SSCI 318 Global Health Exam 3 study guide

Question 1

What are the most important communicable diseases in terms of deaths in low- and middle-income countries? In terms of DALYs?

Answer 1

-lower respiratory infections(pneumonia)
-HIV/AIDS
-Tuberculosis

Question 2

In what regions are the deaths from HIV/AIDS the largest, as a share of total deaths? In what regions is the incidence of malaria the highest?

Answer 2

Sub-Saharan Africa for both questions

Question 3

What is driving the HIV epidemic in Russia? In sub-Saharan Africa?

Answer 3

In sub-Saharan Africa, the disease has been spread overwhelmingly through unprotected sex between men and women, especially among those engaging in high-risk behaviors, such as sex workers and their clients and men engaging in sex with multiple female partners. But in Russia, it has been injecting drug users who are HIV-positive and who share needles

Question 4

What groups are especially at risk for malaria? What steps would you take to try to reduce the burden of malaria?

Answer 4

-people in forested areas of Southeast Asia, people in Africa, pregnant women

-Prompt treatment of those infected, based on confirmed diagnosis
-Intermittent preventive therapy for pregnant women
-Long-lasting insecticide-treated bednets for people living in malarial zones
-Indoor residual spraying of the homes of people in malarial zones

Question 5

What are the most important steps that need to be taken to reduce the burden of TB? NEED MORE HERE

Answer 5

A vaccine for TB called Bacillus Calmette–Guérin (BCG) is a standard part of the Expanded Program of Immunization for Children. The vaccine reduces severe TB in children, but because children are not important transmitters of TB and due to variable efficacy of the vaccine in different settings, the vaccine has had little impact on the overall incidence or prevalence of TB. Rather, the control of TB depends on effective treatment of active tuberculosis.
Treating active drug-susceptible TB through an organized quality-assured care program is highly cost-effective, with fairly recent studies showing the cost ranging from $5 to $50 per DALY averted in most regions. The cost of treating a TB case, in fact, is below $200 in several countries. BCG is cost-effective in reducing severe cases of childhood TB in high-prevalence settings

Question 6

If relatively few people die as a direct result of parasitic diseases, why are they so important?

Answer 6

They cause a great amount of disability to individuals which can led to an inability to go to work, school, etc. and a diminished quality of life.

Question 7

What are the concerns about drug resistance for malaria and TB? How can resistance be kept to a minimum?

Answer 7

There is a concern that current medicine will no longer work and we will be back to square 1 with treatment of these diseases. By taking the entire course of treatment and ensuring accurate diagnosis, resistance can be minimized.

Question 8

Why is it important to develop a vaccine for HIV?

Answer 8

There are still more than a million new infections every year, until a vaccine can be found there is little hope for totally preventing the spreading of the virus.

Question 9

What are the drivers of antimicrobial resistance? What measures could a country take to try to reduce the development of resistance?

Answer 9

-people not completing their treatments
-Use directly observed therapy, short course, better quality of antibiotics, better use of antibiotics

Question 10

How important are noncommunicable diseases to the global burden of disease?

Answer 10

The burden of non-communicable diseases is larger than that of communicable diseases in every part of the world, with the exception of sub-Saharan Africa.

Question 11

Why are noncommunicable diseases less important to the burden of disease in sub-Saharan Africa than in other regions?

Answer 11

The burden of communicable diseases is larger than that of noncommunicable diseases in sub-Saharan Africa. However, experts suggest that the burden of both communicable and non-communicable diseases will equal out by 2020.

Question 12

What are the leading risk factors for cardiovascular disease?

Answer 12

unmodifiable (cannot be changed): men are more at risk than premenopausal women; family medical history; ethnicity; age
modifiable (can be changed): hypertension, tobacco use, cholesterol, obesity-> diabetes, which doubles your risk of CVD, excessive use of alcohol
social factors: poverty, stress, depression, isolation

Question 13

What are the most important cancers that affect low-income countries?

Answer 13

Breast cancer is the leading cause of cancer death in low- and middle- income countries. Lung is the most prevalent cancer in less-developed countries, followed by breast, stomach, and liver

Question 14

What are the most important risk factors for cancers?

