1
Q
Aims of GBD Project
A
- Use systematic approach to to summarise the burden of disease and injury at the population level based on epidemiological principles and best available evidence
- To take account of deaths as well as non-fatal outcomes (disabilities) when estimating the burden of disease.
2
Q
Reasons for GBD Project
A
- To get more information on non-fatal outcomes of disease (disability)
- Difficult to estimate comparative burdens of different conditions
3
Q
Disability Adjusted Life Year (DALY)
A
= Years of Life Lost (YLL) + Years Lived with Disability (YLD)
4
Q
Years of Life Lost to mortality (YLL)
A
- Number of deaths
- Years lost per death (ideal age)
5
Q
Years Lived with Disability (YLD)
A
- Number of cases with non-fatal outcomes
- Average duration of non-fatal outcomes
- Disability weight (representing severity of impairment)
6
Q
Demographic Transition
A
Decline in fertility and mortality rates observed in most developed and several developing countries.
7
Q
Epidemiological Transition
A
A characteristic shift in the composition of causes of death and disability from communicable to non-communicable diseases
8
Q
Risk Transition
A
Changes in the risk factor profiles as countries shift from low to higher income countries, where common risks for perinatal and communicable diseases (e.g. unclean water) are replaced by risks for non-communicable diseases (e.g. tobacco)
9
Q
Double burden of disease
A
In many middle-income countries, previously common risks for perinatal and communicable diseases co-exist with increasing risks of non-communicable diseases.
10
Q
DALY/GBD Approach to measuring disability
A
- No disability weighting in regards to social positions, where they live, access to healthcare
- Represents people with a disability as a burden
- Deficit approach, all blame is on the disabled
- Medical Mode of Disability
11
Q
Medical Mode of Disability
A
- Disabled people are defined by their condition
- Regards disability as an individual problem and promotes the view that they are dependants
- Exclude disabled from society
- Control resides with professionals
12
Q
Social Model of Disability
A
- Disability is a social issue caused by policies, practices, attitudes, and environment
- Disabling factor is inaccessible environment
- Focused of ridding society of barriers
- Right to heath approach
13
Q
Right to Health
A
- Aim to promote, protect and ensure equal human rights and freedoms for all
1. Respect (no discrimination)
2. Protect (no interference by 3rd parties)
3. Fulfil (adopt measures to achieve equality) - Freedoms from and entitlements to
14
Q
Recommendations of Commission on the Social Determinants of Health
A
- Improve daily living conditions
- Tackle the inequitable distribution of power, money and resources
- Measure and understand the problem and assess the impact of action
15
Q
Global HIV Trends
A
- 2/3 of the people in the world infected with HIV live in Sub-Saharan Africa
- 60% of those infected with HIV in Sub-Saharan Africa are female
- The proportion of people in the world infected with HIV is increasing while the death rates due to AIDS and the new people becoming infected with HIV is going down
- 95% of new infections of HIV were in low and middle income countries.
16
Q
Pacific Island Trends
A
- 90% of the HIV burden its in Papua New Guinea
- Largely heterosexual transmission
- Other PI nations have a low prevalence of HIV/AIDS but high prevalence of other STI’s makes HIV i potentially major problem
17
Q
New Zealand Trends
A
- 75% of people living with HIV in NZ are men who got HIV from a man
- 15% is from heterosexual transmission
- No mother to child cases since 2007
18
Q
Global Factors Shaping Epidemic
A
- AIDS related deaths are decreasing and people are living with HIV longer due to better treatment and care
- High proportion of people living with HIV do not know their HIV status
19
Q
Main modes of HIV transmission
A
- Unprotected sex with HIV+ person
- Sharing unsterilised injecting equipment (NZ Needle Exchange Programme)
- Mother to child transmission
- Blood bourn
20
Q
Feminisation of HIV Epidemic
A
Increasing proportions of new infections are among women, primarily due to heterosexual transmission of the infection.
- Of the new infections among people aged 15 years and older:
- 47% were among women, at a global level heterosexual transmission has become the dominant mode of transmission.
