Exam 2 Flashcards
(156 cards)
1
Q
What is hunger
A
Scientific food deprivation (absense of food)
2
Q
What is malnutrition
A
Deficiencies, excesses, or imbalances in macro/micro-nutrients
3
Q
How are poverty and food insecurity related
A
Poverty is a cause of hunger and lack of adequate and proper nutrition is an underylying cause of poverty
4
Q
What are 3 overlapping global crises with global hunger
A
Conflict (e.g. war in Ukraine), climate change, and economic effects of COVID-19 pandemic
5
Q
What are 5 underlying factors of global hunger
A
Poverty, inequality, poor infrastructure, low state capacity, and low agricultural productivity
6
Q
Where is global hunger most prevalent
A
In subsaharan Africa, India, Yemen, etc.
7
Q
What is food availability
A
The physical presense of sufficient quality food at global, national, regional, and local levels
8
Q
What is food access
A
A combination of economic resources, physical access, and socio-cultural factors with preferences shaped by cultural, religious, and personal factors
9
Q
What is food utilization
A
How the body uses nutrients from food, emphasizing proper food preparation, hygiene, diverse diets, and intra-household food distribution
10
Q
What is stability of food security
A
The consistent availability, access, and utilization of food over time
11
Q
What are the 4 dimensions of food security
A
Food availability, food access, food utilization, and stability of food security
12
Q
What are 3 ways climate change affects food availability
A
Decreases crop yields (6% for every 1 C increase), reduces productivity of rain-fed agriculture due to droughts/floods, and decreases fish stocks
13
Q
What are 3 ways climate change affects stability of food supplies
A
Natural disasters, pest and disease outbreaks, and seasonal variability
14
Q
What are 4 ways climate change affects access to food
A
Economic access: Price of food and loss of livelihoods
Physical access: Infrastructure damage and climate-induced displacement
15
Q
What are 4 ways climate change affects food utilization
A
Nutritional quality: Decreased nutritional content and seasonal variability/shifts in diets (from traditional to processed)
Water & Sanitation: Water scarcity and spread of waterborne diseases due to flooding/droughts
16
Q
What is Forecast based Financing (FbF)
A
An anticipatory mechanism to enable access to funding before a disaster occurs using impact based forecasts (predictions)
17
Q
What is Famine Early Warning Systems Network (FEWSNET) and what 7 indicators does it use
A
A way to forecast food insecurity looking at crude mortality rate, malnutrition prevalence, food access/availability, dietary diversity, water access/availability, coping strategies, ad livelihood assets
18
Q
What are experiential indicators
A
How you feel about your status
19
Q
What are the 3 ways to measure experiential indicators of food insecurity
A
Food Consumption Score (FCS), Coping Strategy Index (CSI), and Household Food Insecurity Access Scale (HFIAS)
20
Q
What 2 programs developed the Coping Strategy Index (CSI)
A
World Food Program (WFP) and CARE
21
Q
What does the CSI do
A
Assess the frequency and severity of different types of coping strategies in response to food insecurity experiences (higher scores indicate greater food insecurity)
22
Q
What 3 things does the CSI help with
A
Measures and monitors impact of food assistance programs, acts as early warning indicator of impending food crises, and identifies areas/pops. with greatest needs
23
Q
What are the 2 types of CSI
A
Country-specific (for more severe coping behaviors based on context-specific strategies and context-specific severity scores) and reduced (measures several common, less severe coping behaviors to allow comparison among areas and countries)
24
Q
What is Food Consumption Score (FCS)
A
Proxy indicator for current HH food utilization
25
What 3 things is FCS based on
Dietary diversity, food frequency, and nutritional importance
26
What is dietary diversity
The number of individual foods consumed over a reference period
27
What is food frequency
Number of days (in the past week) that a specific food item has been consumed (e.g. how often you're eating)
28
What is nutritional importance
Food groups are weighted to reflect their nutritional importance
29
What are the 3 consumption groups in the FCS
Poor (0-21), borderline (21.5-35), and acceptable (>35)
30
What does the HFIAS measure
What people do when they can't access enough food (9 qs about feelings of uncertainty or anxiety related to food supply)
31
What are critiques of HFIAS
It is subjective and not applicable across cultures
32
What are the 3 nutritional indicators
Acute malnutrition (wasting), chronic malnutrition (stunting), and underweight (wasting and stunting)
33
Nutritional status is usually measured for which populations for WHO
Children < 5
34
What is wasting and how is it calculated
Thinness measured by weight for height
35
What is stunting and how is it measured
Shortness measured by height for age
36
What is mid-upper arm circumference (MUAC) used for
Provides assessment of chronic nutritional status over time by comparing to standard
Underweight is MUAC <12.5 in children and <22.5 in women
37
What are 4 measurement limitations of the MUAC
