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Unformatted text preview: Chapter 1:
Global Health What is international health (IH)?
International health = health in low-income areas
– Infectious disease
Reproductive (maternal) health
Water & sanitation
Aging, mental health, culture, and other global issues Global health = health concerns that cross
Sometimes global health = international health What do you need to know to
Social contributors to disease
Biological causes of disease
Environmental contributors to disease WHO Constitution
World Health Organization (WHO) –
United Nations (UN) agency that
specializes in health
Health is “a state of complete physical,
mental, and social well-being and not
merely the absence of disease or
infirmity.” WHO Constitution
Areas with poor health standards put
everyone at risk of pandemic outbreaks of
Health is linked with peace
Health is a human right
“The enjoyment of the highest attainable
standard of health is one of the
fundamental rights of every human being.”
fundamental What is a “standard of health”?
This means that the “standard” of health
should be raised so that everyone has
access to at least basic medical and
psychological care, especially at-risk
This does not mean that everyone has the
right to advanced medical therapies.
What is the “standard of care” that should
be available to everyone?
be Medicine and Public Health
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
Individual Domain of
Medicine Framework for Understanding
National / regional policies that affect health
services Access to
air quality Income,
level Individual / household level factors that affect health Social services Transportation,
exercise) 5 Fields of Public Health
Health services administration
Epidemiology determine risk factors for
mortality (death), morbidity (illness), and
disability in populations
disability Risk Factors
Exposure Outcome (morbidity, mortality, disability)
A exposure is a risk factor if:
– 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 is harder to prove CAUSATION Criteria for Causation
For a risk factor to CAUSE an outcome:
Clear time sequence (temporality)
Removal of the risk factor reduces risk of
Findings are consistent and plausible Risk Factor Examples
John Snow tracks cholera outbreak in London
back to the Broad Street pump during an
outbreak in the late 1800s.
– Potential risk factor: Broad Street pump
– Association or causation? William Farr tracks cholera to sea level: people
who live in low-lying areas more likely to become
ill during the outbreak.
– Potential risk factor: Living near sea level
– Association or causation? Risk Factor Examples
People who eat ice cream more likely to
be attacked by a shark.
– Potential risk factor: eating ice cream
– Association or causation? Types of Risk Factor
Unmodifiable risk factors
Behavioral / modifiable risk factors
Which type of risk factor do public health
professionals care more about? Why?
professionals Descriptive Epidemiology
Person – Place – Time
– WHO gets the disease?
– WHERE does it happen?
– WHEN does it happen? Causal Webs
What are the immediate biological causes
What are the more distant causes?
Which pathways can be prevented?
Which exposures are necessary?
necessary Causal Web for Diarrhea
Access to a
other) Use of
community Ingestion of
dose of the
diseasecausing agent Diarrhea Prevention
Prevent disease from ever
occurring Reduce severity of disease
and prevent disability and
Rehabilitation Reduce impairment and
minimize suffering / pain
What are some examples of each type of prevention? Screening
Target: all people in an at-risk population
– Identify people at risk
– Diagnose disease at an early, more treatable
stage Criteria: severe disease, important to
public health, common, treatment
available, detectable at early stage
available, Timeline without screening:
disease Disease could
through testing Symptoms
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:
time Disease could
through testing Diagnosis
begins Screening Examples
Pap smears (cervical cancer)
PSA tests (prostate cancer)
Mammograms (breast cancer)
Mole checks (skin cancer)
Healthy child check-ups Selecting Interventions
Traditional medicine (TM) – a.k.a.
Complementary / Alternative Medicine (CAM)
– Used by >50% of Americans
– 1 in 4 new drugs first used traditionally Health beliefs – what causes disease and how
does that relate to prevention and cures?
– Supernatural (god / ancestors)
Disequilibrium / imbalances
Mechanistic breakdown ...
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- Fall '11