Answer 14

environmental factors and standard of living; reproductive, dietary, and hormonal risk factors associated with the lifestyles of high-income countries; alcohol, tobacco, obesity, and low physical activity; risk increases with age

Question 15

What factors are causing the epidemic of diabetes that is occurring worldwide?

Answer 15

the rise of obesity; poor diets; low amounts of physical activity.

type 1 diabetes is associated with a family history of diabetes. In addition, environmental factors, increased weight and height development, increased maternal age at birth, and exposure to some viral infections have also been linked to developing type 1 diabetes. Type 2 diabetes is also associated with a family history of diabetes. In addition, it is associated with diet and physical inactivity, obesity, insulin resistance, ancestry, and increasing age. In high-income countries, less-educated and lower-income individuals have higher rates of diabetes than better-educated and wealthier people.

Question 16

Why are mental disorders so important to the burden of disease?

Answer 16

Together, mental and behavioral disorders cause about 7.4 percent of all DALYs in low- and middle-income countries in 2010; mental disorders often go undiagnosed and untreated.

Question 17

What measures have proven effective in reducing the use of tobacco?

Answer 17

nstituting a “sin tax” on cigarettes; banning tobacco advertising; counseling for teens; medications that help with quitting the addiction

■ Monitor tobacco use and prevention policies

■ Protect people from tobacco smoke

■ Offer help to quit tobacco use

■ Warn about the dangers of tobacco use

■ Enforce bans on tobacco advertising, promotion, and sponsorship

■ Raise taxes on tobacco

Question 18

What evidence is developing about community-based mental health programs?

Answer 18

Moreover, a significant amount of the mental health care in low- and middle-income countries is offered in large psychiatric hospitals that consume an overwhelming share of the mental health budget in those countries. Yet, a range of mental disorders can be prevented and treated effectively outside such settings. In fact, the evidence is growing that for $3 to $4 per person per year, countries could provide more community-based approaches to care that would offer drug therapy combined with psychosocial support for bipolar disorder, depression, and schizophrenia, as well as drug therapy for panic disorder.
In this light, and with increasing attention to mental disorders, in 2013 WHO published the Mental Health Action Plan, 2013–2020.66 This plan takes a comprehensive view of both needed actions and the various actors who must be involved in improving action on mental disorders, from stakeholders to government to the global community. Some of the key recommended actions in the plan are noted here:

Question 19

What measures have been effective in reducing the abuse of alcohol?

Answer 19

policy and legislative actions; drunk driving laws; controlled advertising; tightened law enforcement

Question 20

How important are injuries to the global burden of disease

Answer 20

Injuries are exceptionally important and are among the leading causes of deaths and disability-adjusted life years (DALYs) worldwide. In 2016, about 8.4 percent of total deaths worldwide, equal to about 4.6 million deaths, were due to injuries. This is fewer than the number who died of ischemic heart disease or stroke that year. However, it is more than the number of people who died of chronic obstructive pulmonary disease or lower respiratory infections in 2016.

Question 21

What injuries cause the most deaths?

Answer 21

road traffic injuries or accidents the most, drowning, poisoning, and fires

Question 22

How does the rate of death from road traffic accidents vary by region, and why?

Answer 22

Because of differences in driver training, the way roads are engineered and maintained, and car safety. High rate of death in Middle East and North Africa where there is no a lot of attention on driver education, road engineering, car safety, or low emergency medical services

Question 23

What are the most important injuries that affect children?

Answer 23

Drowning, poisoning, car crashes, and fires. exposure to unsafe workplaces.

Question 24

Do men and women suffer from injuries at the same rates? Why or why not?

Answer 24

Men have higher rate that comes from drowning, falling, being poisoned, road traffic accidents, and other injuries. Only women have the most rates for fire.This could be due to men having more dangerous jobs, such as driving trucks for long hours or being engaging is high risk behaviors such as drinking and driving.

Question 25

What are the risk factors for road traffic accidents?

Answer 25

increase in use of motor vehicles; more use of two-wheeled vehicles; insufficient attention is paid to the design, planning, engineering, signage, or traffic management for roads; laidback approach to speed limit enforcement; use of unsafe vehicles (no safety belts, airbags, and lack of knowledge about infant carseat); laidback approach to use of motorcycle helmets

Question 26

What are the risk factors for drownings?

