Important facts of the literature for the final exam
A biosocial approach to global health
● Five of the leading causes of death in low-income countries: diarrheal diseases, HIV/AIDS, tuberculosis,
neonatal infections and malaria
● AIDS is the leading infectious killer of young adults in most low-income countries
● The WHO defines health as a state of physical, mental, and social well-being
● Structural violence: beyond the direct experiences of individuals are social, political, and economic
factors that drive up the risk of ill health for some while sparing others
Action on the social determinants of health and health inequities goes global
● WHO was established in 1948
● CDSH: emphasizing the extent of health inequities between and within countries and the role of social
factors play in producing those inequities
● 1978 Alma Ata conference with the WHO and UNICEF > resulted in primary health care (PHC)
● Establishment of the Commission on Social Determinants of Health (CSDH) in 2005 reasons:
o First, the inequities in health outcomes between and among populations remain large and, in
many instances, have increased
o Second; the changed nature of the world’s health problems. A complex triple threat of CD’s
and NCD’s and accidents and injuries has arisen and increased rapidly in LMIC’s.
o Third; the conceptual understanding and global evidence base concerning health inequities
have been growing, responding to the changing health and social conditions, including the
changing global economic and political context
● CHDS aims of gathering evidence:
o Harnessing national and local efforts
o Detailing what effective social action must entail to maintain, promote and provide better
health for all
o Advocating for change
o Engaging with those responsible for health-related decision making
● Final report in 2008 by the CSDH process recommendations
o Inequities in the daily circumstances in which people are born, grow, live, work, and age
cause health inequities within and between countries
o These conditions of daily life are influenced by inequities in structural drivers, inequities in
power, money, and resources
o The need to expand the knowledge base on the social determinants of health, to evaluate the
action taken, and critically, to develop a workforce that is trained in the SDOH
● WHA resolution in May 2009 Department of Ethics, Equity, Trade and Human Rights (ETH) pursued
three domains of work
o Policy implementation
o Policy and program coherence
o Health equity analysis and research
● A number of countries have been using the CSDH report as a starting point and critically exanimating
how to achieve health equity through action on the social determinants of health in the context of
their different political and social systems
Disability in children and adolescents must be integrated into the global health agenda
● People with disability are among the worlds most marginalized and discriminated against groups
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, ● There are three good reasons why countries urgently need to tackle this
o Firstly, the number of people living with disability is set to increase dramatically because of
epidemiological and demographic trends
▪ Relatively young populations of low-income countries > increasing disability among
older people with chronic conditions rather than among children
o Secondly, children with disability often need specific rehabilitation services related to their
impairment or disability
▪ The limited evidence available shows major gaps and unmet needs for such services,
particularly in low-income countries
o Lastly, access to appropriate care is a fundamental human right
● The low priority accorded to disability is reflected in the lack of data
● The numbers of children and adolescents living with disability are increasing > these numbers are set
to escalate with demographic trends: in low-income countries particularly in sub-Saharan Africa
● Basic healthcare needs of children with disability are often not met, with a lack of access to primary
care or community services
● Rehabilitation services do not exist or are underdeveloped or under resourced. And when available,
services are often costly, not physically inclusive, or accessible only in urban areas
● Key barriers
o Limited resources
o Invisibility of children with disability is the root problem of many deficiencies
o A lack of evidence and data hinders policy making
o Lack of qualified healthcare professionals and medical equipment
o High out of pocket expenses, long waiting times, a lack of awareness about what
rehabilitation entails
o Discrimination for access to care
● Low- and middle-income countries especially need to tackle the huge unmet need for services which
will only escalate with demographic changes
● The needed shift of attitudes to move forward
o Governments need to scale up service delivery with a strong focus on primary healthcare to
widen access
o Primary care can become an essential platform and starting point for the care needed
o Rehabilitation services need to be expanded to reach all children in need, through integration
into the health system and specifically at the primary care level
Global health, sexual and reproductive health and rights, and gender: square pegs, round holes
● In SRHR the overall health and well-being objective cannot only be tangible health outcomes, but,
more significantly, also reproductive, and sexual agency and bodily autonomy
● Their purpose is to ensure that any individual has the necessary agency to determine their
reproductive decisions and sexuality, regardless of gendered norms and gender-based discrimination
● SRHR key aspects
o Interventions that affirm and support women’s sexual health, wellbeing and pleasure
o Gender transformative and gender inclusive comprehensive sexuality education
o Shifting masculinities in relation to sexuality
o Attention to the underlying gender norms sexuality and/or gender identity that underpin
gender-based violence and harmful practices
o Gender transformative and gender inclusive sexual health preventative care and treatment
o Gender-affirming care for trans and gender diverse people
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