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Public Health > Global Health > Flashcards

Global Health Flashcards

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
Q

Examples of migrant types

A

Asylum seekers
Refugees
Trafficked people
Migrant workers
Family workers
Family joiners
International students

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26
Q

Causes of vulnerability to migrants

A

Persecution, war, political and social unrest
Exploitation, torture, rape and bereavement
Burden of disease and socioeconomic status

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27
Q

Lampedusa

A

Italian island
Closest European territory to shores of Libya
Primary transit point for immigrants from Africa
Deadliest migrant torture in the world

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28
Q

3 leading causes of death in children in developing countries

A

Pneumonia
Diarrhoea
Malaria

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29
Q

Health challenges of poorest countries

A

Underweight
Unsafe sex
Unsafe water and sanitation
Indoor smoke from solid fuels
Zinc/iron/vitamin A deficiency
High blood pressure
Tobacco
High cholesterol

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30
Q

Health challenges of developed countries

A

Tobacco
High blood pressure
Alcohol
High cholesterol
High BMI
Low fruit and vegetable intake
Physical inactivity
Illicit drugs
Unsafe sex
Iron deficiency

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31
Q

Theories of causation of health inequalities:

A

Psychosocial
Neo-material
Life course
Proportional universalism

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32
Q

Theories of causation of health inequalities: psychosocial

A

Stress results in ability to respond efficiently to body’s demands
Impact on BP, cortisol levels and inflammatory and neuroendocrine markers

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33
Q

Theories of causation of health inequalities: neo-material

A

More hierarchical societies are less willing to invest in provision of public goods
Poorer people have less material goods and of less quality

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34
Q

Theories of causation of health inequalities: life course

A

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
Q

Theories of causation of health inequalities: proportional universalism

A

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
Q

Responses to health inequalities

A

Ignacz Semmelweis 1847
The block report 1980
The Acheson report 1998

37
Q

Ignacz Semmelweis 1847

A

Campaigned for hand washing
Found correlation between puerperal fever and dissection

38
Q

The block report 1980

A

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
Q

The Acheson report 1998

A

Income inequality should be reduced
Give high priority to the health of families with children

40
Q

What does QALYs stand for

A

Quality adjusted life years

41
Q

Use of QALYs

A

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
Q

Health economics:

A

Basic economic problem
Opportunity cost
Economic efficiency

43
Q

Health economics: basic economic problem

A

Finite limit to resources
Desire for goods and services is infinite
No country treats all treatable ill health- rationing
Choose cannot be avoided

44
Q

Health economics: opportunity cost

A

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
Q

Loewy approach to health economics

A

Select a few from all treatment options

46
Q

Efficiency approach to health economics

A

More from the cheapest areas
Ignores expensive treatments

47
Q

Health economics: economic efficiency

A

Resources are allocated to maximise benefit (defined in terms of health)
Economics evaluation used to assess whether health is maximised

48
Q

What is economic efficiency sometimes incorrectly referred to as

A

Cost effectiveness

49
Q

Economic evaluation

A

Measures economic efficiency
Cost and effects are a a,used in terms of their differences

50
Q

Types of economic evaluation

A

Cost minimisation analysis
Cost effectiveness analysis
Cost utility analysis
Cost benefit analysis

51
Q

Cost minimisation analysis

A

Outcomes equivalent to

52
Q

Cost effectiveness analysis

A

Outcomes measured in natural units

53
Q

Cost utility analysis

A

Outcomes measured to QALY

54
Q

Cost benefit analysis

A

Outcomes measured in monetary units

55
Q

Effectiveness ration equation

A

Incremental costs/ difference in QALY

56
Q

Incremental costs equation

A

New treatment cost - old treatment cost

57
Q

QALY equation

A

Years increase x utility time

58
Q

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?

A

Inverse care law

59
Q

Factors that are important when deciding what to fund in nhs

A

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
Q

Scarcity

A

Resources are limited
Desire for goods and services exceeds current resources

61
Q

Opportunity cost of a choice

A

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
Q

Economic efficiency

A

Achieved when resources are allocated between activities in such a way to maximise benefit
-maximum health benefit from fixed budget

63
Q

Economic evaluation

A

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
Q

Natural units examples

A

Blood pressure
Pain score
Number of cases detected
Walking distance
Blood cholesterol

65
Q

QALYs

A

Quality adjusted life years
Combines length and quality of life
-full health has a utility of 1
-death has a utility of 0

66
Q

Advantages of QALYs

A

Allows comparison across diseases

67
Q

How to calculate QALYs

A

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
Q

Monetary value

A

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
Q

What are measured to calculate monetary units

A

All relevant costs eg drug treatment, hospital stay, outpatient appointments
-costs to nhs

70
Q

How is health benefit measured

A

Natural units
QALYs
Monetary value

71
Q

4 types of economic evaluation

A

Cost-effectiveness analysis
Cost-utility analysis
Cost-benefit analysis
Cost-minimisation analysis

72
Q

What can reduce senescence burden

A

Exercise
Drugs

73
Q

Cost-effectiveness analysis

A

Outcomes measured in natural units
Costs in monetary units

74
Q

Cost-utility analysis

A

Outcomes = QALYs
Cost = monetary units

75
Q

Cost-benefit analysis

A

Outcomes = monetary units
Costs = monetary units

76
Q

Cost-minimisation analysis

A

Outcomes = any units
Equal in both treatments
So just minimise cost

77
Q

Incremental cost effectiveness ratio

A

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
Q

Incremental cost effectiveness ratio example

A

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
Q

What department decides if a new treatment should be available on the NHS

A

NICE (national institute of health and care excellence)

80
Q

How much is the NICE threshold

A

£20000

81
Q

How we value a QALY

A

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
Q

Equity

A

Fairness or justice of the distribution of costs and benefits

83
Q

Rationing

A

Choose not to fund some treatments

Public Health (7 decks)

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