Answer 26

young children are most likely to drown; males are more likely; occur during normal activities that are near water; in high-income it is associated with recreational activities; assumed that poor children and those from larger families are most likely to drown

Question 27

What are the key risk factors for burning, and how do they vary by region?

Answer 27

low income, poor housing, living in a crowded home. People in rural areas have a higher rate. In South Asia and China, women have a higher rate of getting burned than men

Question 28

What is Haddon’s matrix, and how would you apply it to analyze accidents?

Answer 28

Measures to prevent unintentional injuries have usually focused on education, enforcement, and engineering in the context of Haddon’s matrix.

It is a model that can be used to analyze accidents. It takes into accident three factors- the host, the vector, and the environment. How do these interact with one another leading up to, during, and after the collision?
Host= driver and their behavior
Vector= the vehicle
Environment = the road

Question 29

What are the most cost-effective steps that low- and middle-income countries can take to reduce the burden of road traffic accidents on health?

Answer 29

Introduce a helmet law for people that will be riding motorcycles.

There is increasing evidence from a range of countries of measures that can be taken to improve vehicle operator safety, build safety into vehicles, make plans for land use and traffic, and enforce key traffic rules. These measures can be implemented in a phased manner in low- and middle-income countries and adapted to local settings. Reducing the burden of road traffic injuries and other injuries will require enhancing community-based approaches to providing information about how the community can reduce risk factors for such injuries.

Question 30

How does the annual burden of disease from natural disasters and complex humanitarian emergencies compare with other causes of illness, death, and disability?

Answer 30

can lead to increased death, illness, and disability which then leads to a very large economic cost. Burden of disease can also spread very quickly or instantly without warning which is seen with earthquakes or tsunamis.

Question 31

What is a disaster? A natural disaster? A complex humanitarian emergency?

Answer 31

Disaster= an occurrence that causes damage, destruction, death, or a combo that causes issues to maintain health of people that responses from outside communities are needed

Natural disaster= occurs as a result of the natural environment. Ex: floods, volcanoes, and earthquakes

Complex Humanitarian Emergency= when multi-dimensional risks or threats to regional or international security happens as a result of complex, multi-party, or intra-state conflict. Result of lawlessness, chaos, and conflict. Result of any of these can be food shortages, civil strife, and population displacement

Question 32

What is an internally displaced person? A refugee? An asylum-seeker? What are the differences between them?

Answer 32

Internally displaced person= one who flees or is forced to leave their home when a disaster or war occurs, but then end up staying in the country in which they currently live

Refugee= outside their country of nationality or habitual residence, has a fear of being discriminated against because of their race, religion, nationality, or membership in certain social groups, or is unable to gain benefit from the protection of their country, or return there because of the fear of maltreatment

IDP does not leave the country. IDP can return home. Government is responsible for refugees no one is responsible for IDPs

Question 33

What countries in sub-Saharan Africa have been the largest sources of displaced people? What countries in sub-Saharan Africa have received the largest numbers of refugees?

Answer 33

The largest number of refugees Guinea, Kenya, Tanzania, Uganda, and Zambia.

Question 34

What countries in Asia or the Middle East have been the largest sources of displaced people? What countries in Asia or the Middle East have received the largest numbers of refugees?

Answer 34

Afghanistan, Syria, Yemen, Rwanda, Somalia. Countries that receive most refugees Turkey, Lebanon, Jordan.

Question 35

In the early stages of a complex humanitarian emergency, what are likely to be the most significant health concerns for the refugees? How do those health concerns change over time? Who are the most affected by malnutrition, measles, pneumonia, and cholera?

Answer 35

Early stages are diarrheal diseases, respiratory infections, measles, or malaria. Most common cause of death in refugee camps are diarrheal diseases

Concerns change as country politics change. Overcrowding could result in cholera. Diseases can spread fast since not everyone is vaccinated. Conditions can get worse or better over time depending on the governance

Women, children, elderly are most affected by malnutrition, measles, pneumonia, and cholera. Children who are not vaccinated against measles and are deficient in vitamin A are very vulnerable

Question 36

In what ways are women especially vulnerable during complex humanitarian emergencies? What problems do they face as a consequence of these vulnerabilities?

