Week 2

Question 1

why study global health?

Answer 1

• To understand progress made
• To understand global health challenges and how to address them
• To understand health challenges are not limited to national borders
• To understand the concerns about health disparities
• To understand the link between health and development
• To understanding nature of complex global health concerns and collaboration needed

Question 2

think _____ and act ______

Answer 2

think globally and act locally

Question 3

Top 6 health stories of 2024

Answer 3

1. The impact of climate change on health
2. Communicable disease outbreaks
   - e.g., monkey pox in Africa
3. How technology is improving health
   - e.g., AI in health – improving and issues that arrive – water we use to cool them down that we cannot use after – wasting resources
4. Women’s health
5. Health and work

6.Antimicrobial resistance
- e.g.,MRSA, antimicrobial resistance syphilis, TB

Question 4

what is making the news in Canada

Answer 4

Access to family physicians (1 million people in BC do not have a GP)

Winnipeg – 2022 – 4 women went missing – believed to have been murdered – police didn’t find them – eventually it came to the attention that these women may actually be in the landfill – Dec 2024 – now going through landfill to find women’s remains – why did we not here this? Women who went missing are part of the Indigenous community – culture, gender, disparities, how we value people

Need to know what is going on in our communities and nation – what is getting attention and what is not

Looking through equity lens- take sus to the point ask ourselves why are things not being communicated and how

Question 5

This is a global health course…. our focus is on

Answer 5

health equity and social justice

Question 6

root causes of health disparities

tree analogy

Answer 6

Structural barriers, political systems in place and healthcare system in place that they provide various systems that need to be navigated

Distribution of resources – the way they are distributed creates disparities in community and world

Underlying system of cultures and discourses that are most dominant

If soil most problematic – toxic or does not have all the aspects that will support growth – then we will have problems up above – need to start with the soil – need healthy soil to grow healthy tree

Question 7

health outcomes - tree analogy (tree leaves)

health behaviours - tree branches

social determinants of health - tree -trunk

underlying systems of dominant culture and narratives - soils

Answer 7

leaves- COPD, Cancer, behaviours problems, depression, hypertension, diabetes, heart disease, obesity, injury

branches - social connecitons, smoking, substance use, stress, lack of exercise, diet, falls

trunk - built environment, education, violence and trauma, employment, housing, social environment

root causes of health (roots) - isms e.g., heterosexism, classism, racism, poverty, ableism, sexism, structual and institutional barriers, distribution of resources, ageism, religious prejudice, xenophobia

soil

Question 8

historical context: colonialism

Answer 8

Policy or practice of acquiring full or partial political control over another country, occupying it with settlers, and exploiting it economically.

Needs to be identified voiced and needs to be at top of mind when looking at disparities

Dominant group coming in acquiring (not always in peace) land and power – using power and privilege to take over a community land and cultures of others
In Canada – European colonialism still experiencing
Exploiting it economically – coming into land and taking either the land or people and exploiting them for their own needs

Question 9

What happened in Rwanda

Answer 9

colonialism

Genocide that happened in Rwanda – in 1990s – with the experience in Rwanda – colonialism
People from Europe came into Rwanda and using power over the population in Rwanda – they divided the community in to tribes (or how they thought they should be divided) – this led to eventually unrest between the two communities where they thought that one was more dominant than the other

Who to tribes and hoosties tribes – divide was ethnic and created by Europeans that came into Rwanda
Violence due to colonialism – the response globally was minimal
In 100 days, 800,000 people killed, and the international community failed to respond – if they would have responded then there would a potential that this amount of death and violence would not of occurred to this extent

Other – us and them – me and you
Happens when – a view that one group holds power and privilege, and the other group does not –
Coin model – always two sides to the coin

Question 10

colonialsim depends on:

Answer 10

Colonialism depends on the oppression of one group by another

Begins with a process described as “othering”

Society sorts people into two categories:
-1.the reference group (holds power and privilege) and…
-2. the “other“

Question 11

what happens when we other

Answer 11

No equity
No equality
That is where disparities start to arise

Question 12

colonial canada and policies

Answer 12

Colonialism had an enormous impact on Indigenous Population in Canada
The federal government systematically stole Indigenous land while also attempting to destroy their unique cultures and heritages (Moore et al., 2011)

Deliberate policy measures
Indian Act - 1876
White Paper - 1969

Question 13

Indian Act - 1876
White Paper - 1969

Answer 13

Some policy measure that were put in place that were in response to trying to make it better

Indian act was very problematic – in the sense that their was a definition of who is indigenous and who is not, who could live on reserve and not, who could be in a certain band or not

White paper in response to Indian act –that document want to eliminate the Indian status and eliminate the act – all Canadians to Canadians – convert reserve land to private property- indigenous population refused the white paper

