health due to diseases,
injuries, and risk factors
it measures the impact of living with illness and injury and dying prematurely with
e.g., mortality and morbidity (indicators)
estimated/calculated in terms of disability- adjusted life years (DALYs) which
quantify the number of years of life lost (YLL) due to disease & premature death and
the number of years of life a person lives with disability caused by the disease (YLD)
DALY = YLL (mortality) + YLD (morbidity)
YLL – years of life lost to (early) death
YLD – years of life with disability
1 DALY = the loss of one year of healthy life due to disability or premature death
The global burden of disease study
a systematic scientific effort to quantify the comparative magnitude of health loss due to
diseases, injuries and risk factors by age, sex, and geographies for specific time points
WHO – main causes of death:
Group 1 – communicable, maternal, perinatal, and nutritional conditions (CDs)
Group 2 – non-communicable conditions (NCDs)
Group 3 – injuries, including motor vehicle accidents and homicide; mental health
problems and suicide
Communicable diseases (CDs)
a communicable disease is one that can be spread from one person to another through a
variety of ways, including:
