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Unformatted text preview: Chapter 1: Chapter Global Health What is international health (IH)? What International health = health in low-income areas – – – – – – Infectious disease Nutrition Child health Reproductive (maternal) health Water & sanitation Aging, mental health, culture, and other global issues Global health = health concerns that cross borders borders Sometimes global health = international health What do you need to know to understand IH? understand Social contributors to disease Biological causes of disease Environmental contributors to disease WHO Constitution WHO World Health Organization (WHO) – World United Nations (UN) agency that specializes in health specializes Health is “a state of complete physical, Health mental, and social well-being and not merely the absence of disease or infirmity.” infirmity.” WHO Constitution WHO Areas with poor health standards put Areas everyone at risk of pandemic outbreaks of infectious disease infectious Health is linked with peace Health is a human right “The enjoyment of the highest attainable The standard of health is one of the standard fundamental rights of every human being.” fundamental What is a “standard of health”? What This means that the “standard” of health This should be raised so that everyone has access to at least basic medical and psychological care, especially at-risk populations. populations. This does not mean that everyone has the This right to advanced medical therapies. right What is the “standard of care” that should What be available to everyone? be Medicine and Public Health Medicine World Public health cares about the health of groups of people (populations) World Region Nation Domain of Public Health State/Province Community Medicine cares about the health of individuals individuals Household Individual Domain of Medicine Framework for Understanding Population Health Population National / regional policies that affect health Health policy and services Environmental policy and enforcement Economic and trade policy Educational policy and services Access to health care including preventive and mental health services Water, sanitation, fuel, agricultural productivity, waste disposal, air quality Income, employment Literacy, educational level Individual / household level factors that affect health Social services Transportation, lifestyle choices (alcohol and tobacco use, exercise) 5 Fields of Public Health Fields Health education Health services administration Environmental health Biostatistics Epidemiology determine risk factors for mortality (death), morbidity (illness), and mortality morbidity disability in populations disability Risk Factors Risk Exposure Outcome (morbidity, mortality, disability) (morbidity, A exposure is a risk factor if: exposure risk – It precedes the onset of disease – and it increases the likelihood that the disease outcome will occur outcome It is easy to prove ASSOCIATON It ASSOCIATON (statistical relationship) (statistical It is harder to prove CAUSATION Criteria for Causation Causation For a risk factor to CAUSE an outcome: Strong association Clear time sequence (temporality) Dose-response effect Removal of the risk factor reduces risk of Removal disease disease Findings are consistent and plausible Risk Factor Examples Risk John Snow tracks cholera outbreak in London John back to the Broad Street pump during an outbreak in the late 1800s. outbreak – Potential risk factor: Broad Street pump – Association or causation? William Farr tracks cholera to sea level: people William who live in low-lying areas more likely to become ill during the outbreak. ill – Potential risk factor: Living near sea level – Association or causation? Risk Factor Examples Risk People who eat ice cream more likely to People be attacked by a shark. be – Potential risk factor: eating ice cream – Association or causation? Types of Risk Factor Types Unmodifiable risk factors Behavioral / modifiable risk factors Which type of risk factor do public health Which professionals care more about? Why? professionals Descriptive Epidemiology Descriptive Person – Place – Time – WHO gets the disease? – WHERE does it happen? – WHEN does it happen? Causal Webs Causal What are the immediate biological causes What of disease? of What are the more distant causes? Which pathways can be prevented? Which exposures are necessary? Which necessary Causal Web for Diarrhea Electricity for safe food storage Other infections Malnutrition Biological susceptibility Education level Personal hygiene Poverty Access to a source of clean water Community infrastructure (water, sanitation, and other) Use of sanitation facility by individual and community Ingestion of an infectious dose of the diseasecausing agent Diarrhea Prevention Prevention Level Also Also called… called… Prevention Primary Primary Prevention Prevention Secondary Treatment Secondary Prevention Prevention Goal Prevent disease from ever Prevent occurring occurring Reduce severity of disease Reduce and prevent disability and death death Rehabilitation Reduce impairment and Reduce Tertiary Tertiary minimize suffering / pain Prevention Prevention (palliative care) (palliative What are some examples of each type of prevention? Screening Screening Secondary prevention Target: all people in an at-risk population Goals: Goals: – Identify people at risk – Diagnose disease at an early, more treatable Diagnose stage stage Criteria: severe disease, important to Criteria: public health, common, treatment available, detectable at early stage available, Timeline without screening: Biological onset of disease Disease could be detected through testing Symptoms of disease develop Diagnosis Medical made and care is treatment sought begins time time period when screening will detect disease early so therapy can begin at an earlier stage of disease Timeline with screening: Biological onset of disease time Disease could be detected through testing Diagnosis made and treatment begins Screening Examples Screening Pap smears (cervical cancer) PSA tests (prostate cancer) Mammograms (breast cancer) Mole checks (skin cancer) Blood pressure Weight Pregnancy check-ups Healthy child check-ups Selecting Interventions Selecting Conventional medicine Traditional medicine (TM) – a.k.a. Complementary / Alternative Medicine (CAM) Complementary – Used by >50% of Americans – 1 in 4 new drugs first used traditionally Health beliefs – what causes disease and how Health does that relate to prevention and cures? does – – – Supernatural (god / ancestors) Disequilibrium / imbalances Mechanistic breakdown ...
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This note was uploaded on 09/23/2011 for the course GCH 100 taught by Professor Corso during the Fall '11 term at George Mason.

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