Inaccurate representation (researcher didn't understand something), under coverage bias (overlooked populations), differing growth trajectories, and standardization (western-centric)
38
What 2 main institutions were established during the Bretton Woods Agreement post-WWII
World Bank (led by US) and International Monetary Fund (IMF)
39
What was the World Banks Mission
To "end extreme poverty and promote shared prosperity in a sustainable way"
1970s: Focused aid on education and health
1980s/1990s: Helped change dialogue from health as a human right to cost effectiveness
40
How did the World Bank go about accomplishing it's mission
Mainly providing loans to low-middle income countries
41
What are 2 critiques of the World Bank
Governed by wealthiest countries (represents their interests) and structural adjustment programs (loans w/stipulations) often negatively impacted already struggling countries/regions
42
What did the World Health Organization (WHO) develop out of
Pan American Health Organization (PAHO)
43
What is WHO's mission
"The attainment by all people of the highest possible level of health"
44
Does WHO provide health services
Not usually, but they develop guidelines, convene experts, and provide technical expertise (find people who will help)
44
How did WHO use to be funded vs now
Member states would vote in World Health Assembly (1 country, 1 vote) but now funded by dues from member states and private donations
45
What are 2 critiques of WHO
Inflexible to local circumstances (assume they know best) and voluntary donors now decide financial priorities more than assembly
46
How has WHOs approach to healthcare changed over time
Historically vertical initiatives, then Primary Health Care after the Alma Ata, then Selective Primary Health Care after Bellagio
47
What are the 4 characteristics of Primary Health Care
Access to basic care, equitable distribution of resources, local participation, and achieve a level of health that enables productive lives
--> Epitomizes a "horizontal approach"
48
What was the bedrock of horizontal approaches to healthcare
Community Health Workers (CHWs)
49
What are the 4 characteristics of vertical programs
Often disease-specific, cure-focused, driven by donors/outsiders, and not sustainable w/o continued funding
50
What are the 4 characteristics of horizontal programs
Focus on a range of issues (not 1 disease), prevention-focused, driven by affected community, and integrate into the health system to aid sustainability
51
Who was invited to the Alma-Ata Conference
All UN member countries
52
What did the Alma-Ata do
Identified primary health care as the key to attainment of the goal of health for all
53
What was the declaration of the Alma-Ata (5 parts)
Said health was a human right, support basic needs of entire population, emphasized CHWs, included community into program design, and wanted to attain health for all by 2000
54
What were 3 problems with the Alma Ata
No mechanism identified to fund the plan, no plan on how to accomplish the goals, and signing on just meant a country supported the ideas but didn't necessitate action
55
What happened at the Bellagio conference
1 yr after Alma Ata, selective primary healthcare was introduced as an interim strategy
56
Who attended the Bellagio conference
Just the wealthiest countries
57
What is another name for the Bellagio conference
The Rockefeller Foundation Conference on Health and Population Development
58
What does selective primary health care (SPHC) focus on
Prevention or treatment of the few diseases which cause the most mortality and morbidity + which have effective interventions
59
What does SPHC target
Kids under 5, pregnant people, and birth control
60
What is a pro of SPHC
It has specific, measurable goals (makes easier to fund)
61
What is a con of SPHC
It is not a plan to meet health care needs of whole populations and it may not address the main concerns of local communities bc/of top-down approach
62
What is neoliberalism
An economic and political theory that emphasized free marked rather than government involvement + thus saw health as a commodity (instead of health as a human right in Alma Ata)
63
Who were the main players in neoliberalism movements
Reagan and Thatcher in 1980s who then appointed IMF and World Bank directors with these ideations
64
How did World Bank policy change under neoliberal influence
Emphasis on private sector and fees for service (meaning people had to pay to use healthcare systems)
65
What 3 things did the World Bank use to rationalize their neoliberal policies
They said it generated money for health services, reduced "overconsumption" of health services, and subsidized rural health care with money collected from urban fees
66
What were 3 results of the World Bank's neoliberal policies
Under-consumption of health services, little revenue (only 5% operating costs recouped through user fees), and didn't really strengthen public delivery of health services
67
What are structural adjustment programs (SAPs)
New, stricter conditions for loans to developing countries (typically countries who had just gained independence)
68
What are 2 critiques of SAPs
Keeps countries impoverished and in a cycle of debt and benefits multinational corporations at the expense of the poor
69
What does UNICEF stand for
United Nations International Children's Emergency Fund
70
How was UNICEF funded