- 39% Of new infections are among people ages 15-24 years (majority are female and live in Sub-Saharan Africa)
21
Q
Prevention Impact of Antenatal Screening
A
- Without treatment 1/3 children born to HIV+ mothers will become infected
- Can screen and treat with anti-retroviral drugs to prevent
- Sub-Saharan Africa is home to 91% of pregnant mothers needing Rx
22
Q
Main opportunities for Intervention
A
- Safer sex
- Safer products
- Reduce discrimination
- Increased access to healthcare
23
Q
Distribution of RTI’s
A
- 1.2 million people a year die of RTI’s
- 20-50 million more are injured/disabled
- More than 95% of the burden of RTI is from low and middle income countries
- 1-2% of GDP is provided to low income countries - exceeds international aid
24
Q
Trends of RTI’s
A
- Percentage change in RTI fatality is going down for rich countries and up for poor countries - socioeconomic differentials
- Males have a much greater fatality rate due to RT’sI than women - mostly ages 15-45
25
Vulnerable Road Users
Bicyclists, Pedestrians, Motorised 2-wheelers
- These in poorer countries
- In richer countries most deaths are motorised 4-wheelers
26
5 Key Risk Factors by WHO as Prevention for RTI's
1. Speed
2. Alcohol
3. Helmets
4. Visibility
5. Seat belts and child restraints
27
Inverse Care Law
The availability of good medical care tents to vary inversely with the need for the population served
- higher income areas get better healthcare than lower income areas
28
GBD Trends
- Over time increasing risks for NCD's and decreasing risks for perinatal and communicable diseases
- As socioeconomic status increases for a country there is also increasing risks for NCD's and decreasing risks for perinatal and communicable diseases
29
Commercial sectors influence on NCD epidemic
Difficulties with behaviour change are actively explored by industries
- Emphasis on downstream interventions has put our current population at risk
- Industries market unhealthy commodities and promote unhealthy consumption
- Marketing seeks vulnerable tagets, reinforces power inequalities and changes environments
- Industrial epidemic
- We need to shift focus from individual behaviour to the broader environment and upstream derivatives of unhealthy product consumption
30
Smoking Prevention Strategies
```
Monitor tobacco use and prevention
Protect people from tobacco use
Offer to help quit tobacco (downstream)
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion, sponsorship
Raise taxes on tobacco
```
31
Factors shaping the worlds climate
- Extremely high CO2 levels in the atmosphere
- Largest but not only climate active pollutant (CH4, N2O, CO)
The Greenhouse effect
- Greenhouse gases trapping suns energy and heating up the lower atmosphere while cooling the upper atmosphere (Greenhouse Fingerprint)
32
Climate Trends and Forecasts
- Believed global temperature will increase by 2 degrees in the next 20-30 years which is the limit of our knowledge of consequences to Earth
- In the next 100 year the global temperature will raise but 4 degrees and effects are unknown (40% chance outdoor work in Northern India will be impossible in hottest month)
- It is the rate of warming that is having drastic negative effects
33
How does climate change effect health?
1. Direct effects
2. Effects mediated by natural systems
3. Those resulting form social disruption - displacement of populations or economic instability
34
Vector borne Diseases
Dengue will thrive when climate increases as mosquitos are more successful in a warmer, damper environment
35
Food security
- Planet is already reaching its upper temperature limit regarding success rate of crops
36
Wet Bulb Globe Temperature (WBGT)
- A measure of heat stress that is sensitive to air temperature, radiant temperature, humidity and wind velocity
- Extreme risk for competitive athletes if the WBGT exceeds 28 degrees (+2)
- When WBGT exceeds 36 degrees heavy work will not be safe even with breaks
- When WBGT exceeds 40 degrees it is not possible to stay in heat balanced even at rest
37
Right to Health in a Human Rights Framework
1. Health inequities are evidence of laws, policies, and practices that distribute resources and opportunities in a discriminatory mange and limit full participation
2. Health is acknowledged as political (power, social context and politics) and healthy policy decisions that have a legal dimension rather just one that is purely political
Pop Health 111
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