Global Health and Pharmacotherapy
Lecture 1: Introduction
Three diseases are discussed in this course: hypertension, rheumatoid arthritis and pain, acute
infectious disease, and COVID-19. What is mentioned are the symptoms, clinical trials,
pharmacotherapy, guidelines, and side effects.
GLOBAL HEALTH
Global health issues concern many countries. Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity.
Global health is an area for study, research, and practice that place a priority on improving health and
achieving equity in health for all people worldwide. Global health emphasises transnational health
issues, determinants, and solutions; involve many disciplines within and beyond the health sciences
and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with
individual-level clinical care.
Different figures:
- The case fatality rate (CFR) is the number of confirmed deaths divided by the number of
confirmed cases
- The crude mortality rate: dividing the number of deaths from the disease by the total
population
- The infection fatality rate (IFR) is the number of deaths from the disease divided by the total
number of cases
The biggest threats and challenges for global health:
- COVID-19 pandemic – a global health challenge
▪ 31/12/2019: WHO informed of cases of
pneumonia of unknown microbial aetiology
associated with Wuhan City, China.
▪ Novel coronavirus detected and identified
▪ 30/01/2020: WHO declared public health
emergency
▪ 11/03/2020: Pandemic
Severe acute respiratory syndrome coronavirus 2 (SARS-
CoV-2) causing coronavirus disease 19 (COVID-19). It is an
RNA-virus coming from the SARS-family.
▪ Respiratory infections
▪ Symptoms ranging
from mild common
cold-like illness to
severe viral pneumonia
with potentially fatal
acute respiratory
distress syndrome.
Characteristics are
fever, cough, and
dyspnoea.
Complications of the
, severe diseases are multi-organ failure, septic shock, and blood clots.
No drug currently proven to be effective in treating COVID-19, as well as a vaccine.
Possible impact on long term:
▪ Changes in supply chains for pharmaceuticals and equipment
▪ More investments in infectious disease prevention, treatment, and preparedness
▪ Increase in inequities: poor and disadvantaged affected much more by crisis and
consequences.
- Air pollution and climate change
▪ Problem: microscopic pollutant enter respiratory and circulatory systems and damage
in the lungs, heart and brain causing/contributing to diseases such as cancer, stroke,
heart and lung diseases
▪ Consequence: 7 million people die prematurely every year
- Fragile and vulnerable settings
▪ 22% of the global population without access to basic care because of drought, famine,
conflict, and population displacement
- Weak primary health care
- Global influenze pandemic
- Dengue
▪ Mosquito-borne disease, especially during rainy seasons fo countries such as
Bangladesh and India causes flu-like symptoms. 390 million infections a year, about
40% of the world is at risk of dengue fever up to 20% of those with severe dengue die
- HIV/AIDS
▪ Around 37 million worldwide live with HIV. 22 million are on treatment and about 1
million people die every year
- Ebola and other high-threat pathogens
▪ In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks,
both of which spread to cities of more than 1 million people
- Vaccine hestiancy
▪ 1.5 million deaths a year could be avoided
- Antimicrobial resistance
- Noncommunicable diseases
▪ Diabetes, cancer, and heart disease. These diseases are not transmitted by microbes
or other infectious agents.
Global health deaths
- Blue:
noncommunicable
diseases
- Red:
Infectious diseases
- Green:
Accidents
Most western countries
have a good access to
health care and a good
quality (the Netherlands,
USA, Australia, etc.). However, other countries have a low index and a lower access to health care
(Africa).
,WHO sustainable development goals:
1. No poverty
2. Zero hunger
3. Good health and well-being
4. Quality education
5. Gender equality
6. Clean water and
sanitation
7. Affordable and clean
energy
8. Decent work and
economic growth
9. Industry, innovation and
infrastructure
10. Reduced inequalitites
11. Sustainable cities and
communities
12. Responsible consumption and production
13. Climate action
14. Life below water
15. Life on land
16. Peace, justice and strong institutions
17. Partnerships for the goals
Targets for SDG 3 to be achieved by 2030:
- Global maternal mortality
- Preventable deaths of newborns and children (<5 years)
- AIDS, tuberculosis, malaria, neglected tropical diseases, hepatitis, water-borne diseases and
other communicable diseases
- Premature mortality from non-communicable diseases and mental health
- Substance abuse (marcotics, alcohol, etc.)
- Road traffic accidents
- Access to sexual and reproductive health-care services
- Universal health coverage
- Deaths/illnesses from hazardous chemicals and
air, water and soil pollution and contamination
- Tobacco control
- Research/development of vaccines and
medicines for diseases of developing countries
and access to affordable essential medicines
and vaccines
- Health financing and health workforce in
developiing countries
- Early warning, risk reduction and management
of national and global health risks
The COVID-19 crisis has shone a harsh spotlight on a range of development challenges, and the
choices the world makes now in its path to recovery will shape the trajectory of sustaineable
development for years to come
, Summary
- Global health strives improving health worldwide emphasizing transnational health issues
- Communicable diseases and non-communicable diseases remain a challenge
- Sustainable development goals are a call to action to end poverty, protect the planet and
ensure that all people enjoy peace and prosperity
- The global outbreak of COVID-19 will have an unprecedented – and as yet unknown – effect
on our work towards a healthier world
PHARMACOTHERAPY
The beginnings of pharmacotherapy are from
plant-origin. Drugs are small organic molecules
or large molecules, which are often proteins.
These proteins are increasingly important.
Besides the molecules, the route of
administration is important in
pharmacotherapy.
What happens to the medicine in the body is
called pharmacokinetics. This is combined in the
principles of ADME. The interrelationship of the
absorption, distribution, binding, metabolism,
and excretion of a drug and its concentration at
its site of action. Drug move across
membrane and cellular barriers in a
variety of ways. The
pharmacodynamics describe the
biochemical, cellular, and physiological
effects of drugs and their mechanisms
of action. Effects of drugs often due to
interaction with drug receptors or drug
targets. There are desirable
(therapeutic) and undesirable effects. These undesirable effects are divided into nondeleterious (side
effects) and deleterious (toxic effects). Deleterious effects can be pharmacological, pathological, and
genotoxic. Individual response to a drug depends on age, gender, pharmacogenetics, organ function,
co-morbidities and co-medication.
Drug-drug interactions may occur when
patients take more than one prescribed
drug, use over-the-counter medications,
vitamins, and other ‘natural’ supplements
in addition to prescribed medicine and
have unusual diets. A consequence is
failure of therapy and/or toxicity.
There are two mechanisms
(pharmacokinetic and pharmacodynamic)
and two classifications (additive,
synergistic, potentiation, and antagonism)
