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Global Health Flashcards

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1
Q

What is global health

A

health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions

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2
Q

Most important risk factors in poorest countries

A
  1. Underweight
  2. Unsafe sex
  3. Unsafe water and sanitation
  4. Indoor smoke from solid fuels
  5. Zinc deficiency
  6. Iron deficiency
  7. Vitamin A deficiency
  8. High blood pressure
  9. Tobacco
  10. High cholesterol
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3
Q

Most important risk factors in developed countries

A
  1. Tobacco
  2. High blood pressure
  3. Alcohol
  4. High cholesterol
  5. High BMI
  6. Low fruit and vegetable intake
  7. Physical inactivity
  8. Illicit drugs
  9. Unsafe sex
  10. Iron deficiency
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4
Q

Millennium development goals

A

eight goals to be achieved by 2015 that respond to the world’s main development challenges

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5
Q

8 MDGs

A

Goal 1: Eradicate Extreme Poverty & Hunger
Goal 2: Achieve Universal Primary Education
Goal 3: Promote Gender Equality & Empower Women
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV/AIDS, Malaria and Other Diseases
Goal 7: Ensure Environmental Sustainability
Goal 8: Develop a Global Partnership for Development

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6
Q

Key actors in global health

A

Agencies of the United Nations
Multilateral development banks
Bilateral agencies
Foundations
Non-governmental organisations

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7
Q

Global health issues

A

Great population growth and Changes in age distribution
Low fertility in developed countries
Digital divide
International migration
Global environmental change
International political crisis
International agreements

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8
Q

What is happening to worlds fertility

A

Decreasing

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9
Q

Births per woman: less developed countries

A

Decreasing

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10
Q

Births per woman: developed countries

A

Remains stable

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11
Q

Developing countries account for what percentage of the worlds population

A

84%

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12
Q

Developing countries account for what percentage of the burden of disease

A

93%

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13
Q

Developing countries account for what percentage of the global income

A

18%

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14
Q

Developing countries account for what percentage of the global health spending

A

11%

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15
Q

Environmental changes

A

CFCs and stratospheric ozone depletion
Loss of biodiversity within ecosystems
Freshwater decline and land degradation
Loss of natural fisheries
Increasing desertification

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16
Q

Sustainability

A

Meeting the needs of today without compromising the ability of future generations to meet the needs of tomorrow

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17
Q

Possible consequences of climate change

A

Heatwaves- bacteria friendly environment
Sea levels rise
New disease
Scarcity of resources

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18
Q

Solutions to consequences of climate change

A

Control world population
Reduce energy consumption
Get energy from renewable resources

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19
Q

Key actors in global health

A

United Nations and their agencies (UNICEF/UNAIDS/WHO)
Multilateral developmental banks (world bank/Asian development bank)
Bilateral agencies (USAID/CIDA/DFID)
Private foundations
Non-governmental organisations
Global health partnerships