Indian act – to erase the indigenous people – to humanize them

Question 14

genocide canada

Answer 14

Argument that people are saying is that it no longer exists – provides a lense that affirms that we are still seeing genocide in Canada
Cause lots of backlash in Canada

What has hapeneded to the people who were here before colonization – it is genocide e.g., 60 scoops, millennial scoop (more than 50% of children in care are indigenous), residential schools, missing and murdered indigenous women and girls – all the cases that have not been solved

Still happening – important to know the effects of colonization happen for many many decades and here over a century

Question 15

social determinants of health

Answer 15

• education access and quality
• economic stability
• social community context
• health care access and quality
• neighbourhood and built environment
• social and community context

Question 16

why are social determinants of health important

Answer 16

Social determinants of health help us define disparities

Everything boils down to income – how does it play a role in health and disparities?

So multi layered

Tree – income would be part of trunks and affect all those peices from their

Income affects education ,access to healthcare, physical activitie, housing, impacts mental health, substance use

WHO – 5 social determinatns of health

12 form CDC

Question 17

Social Determinants of Health definition

Answer 17

SDOH are non-medical factors that affect health outcomes

conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life

economic policies and systems, development agendas, social norms, social policies and political systems

Question 18

who is at risk when we think about health disparities and social determinants of health

Answer 18

minority groups

Question 19

how are SDoH and Global Health linked

Answer 19

How are they linked?

Income and health e.g., can’t afford healthy foods, only can afford sugars – leads to diabetes – globally not just in high income countries most common noncommunicable disease globally

Income and education factors for implications of diabetes – use to be that only saw diabetes in actually higher income population because had access to fast foods and convenience foods now seeing rise in diabetes in lower income countries – that is not completely attributed to the move of all of those restaurants into those communities

Question 20

globalization and economic gobalization

Answer 20

A broad term that refers to international economic expansion
Information, scientific knowledge (technology), and money flow across borders

Economic globalization is characterized by increased trade and investment liberalization (free trade)

Question 21

Emergence of UN and 3 top international institutions :

Answer 21

1. World Bank (WB)
2. International Monetary Fund
3. General Agreement on Tariffs and Trade -> WTO

Question 22

world bank

Answer 22

WB: provides loans and grants to the governments of low- and middle-income countries for the purpose of pursuing capital projects

Question 23

international monetary fund

Answer 23

IMF: Maintain global economic stability by lending funds and ensuring balance of payments

Question 24

gneeral agreement of tariffs and trade WTO

Answer 24

GATT: Promote international trade by reducing or eliminating trade barriers such as tariffs or quotas

Question 25

GATT and covid vaccines

Answer 25

e.g., GATT and Covid vaccine variability – did we have enough? Yes enough in Canada and other countries we hoarded – which made it less available to other countries around the world Currently hoarding monkey pox vaccines – yet in Africa no access to vaccine

Question 26

Globalization: The GOOD

Answer 26

Economic: - Growth of Transnational Companies (TNCs) - Free trade and capital mobility - Global market in which prosperity, wealth, power and democracy are diffused around the globe - Underlying belief that economic growth is the key to health and that eventually this growth will trickle down to all people Cultural: - Exchange of culture & ideas - Increase in global cooperation

Question 27

globalization bad

Answer 27

Economic: Globalization is essentially Western (mainly American) imperialism with corporate empires and global markets replacing domination by other means Cultural: Threatening local traditions and identities

Question 28

Globalization: The UGLY

Answer 28

Structural Adjustment Program (SAP) World Bank & IMF provided “New Structural Loans” to help countries experiencing economic crises with debt rescheduling (1980s) Corruption – IMF called in loans Brain Drain Scientists, doctors and nurses leave their own low resource country: US, UK and Canada

Question 29

Globalization: More Ugly

Answer 29

Rich are richer, the poor are poorer, and the gap is widening with the middle class disappearing Increased prices + decreased income = Increased poverty Decreased spending by governments on social services and health

Question 30

Resource Disparities Globally

Answer 30

8 billion people in the world Percentages the same over 50% - live on less than 2.50$ a day at least 80% of humanity Lives on less than 10$ a day of the 1.3 biliion people who live in absolute poverty around the globe. 70% are women.

Question 31

* The annual expenditure on cosmetic makeup is $18 billion, it would take $12 billion to provide health care for all women. * The goal ending global hunger and malnutrition would need an annual investment of $19 billion, just $2 billion more than Europeans and Americans spend per year on pet food. * The bill for immunizing every child would come to $1.3 billion, a 10th of the amount Europeans spend on ice cream each year

Answer 31

Not a lack of money around the globe – how we allocate the funding and see people and how we see issues Not so much, how we see problems People will comment that is not my problem but their problem – you here in the discourse and literature – why don’t they go get another job – they just… where is the empathetic civilization, compassion in society, seeing people as human beings Not an us vs them When you look a the perspective of humans helping humans – ultimately we are all effected by poverty, people not having good health – affects all of us – we are not immune

Question 32

How does power and privilege become leveraged to disseminate resources and money to all people?

Question 33

giving pledge

Answer 33

is a movement of philanthropists who commit to give the majority of their wealth to charitable causes, either during their lifetime or in their wills One example – giving pledge – movement of philanthropist who do support and provide financial backing to various programs – Still come from a group of people that hold a large amount of money – still have the power to decide where it goes – its something 2024 – 242 pledgers More we have people who are dispersing resources then we might see some what of a change – not perfect answer – more to it then that One peice

Question 34

health disparities

Answer 34

“preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations”

Question 35

health disparities common patterns:

Answer 35

The less well off = worse health ‘Generally,’ the less well off = underrepresented populations, women, Indigenous population, poor, those living in rural areas, lower education, working in the informal sector of the economy.

Question 36

Equality vs. Equity

Answer 36

Equality is treating everyone the same Equity is giving everyone what they need to be successful

Question 37

Health Inequality

Answer 37

Inequalities = differences in health status between groups independent of any assessment of fairness Refers to “Outcomes” - Life expectancy - Access to care

Question 38

health inequity

Answer 38

Inequities in health status = differences that are unnecessary, unfair, unjust and avoidable refers to fairness overcoming poverty is not a gesture of charity it is an act of justice

Question 39

Health Inequality or Inequity? Sickle cell disease is more common in black Americans than in other ethnicities Black women in the US are 3-4 times more likely to die from pregnancy-related complications than white women COVID-19 deaths are higher in Canadian neighbourhoods with a higher proportion of population groups designated as visible minorities Age is the most common risk factor for cancer

Answer 39

1. Inequality – not avoidable 2. Inequity – something that we can shift the outcome or what is happening that leads to complications 3. Inequity – avoidable, changeable, make it change 4. Inequality - unavoidable

Question 40

how are global health disparities measured? differences refelct:

Answer 40

Health outcomes in different groups of people - Life expectancy - Morbidity - Mortality - Maternal mortality rate/Infant mortality rate Differences reflect status of economic development, inequitable relationships between countries, and political choices

Question 41

maternal mortality rate/infant mortality rate importance?

Answer 41

Maternal mortality rate/infant mortality – this indicator is an important in one in terms of population health and the population of the community is only as healthy as their women and children and for the overall population to thrive and grow and sustain the people in that community, then we go back to promoting and enhancing the maternal and infant mortality rate

Question 42

"Sweden is a leader in healthcare, with one of the lowest mortality rates from heart attacks”, why do we see disparity in treatment/outcomes?

Answer 42

Sweden – disparity in outcomes and treatments Happens between men and women More women in Sweden having poor outcomes or dying then men – Most equitable countries around the globe but disparities around treatment and outcomes of heart attacks Men's pain treated differently then women's pain – gender, social pieces Lack of research in women's health compared to men's health Gender inequity – treatment, smypotms, how people experience pain, research, accesiblity Women were not receving the recommended care – not receiving care that were highlighted in the care paths Can be changed – avoidable = inequity

Question 43

Health Disparities Nationally

Answer 43

Some countries have substantial variation in health indicators across population groups High income countries show a disadvantage to marginalized populations Low-middle income countries have a high variance in health indicators

Question 44

Health Disparities Nationally - broken down into:

Answer 44

Location: Historically Urban better (rural generally have lower incomes, less education, less access to healthcare services) Gender: “Being born female is dangerous to your health” E.M. Murphy 2SLGBTQIA+ experiences discrimination Income: Large gap in access, coverage, fairness, and benefits between less well-off and better-off Ethnicity and Marginalized Groups: Strong association between ethnicity and health status, access, and coverage

Question 45

Does more $ = Better health?

Answer 45

not always - about how we spend money Think of US what they spend on health care – public and private – 80% spending - health status overall not great = diabetes, obesity, cardiovascular Canada spend 17% - and life expectancy is 12% higher Japan has the highest life expectancy – blue zone areas – they have very low spending per capita on healthcare Just spending more GDP does not equate to overall life 77 years - us 81 - canada 86 - japan

Question 46

What % of national income do most high-income countries spend on health?

Question 47

What % of national income do most low-income countries spend on health?

Question 48

Which country spends the most (as a share of GDP)?

Question 49

Which country spends the lowest (as a share of GDP)?

Question 50

Which countries spend HIGH with LOW life expectancy?

Question 51

Which countries spend LOW with HIGH life expectancy?

Question 52

Why doesn’t $ = Health?