Answer 36

At risk of sexual violence. Rape and trading sex for food or money is very common. Young women are very vulnerable to rape

Question 37

What are key steps that need to be taken within the first few days of people fleeing to a refugee camp? How do those concerns change over time?

Answer 37

Focus on diseases known to cause epidemics. Vaccinate. People need to maintain their environment and personal hygiene. Toilet segregated by gender for every 200 people. Temporary shelter

Moving towards more appropriate ways to maintain hygiene, control diseases, keep people well nourished, and allow for proper shelter. More structurally sound shelters. Also moving towards toilets for a smaller number of people. One toilet for every 20 people

Question 38

How can one try to ensure that relief agencies work together around a common framework and that they focus on the most cost-effective activities?

Answer 38

Requires a set of common standards and protocols to be followed in responses. Organizations need to do so as well. Also train their staff to work with procedures and work closely with communities.
Cluster approach!!!

Focus on urgent needs

Question 39

What are the most important organizations that work on global health issues?

Answer 39

World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the United Nations Development Programme (UNDP). This section examines the three UN agencies most involved in health: the World Health Organization, the United Nations Children’s Fund, and UNAIDS.

Question 40

What functions do these organizations play?

Answer 40

They could, for example, participate in generating and sharing knowledge. They could engage in advocacy. They might be involved in the setting of technical standards or the provision of technical assistance. In addition, they might provide financing for health efforts. Generally, these organizations work along a continuum, engaging in one or more of the listed activities, but often specializing in only a few of them.

Question 41

Why is it important that different actors cooperate to address global health concerns?

Answer 41

Another important reason for cooperation to achieve global health aims is the fact that many aspects of global health are global public goods. In the simplest terms, a global public good is a good that benefits everyone, such as clean air or the eradication of polio. WHO described global public goods in economic terms:

Question 42

Name some of the most important successes of cooperative action on global health.

Answer 42

Perhaps the greatest single effort at global cooperation in health began in 1966 with the start of the global program to eradicate smallpox. During this period of intensive attention to specific diseases, WHO also led work to combat malaria and other communicable diseases of special importance for the poor, such as leprosy,lymphatic filariasis, and onchocerciasis.

Question 43

What are some of the future challenges that demand continued or strengthened collaboration in global public health?

Answer 43

There are a number of challenges to effective collaborative action in global health. First, the types of health conditions that the world faces are evolving, with an increasing burden of noncommunicable diseases, even in low- and middle-income countries. Second, there have been and will continue to be emerging and re-emerging infectious diseases that could challenge the ability of both countries and the global community to respond effectively, as Ebola virus has done in 2014, 2015, and 2018. The global community needs to align its assistance with changing burdens of disease and has to be ready, through collaborative efforts, to carry out surveillance, prevention, and treatment of any diseases that emerge or re-emerge.

Question 44

What is a public–private partnership for health, and why might it be valuable?

Answer 44

The TB Alliance is a not-for-profit product development partnership among governments, nongovernmental organizations, professional organizations, academia, foundations, and pharmaceutical and biotechnology companies that have pledged to work together to accomplish this mission. The TB Alliance comprises the largest effort in history for TB drug development, and the partnership has led to the largest portfolio of TB drug candidates to date.98 The TB Alliance is funded by governments, government-supported research bodies, and the Bill & Melinda Gates Foundation

Question 45

Why is cooperative action needed to address problems like onchocerciasis and Guinea worm?

Answer 45

Success in controlling onchocerciasis could not have been attained without a genuinely shared vision among all partners in the program. Commitment among the African governments was critical to coordinating a regional effort across national borders. Long-term commitments from donors, along with Merck’s decision to donate ivermectin indefinitely, were essential elements for the program’s sustainability. The participation of a wide range of organizations, such as multilateral institutions, private companies, and local NGOs, allowed for a cost-effective and efficient intervention. The ComDT framework, by emphasizing local ownership and participation, proved a cost-effective and self-sustaining means of delivering drugs to remote populations. The onchocerciasis program proved that effective aid programs, implemented with transparency and accountability, can deliver lasting results.

Question 46

What are some of the ideal properties that diagnostics, vaccines, and drugs should have to be most appropriate to the health and health system needs of low- and middle-income countries?