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20
Q

Examples of private foundations improving global health

A

Rockefeller foundation
Bill and Melinda gates foundation

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21
Q

Examples of non-governmental organisations improving global health

A

Doctors Without Borders
Save the children

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22
Q

Defining a migrant

A

Country of birth
Country of nationality
Duration of stay

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23
Q

Which countries do asylum seekers come from

A

Pakistan
Iran
Sri Lanka
Syria

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24
Q

Which countries do economic migrants come from

A

Romania
Poland
Spain
Italy
Bulgaria

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25
Examples of migrant types
Asylum seekers Refugees Trafficked people Migrant workers Family workers Family joiners International students
26
Causes of vulnerability to migrants
Persecution, war, political and social unrest Exploitation, torture, rape and bereavement Burden of disease and socioeconomic status
27
Lampedusa
Italian island Closest European territory to shores of Libya Primary transit point for immigrants from Africa Deadliest migrant torture in the world
28
3 leading causes of death in children in developing countries
Pneumonia Diarrhoea Malaria
29
Health challenges of poorest countries
Underweight Unsafe sex Unsafe water and sanitation Indoor smoke from solid fuels Zinc/iron/vitamin A deficiency High blood pressure Tobacco High cholesterol
30
Health challenges of developed countries
Tobacco High blood pressure Alcohol High cholesterol High BMI Low fruit and vegetable intake Physical inactivity Illicit drugs Unsafe sex Iron deficiency
31
Theories of causation of health inequalities:
Psychosocial Neo-material Life course Proportional universalism
32
Theories of causation of health inequalities: psychosocial
Stress results in ability to respond efficiently to body’s demands Impact on BP, cortisol levels and inflammatory and neuroendocrine markers
33
Theories of causation of health inequalities: neo-material
More hierarchical societies are less willing to invest in provision of public goods Poorer people have less material goods and of less quality
34
Theories of causation of health inequalities: life course
Combination of both psychosocial and neo-material Critical periods posses greater impact at certain points in the life course eg childhood Accumulation of hazards and their impacts add up Interactions and pathways eg sexual abuse in childhood may lead to poor partner choice in adulthood
35
Theories of causation of health inequalities: proportional universalism
Focusing on the disadvantaged only will not help to reduce inequality Action must be universal Scale intensity proportional to disadvantaged Fair distribution of wealth
36
Responses to health inequalities
Ignacz Semmelweis 1847 The block report 1980 The Acheson report 1998
37
Ignacz Semmelweis 1847
Campaigned for hand washing Found correlation between puerperal fever and dissection
38
The block report 1980
Material- environmental causes, might be mediated by behaviour Artefact- an apparent product of how the inequality is measured Cultural/behavioural -poorer people behave in unhealthy ways Selection- sick people sink socially and economically
39
The Acheson report 1998
Income inequality should be reduced Give high priority to the health of families with children
40
What does QALYs stand for
Quality adjusted life years
41
Use of QALYs
Used in some economic evaluations to measure health Combines length and quality of life Allows one to compare interventions that have different types of effects Makes funding decisions easier
42
Health economics:
Basic economic problem Opportunity cost Economic efficiency
43
Health economics: basic economic problem
Finite limit to resources Desire for goods and services is infinite No country treats all treatable ill health- rationing Choose cannot be avoided
44
Health economics: opportunity cost
Cost of any decision measured in terms of the next best alternative that had to be sacrificed /forgone in the making of the decision eg balancing time and money Loewy approach Efficiency approach
45
Loewy approach to health economics
Select a few from all treatment options
46
Efficiency approach to health economics
More from the cheapest areas Ignores expensive treatments
47
Health economics: economic efficiency
Resources are allocated to maximise benefit (defined in terms of health) Economics evaluation used to assess whether health is maximised
48
What is economic efficiency sometimes incorrectly referred to as
Cost effectiveness
49
Economic evaluation
Measures economic efficiency Cost and effects are a a,used in terms of their differences
50
Types of economic evaluation
Cost minimisation analysis Cost effectiveness analysis Cost utility analysis Cost benefit analysis
51
Cost minimisation analysis
Outcomes equivalent to
52
Cost effectiveness analysis
Outcomes measured in natural units
53
Cost utility analysis
Outcomes measured to QALY
54
Cost benefit analysis
Outcomes measured in monetary units
55
Effectiveness ration equation
Incremental costs/ difference in QALY
56
Incremental costs equation
New treatment cost - old treatment cost
57
QALY equation
Years increase x utility time
58
There are large geographical inequalities in mortality and morbidity in the UK: Tudor-Hart (1970) suggested that access to health care tends not to be proportionate to the actual need for care in the population served. Which term below best describes this concept?
Inverse care law
59
Factors that are important when deciding what to fund in nhs
Size of problem Effectiveness of intervention Alternatives” Fault? Health problem? Is NHS responsible? Special population Large payback for treatment? Is the disease population particularly deserving?
60
Scarcity
Resources are limited Desire for goods and services exceeds current resources
61
Opportunity cost of a choice
The lost benefit of the best alternative - the sacrifice in terms of the benefits forgone from not allocating resources to next best activity Eg spending spare budget on hip replacements means it can’t be spent on mental health services. The opportunity cost is the lost benefit of the mental health services.
62
Economic efficiency
Achieved when resources are allocated between activities in such a way to maximise benefit -maximum health benefit from fixed budget
63
Economic evaluation
Assessment of economic efficiency Comparative study of the costs and benefits of health care interventions for some given disease Analysed in terms of their increments or differences between the interventions
64
Natural units examples
Blood pressure Pain score Number of cases detected Walking distance Blood cholesterol
65
QALYs
Quality adjusted life years Combines length and quality of life -full health has a utility of 1 -death has a utility of 0
66
Advantages of QALYs
Allows comparison across diseases
67
How to calculate QALYs
Length (years) x quality (utility) weighing (0 - 1 scale) 1 year perfect health = 1 QALY 2 years with utility of 0.5 = 1 QALY
68
Monetary value
Health is measured in monetary terms This draws on the idea of “willingness to pay” How much is someone prepared to pay for some health benefit? Difficult to determine in a healthcare system that is free at the point of use Has various problems: richer people might be willing to pay more than poorer people. Does this mean their health is more valuable? Is this fair?
69
What are measured to calculate monetary units
All relevant costs eg drug treatment, hospital stay, outpatient appointments -costs to nhs
70
How is health benefit measured
Natural units QALYs Monetary value
71
4 types of economic evaluation
Cost-effectiveness analysis Cost-utility analysis Cost-benefit analysis Cost-minimisation analysis
72
What can reduce senescence burden
Exercise Drugs
73
Cost-effectiveness analysis
Outcomes measured in natural units Costs in monetary units
74
Cost-utility analysis
Outcomes = QALYs Cost = monetary units
75
Cost-benefit analysis
Outcomes = monetary units Costs = monetary units
76
Cost-minimisation analysis
Outcomes = any units Equal in both treatments So just minimise cost
77
Incremental cost effectiveness ratio
The incremental cost of one treatment versus another, divided by the incremental benefit of one treatment versus another Cost New - Cost Old Benefit New - Benefit Old
78
Incremental cost effectiveness ratio example
New drug Costs £25,000 per person 6 QALYs of benefit Existing drug Costs £10,000 per person 5 QALYs of benefit ICER = (£25,000 – £10,000) / (6 – 5) = £15,000 per QALY gained
79
What department decides if a new treatment should be available on the NHS
NICE (national institute of health and care excellence)
80
How much is the NICE threshold
£20000
81
How we value a QALY
NICE thinks that any services that are closed down to fund new services probably generate benefits at a cost of about £20,000 per QALY gained Taking £20,000 from somewhere else in the NHS to fund a more expensive drug therefore loses 1 QALY So, it only makes sense to fund new things if we get at least 1 QALY per £20,000 Equivalent to requiring the cost to be less than £20,000 per QALY gained for something to be cost-effective £20,000 is called the “NICE threshold”
82
Equity
Fairness or justice of the distribution of costs and benefits
83
Rationing
Choose not to fund some treatments

Public Health (7 decks)

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