Via government contributions and fundraising
71
What 4 things did the 1987 UNICEF report do
Documented how SAPs undermined health in many contexts, countries paying off debt meant less for education and health services, focused on how large-scale health projects can improve health, but didn't fully critique neoliberal economic thinking
72
What is UNICEFs mission
To provide humanitarian and development assistance to children
73
What 6 things does UNICEF do
Provide immunizations and disease prevention, administer treatment for children and moms with HIV, enhance childhood and maternal nutrition, improve sanitation, promote education, and provide emergency relief in response to disasters
74
What was UNICEF's SPHC strategy
GOBI-FFF
75
What does GOBI-FFF stand for
G: Growth monitoring
O: Oral rehydration therapy (ORT)
B: Breastfeeding
I: Immunizations
F: Food supplementation
F: Female literacy
F: Family planning
76
What were the 2 main focuses of GOBI-FFF
Oral rehydration therapy and immunizations
77
What are 3 strengths of UNICEF
Immunization successes with many global health actors involved, involved in working to get 'days of tranquility', and GOBI-FFF met many of its targets
78
What are 4 critiques of UNICEF
GOBI-FFF didn't do much for primary health for all, focused mainly on O and I at expense of other interventions, faltered after Grant died in 1995, and acted as band-aids for global health rather than sustainable solutions
79
What did the World Bank look like in the 1990s
More directly involved in global health, 1993 World Development Report, and SAPS continued
80
What did the 1993 World Development Report do
Promoted cost-effectiveness to set global health priorities and started Global Burden of Disease (DALYs)
81
What are the 4 biggest current players in global health based on resources
Classic: WHO and World Bank
Newer: The Global Fund and Gavi (vaccine alliance)
82
What are the 3 main sources financing global health actors
USA, UK, and Bill and Melinda Gates Foundation
83
What are 4 impacts of changes to how DAH is financed
1.) Consolidation of influence (Powerful donors impose priorities on low-income countries)
2.) More discretionary funding (less long-term)
3.) More multi-stakeholder governance
4.) Towards narrower mandates/problem-focused vertical initiatives
84
What 3 diseases does the Global Fund focus on
AIDS, TB, and Malaria
85
What kind of initiatives are the Global Fund, Gavi, and the Gates Foundation involved with
Vertical initiatives
86
What are 6 characteristics of NGOs
Private (nongovernmental), voluntary citizen's group organized on local, national, or international levels, uncoerced collective action, shared interests, purposes, and values, not for profit, and bring local community concerns to govt. to spark change
87
What are 3 main advantages to NGOs
They are seen as an alternative to government, vehicles of democratization, and in absence of the state, they can fill a political vacuum
88
What are 6 smaller advantages of NGOs
Innovative, more cost-effective in service delivery, more able to target impoverished and vulnerable, better to develop community-based institutions, better able to promote popular participation, and can correct failures of govt.s and states
89
What are 5 critiques of NGOs
Dependent on donor money (often tied to policies of donor states abroad), not really democratic (top-down), not really innovative (often recycle ideas from other donors), can't say whether it's cost-effective, and doesn't always reach impoverished individuals
90
What is the International Committee of the Red Cross and Red Crescent (ICRC)
An independent, neutral organization that ensures humanitarian protection and assistance for victims of armed conflict and other situations of violence
91
What is a defining characteristic of the ICRC
Strict doctrine of neutrality and discretion
92
What is Medecins Sans Frontiers (MSF) / Doctors Without Borders
An organization combining local journalists and doctors who focus on medical care (and broader health efforts) in response to war/conflict, natural disasters, outbreaks and epidemics, and refugees and internally displaced people
93
How does MSF approach neutrality
They balance operational neutrality with a willingness to speak out
94
What are 4 things MSF and Red Cross have in common
They both emerged in response to conflict, respond to suffering through a health framework, provide health care and humanitarian aid during conflict, and work together despite differences
95
How do MSF and Red Cross differ
On principals of neutrality, confidentiality, impartiality, and independence (MSF goes as soon as possible even if illegal, while ICRC works with legal authorities)
96
What is the purpose of the global development goals
8 time-bound targets to reduce extreme poverty by 2015
97
What did the global (millennium) development goals focus on
Achievable, sustainable, and multisectoral action and development
98
What did the final MDG report find
That the 15-year effort of millennium development goals had produced the most successful anti-poverty movement in history
99
What are the sustainable development goals
17 practical strategies to combat extreme poverty
100
What 4 crises threaten SDG progress
Climate crises, gloomy outlook, COVID, and governmental
101
Where have the SDGs made progress