Answer 46

For diagnostics they must be affordable, specific and sensitive. They must also provide quick and easy to interpret results and they must be easy to store and transport. Additionally, they must be heat stable.

Question 47

To what extent do some of the available vaccines for the six basic antigens and the vaccination schedule for them meet the ideal?

Answer 47

Many countries would require six contacts with the health systems to get all of those vaccines.

Question 48

What health conditions and risk factors deserve additional attention from science and technology? Why have you chosen those conditions and risk factors?

Answer 48

I believe that controlling insect vectors would greatly benefit from additional attention in science and technology. There are many diseases that are transmitted by insects and many low income countries are suffering. Countries most develop a chemical strategy to deplete or incapacitate a disease-transmitting insect population.

Question 49

What are some of the specific gaps in diagnostics, drugs, vaccines, and other medical equipment that could most improve global health if filled?

Answer 49

• creating new vaccines,
• controlling insect vectors
• improve nutrition
• limit drug resistance
• cure infection
• measure health status

Question 50

What have been some of the major constraints to the development of drugs and vaccines that could better meet health needs in low- and middle-income countries?

Answer 50

Unfortunately, the needed advances are unlikely to come about on their own. This is largely a reflection of the fact that the for-profit sector has been a major developer of vaccines and drugs. They don’t believe that the market for these products is sufficient to give it an adequate return on its investment. The public sector is risk averse and prefers to purchase a product developed done by private sector than develop these products itself. There has been very small number of drugs developed. Vaccine development is constrained by the need for substantial investment, small number of producers and divergence of vaccines used in high income and low and middle income countries.

Question 51

What steps can be taken to overcome those constraints? What are the roles in this of publicly supported research? What are the roles of public–private partnerships for health?

Answer 51

Some of these can be push mechanisms that can lower the cost of research and development. For example, direct financing by government of research, the facilitation of clinical trials, or governments offering tax credits for research. Or they could do pull mechanisms, which are intended to help assure satisfactory return to investors. These could include funding mechanisms to increase the uptake of existing vaccines, prizes, patents, copayments, market assurances, and tax credits for vaccines. Government can motivate for profit companies.

Question 52

Why has only 10 percent of all research expenditure worldwide focused on the diseases that most affect the poor in low- and middle-income countries? What is the 10/90 research gap?

Answer 52

Most research is done by for profit companies. In low income countries companies see a small market for this. Additionally, they doubt that governments and individuals in low income countries will be able to pay prices that would give them a sufficient return on their capital.

Question 53

What push and pull mechanisms could most help to encourage the development of new diagnostics, drugs, and vaccines?

Answer 53

Push mechanisms: - Direct financing: Government financing or carrying out of research activities needed to develop a product
- Performing or facilitating clinical trials: This could include government measures to make it easier to carry out clinical trials for the product and to help with the ethical issues involved in such trials.
- Tax credits for research and development: Governments can lower the cost to firms of research and development by giving them credits against their taxes for certain investments

Pull mechanisms: - Increasing the uptake of existing vaccines: Using public funds to increase the vaccines that have not been taken up sufficiently, such as the vaccines for HIB and hepatitis B.
- Prizes: Offering monetary rewards to those firms that develop desired products.
- Transferable patents: In exchange for the development of the desired product, providing the manufactures with the right to extend a patent on another one of their products or patents in market in high-income countries
- Copayments: Governments can provide the manufacturer with a payment for every product sold
- Market assurances: The public sector can promise to buy the products if they are produced
- Tax credits for vaccine sales: Governments can offer tax credits for products that are sold.

Question 54

What lessons does the case study on Xpert suggest for the discovery of diagnostics, drugs, and vaccines?

Answer 54

The development of the Xpert MTB/RIF test owes its success to collaboration across disciplines and organizations. Researchers developed a working technology to improve the efficiency of a common laboratory technique, and a team at the University of Medicine and Dentistry of New Jersey applied the technology to analyze TB in sputum samples.45 FIND aided in negotiations between funding organizations and Cepheid Inc. to reduce the price per cartridge for resource-poor countries. By bringing advanced diagnostics at reduced costs to resource-poor settings, Xpert should improve care for TB patients throughout the world. In addition, this important development has set a foundation for additional efforts in the search for better TB diagnostics