Answer 52

Health is dependent on SDOH Not just about $ spent, but on how it is spent Cost-effectiveness analysis - compares cost of intervention with amount of health that can be purchased with that investment (e.g. Immunizations are very cost effective!)

Question 53

canadian healthcare focus

Answer 53

Not prevention and promotion – very much treat a sickness after someone has a healthcare issue that arise. -overall perspective of health politically – not on prevention

Question 54

Public and Private Health Expenditure

Answer 54

Public Expenditure: vs Private Expenditure: vs Out-of-Pocket Expenditure: Combined system We do not have straight public health If I want, I can go to the doctor and pay x amount of money a year Or I can go to my publicly funded GP – do not need to pay, but can never see them If someone has financial ability, then well I am going to pay because I can call doctor when I am sick and see them this afternoon Not truly public system I want an MRI – can pay for it System that is intwined Health insurances – helps with private pieces as well – create a barrier to accessibility Not truly universal basic health care system We have limits – based on income if you can access other aspects of care

Question 55

Why is it important to respond to disparities?

Answer 55

If we ignore, they just get bigger and bigger Health disparities affects everybody at the end of the day – we all live on this globe together

Question 56

What are we doing about it? - Health Disparities

Answer 56

In 2000, MDGs developed in response to the 21st century needs of the world population Unprecedented effort on the part of the World Bank and a variety of agencies within the UN to measure development and advocate for additional resources for development Goals created addressed 8 important health and development goals to be achieved by 2015 Millennium developmental goals developed Various countries came together to respond to the needs of the world population – created 8 goals that were going to address the dispairities we were seeing going to achieve by 2015 – none met They came back together- politicians, nurses, physicians

Question 57

MDGs

Answer 57

1. eradicate extreme poverty and hunger 2. achieve universal primary education 3. promote gender equality and empower women 4. reduce child mortality 5. improve maternal health 6. combat HIV/AIDs and other disease 7. ensure environmental sustainability 8. a global partnership for development

Question 58

SDGs - overall what are they

Answer 58

17 sustaninable development goals – follow along and expand on the MDGs More specifc clearer targets – and overacharching goals for SDGs was to get rid of extreme poverty and equitable economical growth Sift from MDGs to 17 STGs – shift was to work with the community

Question 59

MDGs vs SDGs

Answer 59

MDGs top down Where SDGs were to enhance and work with the strengths in the community Goal is 2030 for SDGs – continuity and change Dignity, people, planet, partnership, justice – underpin goals

Question 60

SDGs list 1. no poverty 2. zero hunger 3. good health 4. quality education 5. gender equality 6. clean water and sanitation 7. affordable and clean energy 8. decent work and economic growth 9. industry, innovation and infrastructure 10. reduced inequalities 11. sustainable cities and communities 12. responsible consumption and production 13. climate action 14. life below water 15. life on land 16. peace, justice and strong institutions 17. partnerships for the goals

Question 61

which MDGs match SDGs

Answer 61

MDG 1 = SDG 1,2 Transforming food systems, making things more sustainable Take what you have and work with it MDG – broader goal – more gender – SDG – more inclusive for developing countries, whereas MDG eradicating Proposing food waste tax – no frills, Walmart goes to UN to distribute as they see fit – education and resources MDG 2 = SDG 1, 2, 4, 5 MDG younger kids Increased enrollment 83%, narrowed gap in literacy in younger ages In some countries enrollment went up and others went down SDG lifelong learning, build and upgrade inclusive schools, school supplies, infrastructures, more local MDG 3 = SDG 5,10 MDG 4 = SDG 1,2, 3,4,6, 10 (++) SDG more broads – more related to social determinants of health Approach is different as we move from SDG to MDG Health system strengthen Declined by more than 50% between 19090 and 2015 – focused on immunization program MDG – focused on higher income countries – which would save lower income countries Education Statistics used to make decision, but only as good as data collected – many places where births and deaths are not recorded – no record when baby dies – all of these statics that can be used to argue for more education, infrastructure and healthcare are not accurate and cannot be argued MDG 5 = SDG 3,5,10 MDG 5 – reduce by 755 mortality ratio, access to reproductive health, pretty quantitative – focused decreasing the mortality rate SDG – universal health coverage…etc – took maternal one and made all health coverage, more qualitative approach, access to care, family planning More education is needed MDG 6 = SDG 3,4,6 Reduce vaccine stigma MDG 7 = SDG 13 - Reducing single use plastics, composting, waste management MDG 8 = SDG 3 , 17 Distributing the money – comes with connections and Promting connections Enough money but how it is distributed that is the problem

Question 62

The 3 Ps in Global Health

Answer 62

Preventing Disease Promoting Health Prolonging Life

Question 63

Roots of the health issues we see due to

Answer 63

european colonization

Question 64

Private vs Public =

Answer 64

disparities