Access to electricity and internet, treatment for HIV/AIDS, and under-5 mortality
102
What are 4 benefits of vertical health programs
Minimize or eliminate threat of disease in a given population, can lead to benefits of other health outcomes (co-morbidities), can improve heath infrastructure, and often easier to fund
103
What is herd immunity
When very few people are able to carry a disease, the virus can't find a host and therefore can't spread in that population
104
What is r naught
As estimate of how many people an infected person will get sick
105
What is the expanded programme on immunization (EPI) called today
The essential programme on immunization
106
What is the primary goal of the EPI
To immunize all children < 5 by 1990 to 6 vaccine-preventable diseases
107
What was the secondary goal of the EPI
To promote countries delivering immunizations themselves withing their own comprehensive health services to strengthen overall infrastructure
108
Is the EPI vertical or horizontal
Diagonal
109
What is misinformation
False information shared by people who didn't intend to mislead others
110
What is disinformation
False information deliberately created and disseminated with malicious intent
111
What is an eradication campaign
Permanent reduction of a disease through deliberate measures such that interventions are no longer needed (doesn't always use vaccines)
112
What is one example of an eradication campaign without a technical fix
Guniea Worm involved mostly behavioral changes, cloth/nylon filtration, deep well digging, and some larvicide
113
What 5 characteristics made smallpox eradicable
1. Direct human-human transmisison (not zoonotic)
2. Permanent immunity from single vaccination or infection (not recurrent)
3. Short and known latency period (7-14 days)
4. Easily identifiable cases (obvious and distinctive rash)
5. Vaccine was extremely effective and didn't require a cold chain
114
What is surveillance
A system that tracks diseases in the population
115
What are the 2 surveillance methods for polio
Nationwide Acute Flaccid Paralysis (AFP) surveillance and environmental surveillance (testing sewage)
116
What is AFP surveillance
Reporting children with AFP, sending in stool samples, identifying diseases in labs, and mapping the virus to determine the origin of the virus strain
117
What are the 5 characteristics of malaria that made it an unsuccessful campaign
Transmitted via mosquitoes, recurrent, lays dormant in RBCs for a long time, can be confused with other diseases, and many preventions that are becoming less effective as mosquitoes adapt
118
How many people are symptomatic with polio
72% asymptomatic, 25% flu-like symptoms, 1% impact on brain or spinal cord (Paresthesia, Meningitis, or Paralysis of extremities)
119
What are the 5 characteristics of polio that made it a semi-successful campaign
Transmitted fecal-orally or via respiratory droplets, recurrent (20-40% also get post-polio syndrome), long latency period, hard to identify because so many asymptomatic, and vaccine needs a cold chain and often multiple doses
120
What was the eradication strategy for smallpox
Surveilling and containing while selectively vaccinating people who'd been in contact with an infected person
121
What was needed to eradicate polio in addition to surveillance
100% immunization (national immunization days, mop-up campaigns, outbreak response immunization) and political will
122
What else is needed for a successful global health campaign aside from diseases with characteristics like smallpox
Coordination among numerous organizations (government, international, and NGO) and political will
123
What were the unintended consequences of Polio Vaccines and Osama Bin Laden due to the actions of the CIA
People in Pakistan are now distrusting of community health workers and vaccines, and the Taliban has actually banned vaccinations
124
What is a potential drawback of traditional global health training in high-income countries (HICs)
Training should focus instead on low-middle income countries (LMICs) and marginalized communities of HICs
125
What is a potential benefit of traditional global health training in high-income countries (HICs)
Training in HICs then travelling to LMICs could be personally transformative and teach people about their privilege
126
What are 3 advantages of a 'glocal' health program
Addresses local health challenges, provides training and capacity building w/in HICs to foster deeper understandings of vulnerable/marginalized populations, and encourages collaboration as allies to support newcomers settlement and student's growth
127
Does a 'glocal' approach discourage students from HICs from engaging in LMICs
No
128
What is medical tourism
Short-term medical interventions in resource-poor settings led by health professionals from resource-rich settings
129
What is medical voyeurism
When medical professionals go to other countries to do short-term work, they treat the situation like a zoo (patients, conditions, way the health system functions)
130
How can student's (and staff) presence in developing countries be drains on health systems
Student's can't add anything, so rely on community support where resources are already scarce (e.g. nurses acting as translators, bringing appearance of better care, taking away from local med students, etc.)
131
What are 6 ethical issues of medical volunteering
1. Students or health professionals may misunderstand their roles and goals
2. Language and cultural barriers may interfere with respectful engagement
3. Working in resource-poor settings may raise issues that students haven't considered before and are unprepared to address (beyond qualifications)
4. Presence of volunteers can burden communities and waste resources
5. Students may participate in research w/o knowing it and w/o appropriate training
6. Risk that being in a resource-poor environment can serve to reinforce existing stereotypes
132
How can the ethical issues of medical volunteering be addressed
Understanding cultural competency, humility, learning local language, preparing students/staff, putting systems to keep people from doing work out of their scope, learn vs. help, ask what supervision is necessary, ask what resources are available, donate instead, get ethical training, build relationships w/people from local communitites
133
What is the proposed curricula to combat ethical issues of medical volunteering
Create a curricula designed by students, faculty, and staff of universities, community stakeholders, and experts in inter-cultural relationships and global health
134
How does HIV function
It attacks CD4 T cells
135
What is the difference between HIV and AIDS
HIV is the presence of Human Immunodeficiency Virus in the blood
AIDS is having 200 or fewer CD4 T cells per liter of blood or having an opportunistic infection and being HIV positive
136
What can HIV latency look like
People often get flu-like symptoms then are asymptomatic for ~8 yrs (4-20 yr avg) but ~5% stay in latency for over 20 yrs before developing weight loss and fever
137
What is ART
Antiretroviral therapy is a standard daily treatment w/ a combination of drugs that suppress HIV replication to reduce viral load to undetectable (prospect of a normal lifespan)
138
What is PrEP
Pre-exposure prophylaxis is a daily medication for people at high risk for acquiring HIV (90% effective but high stigma)
139
What is PEP
Post-exposure prophylaxis is taken ASAP after a possible exposure to HIV (w/in 72 hrs) and is 80% effective (used by medical practitioners after a needle stick, etc.)
140
Why was US initially unsupportive of generic drug use in Africa
Because they didn't care since US had access to cheap drugs and thought that African people would misuse the drugs and create a resistance that would affect them
141
Why did low-income countries back off from challenging drug patents
Bc/ US interests aligned w/drug companies and they threatened to withhold aid
142
What is a health system
All actors, institutions, and resources that undertake health actions
143
What are health actions
An action where the primary intent is to improve health
144
What are the 3 goals of a health system
To keep people healthy/prevent disease, treat people who are sick, and protect people from financial ruin due to costs of medical care
145
What are the 3 levels of health care
Primary, secondary, and tertiary
146
What does primary care deal with
1st point of contact (e.g. PCP) for illness, injury, acute medical problems, and referrals (acts as barrier to other levels of health care)
147
What does secondary care deal with
Specialists with specific expertise in health issues (e.g. simple surgeries, emergency obstetrics, allergists, etc.)
148
What does tertiary care deal with
Highly specialized equipment and expertise (e.g. cancers, complex surgeries, etc.)
149
What is the difference between primary care and primary health care
Primary care is the first level of health services, primary health care (PHC) is the goal of universal, community-based essential health services
150
What are the 4 models of health care systems
National Health Service (UK model), National Health Insurance Model (Canada, Germany), Out-of-pocket system, and pluralistic model
151
What is the National Health Service Model
Comprehensive health services to all people regardless of ability to pay (universal and considered a human right)
152
What are the strengths and weaknesses of the National Health Service Model
Universal but can take a long time (esp. for specialists)
153
Who pays for the National Health Service Model and how
Government with taxes
154
What are the 2 kinds of the National Health Insurance Model
Public (Canada) and Private (Germany)
155
What is the Public National Health Insurance Model
Universal coverage for hospital and doctor's visits (private or out-of-pocket for other visits), paid for via taxes by national government-run health insurance
